"They are men, they will be looking even if you put on pants or a sweatshirt": Girl athletes' and coaches' experiences of body image in Mexico City sport settings

Body image concerns are a barrier for girls' participation in sports. Scarce evidence from Mexico suggests adolescents experience high levels of body dissatisfaction, and national statistics report low levels of physical activity among girls. This study aimed to explore girls' body image concerns and coaches' perceptions of girls' body image experiences in sport. We used reflexive thematic analysis on secondary data from semi-structured focus groups conducted in Mexico City with 12 girls aged 11-17 years and six coaches from two sports organizations. Girls expressed feelings of self-consciousness about their performance, body-related teasing, the male gaze, and harassment within and outside sports contexts. Lack of support from coaches resulted in making excuses for withdrawing or supporting one another. Coaches' accounts demonstrate gender stereotypes about girls in sport. They acknowledge that girls abandon sport because of appearance-related teasing and body image concerns. In addition, colorism and discomfort with speaking directly about bodily functions are fundamental sociocultural influences affecting their communication. This is the first qualitative study exploring girls' body image concerns and coaches' perceptions of such concerns in Mexico City. Further research in lower- and middle-income countries is key in developing effective intervention programs to help girls benefit from sport.

A six-country study of coaches' perspectives of girls' body image concerns in sport and intervention preferences: Template analysis of survey and focus group data

Coaches are a key influence of athletes' body image, but often feel ill-equipped to address body image concerns and can perpetuate harmful body ideals. Limited research has investigated coaches' attitudes and beliefs and few effective resources are available. The current study explored coaches' perspectives of body image among girls in sport, as well as their preferences for body image interventions. Thirty-four coaches (41% women; Mage=31.6 yrs; SD=10.5) from France, India, Japan, Mexico, the United Kingdom, and the United States took part in semi-structured focus groups and completed an online survey. Template analysis of survey and focus group data resulted in eight first-order themes grouped under three categories: (1) perspectives of body image among girls in sport (objectification and surveillance, impact of puberty, the role of the coach); (2) preferences for intervention design (content of the intervention, accessibility of the intervention, incentives for taking part); and (3) cross-cultural considerations (acknowledging your privilege, cultural and societal norms). Two integrative themes were defined: (1) girls' disengagement from sport and (2) the role of community. Coaches perceived body image to be a significant barrier for girls in sport and a need to address this in a formal and accessible intervention.

How can we help you? A global investigation into girls' body image experiences in sport and intervention preferences

Existing interventions that target the intersection of girls' body image and sports participation are marginally effective, which is, in part, due to methodological limitations pertaining to intervention development (i.e., not theoretically or stakeholder informed). In this research, girls were consulted on their positive and negative body image experiences in sport and their preferences for fostering and remedying these experiences, respectively, in a new intervention. One-hundred and two girls (11-17-years; n = 91) and youth advisory board members (18-35-years; n = 15) from 13 countries participated in semi-structured focus groups and/or surveys. Template analysis of focus group and survey data resulted in 10 first-level themes and three integrative themes, which highlighted factors that both hinder and help girls' body image while playing sport, as well as girls' intervention preferences and cross-national considerations that will eventually impact the adaptation, localisation, and scaling of the intervention. Overall, girls favoured a girl and woman-only, multimodal intervention that upskilled them in appreciating their bodies, while challenging others' harmful behaviours. Stakeholder insights are crucial in creating acceptable, effective, and scalable interventions. Insights from this consultation phase will inform the development of a new scalable, evidence- and stakeholder-informed intervention that aims to foster girls' positive body image and sports enjoyment.

The co-creation, initial piloting, and protocol for a cluster randomised controlled trial of a coach-led positive body image intervention for girls in sport

BACKGROUND

Globally, girls disengage from sports at an earlier age and higher rate than boys. This is, in part, due to the unique body image challenges that girls face, relative to their male peers. Existing intervention efforts that aim to reduce girls' negative body image and movement experiences have proven marginally effective, if not ineffective. This paper outlines the co-creation, initial piloting and protocol for a cluster randomised controlled trial of Body Confident Athletes (BCA); an in-person, coach-led intervention that aims to foster positive body image and sports enjoyment among girls.

METHODS

Following co-creation and an initial pilot, a two-armed cluster randomised controlled trial will assess the immediate (post-intervention) and short-term (1-month and 3-month follow-up) impact of BCA on girls' (N = 1,036; 11-17 years old) body image, sports enjoyment, and affect. Sport organisations will be randomly allocated (1:1) into either an intervention or waitlist control condition. Girls and coaches in the intervention condition will complete three 60-minute sessions over three consecutive weeks. The primary outcome will be the immediate change in girls' body esteem, with secondary outcomes assessing the immediate and short-term changes in girls' body appreciation, self-objectification, attuned self-care, sports enjoyment, and affect.

DISCUSSION

This research is the first to utilise an international multi-stakeholder partnership to co-create and evaluate an intervention that addresses the intersection of girls' body image and sport experiences. The theoretical and methodological considerations of this research have led to a feasible intervention and trial protocol, and if proven effective, BCA may assist in reducing the global gender disparity in sports participation.

TRIAL REGISTRATION NUMBER

NCT05594524 , registered 25^th October 2022.

Using Chatbot Technology to Improve Brazilian Adolescents' Body Image and Mental Health at Scale: Randomized Controlled Trial

BACKGROUND

Accessible, cost-effective, and scalable mental health interventions are limited, particularly in low- and middle-income countries, where disparities between mental health needs and services are greatest. Microinterventions (ie, brief, stand-alone, or digital approaches) aim to provide immediate reprieve and enhancements in mental health states and offer a novel and scalable framework for embedding evidence-based mental health promotion techniques into digital environments. Body image is a global public health issue that increases young peoples' risk of developing more severe mental and physical health issues. Embedding body image microinterventions into digital environments is one avenue for providing young people with immediate and short-term reprieve and protection from the negative exposure effects associated with social media.

OBJECTIVE

This 2-armed, fully remote, and preregistered randomized controlled trial assessed the impact of a body image chatbot containing microinterventions on Brazilian adolescents' state and trait body image and associated well-being outcomes.

METHODS

Geographically diverse Brazilian adolescents aged 13-18 years (901/1715, 52.54% girls) were randomized into the chatbot or an assessment-only control condition and completed web-based self-assessments at baseline, immediately after the intervention time frame, and at 1-week and 1-month follow-ups. The primary outcomes were mean change in state (at chatbot entry and at the completion of a microintervention technique) and trait body image (before and after the intervention), with the secondary outcomes being mean change in affect (state and trait) and body image self-efficacy between the assessment time points.

RESULTS

Most participants who entered the chatbot (258/327, 78.9%) completed ≥1 microintervention technique, with participants completing an average of 5 techniques over the 72-hour intervention period. Chatbot users experienced small significant improvements in primary (state: P<.001, Cohen d=0.30, 95% CI 0.25-0.34; and trait body image: P=.02, Cohen d range=0.10, 95% CI 0.01-0.18, to 0.26, 95% CI 0.13-0.32) and secondary outcomes across various time points (state: P<.001, Cohen d=0.28, 95% CI 0.22-0.33; trait positive affect: P=.02, Cohen d range=0.15, 95% CI 0.03-0.27, to 0.23, 95% CI 0.08-0.37; negative affect: P=.03, Cohen d range=-0.16, 95% CI -0.30 to -0.02, to -0.18, 95% CI -0.33 to -0.03; and self-efficacy: P=.02, Cohen d range=0.14, 95% CI 0.03-0.25, to 0.19, 95% CI 0.08-0.32) relative to the control condition. Intervention benefits were moderated by baseline levels of concerns but not by gender.

CONCLUSIONS

This is the first large-scale randomized controlled trial assessing a body image chatbot among Brazilian adolescents. Intervention attrition was high (531/858, 61.9%) and reflected the broader digital intervention literature; barriers to engagement were discussed. Meanwhile, the findings support the emerging literature that indicates microinterventions and chatbot technology are acceptable and effective web-based service provisions. This study also offers a blueprint for accessible, cost-effective, and scalable digital approaches that address disparities between health care needs and provisions in low- and middle-income countries.

TRIAL REGISTRATION

Clinicaltrials.gov NCT04825184; http://clinicaltrials.gov/ct2/show/NCT04825184.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1186/s12889-021-12129-1.

Development and preliminary validation of the Coach Self-Efficacy Body Image Scale (CSEBIS)

Body image concerns are a commonly cited reason for sport drop out. Researchers have begun to explore the influence of coaches on athletes' body image. However, no measure exists to accurately and easily assess interventions or predict coaches' body image supportive behaviors. Using Self-Efficacy Theory as a conceptual framework, the Coach Self-Efficacy Body Image Scale (CSEBIS) was developed. Content validity was judged by a panel of experts (N = 3) and through interviews with coaches (N = 4) across various sports and experience levels. Following initial item iteration, the CSEBIS was assessed with 682 coaches for reliability and validity. The 27 items across four subscales (knowledge, recognition, engagement, disengagement) showed good reliability (internal consistency, test-retest reliability, inter-item and item-total correlations), validity (convergent and discriminant validity, differentiation between known groups), factor structure, and model invariance across gender. Developing and initially validating the CSEBIS contributes to the existing literature by providing researchers with a novel scale to measure coaches' confidence in identifying and addressing body image concerns among their athletes. Following further testing, this instrument may be used to assess the effectiveness of body image education and intervention efforts in sport, and the impact of coaches' attitudes and behaviors on athletes' body image.

Improving body image at scale among Brazilian adolescents: study protocol for the co-creation and randomised trial evaluation of a chatbot intervention

BACKGROUND

Body image concerns are prevalent among Brazilian adolescents and can lead to poor psychological and physical health. Yet, there is a scarcity of culturally-appropriate, evidence-based interventions that have been evaluated and made widely available. Chatbot technology (i.e., software that mimics written or spoken human speech) offers an innovative method to increase the scalability of mental health interventions for adolescents. The present protocol outlines the co-creation and evaluation of a body image chatbot for Brazilian adolescents via a partnership between academics, industry organisations and the United Nations Children's Fund (UNICEF).

METHODS

A two-armed fully remote randomised controlled trial will evaluate the chatbot's effectiveness at improving body image and well-being. Adolescent girls and boys (N = 2800) aged 13-18 years recruited online will be randomly allocated (1:1) into either: 1) a body image chatbot or 2) an assessment-only control condition. Adolescents will engage with the chatbot over a 72-hour period on Facebook Messenger. Primary outcomes will assess the immediate and short-term impact of the chatbot on state- and trait-based body image, respectively. Secondary outcomes will include state- and trait-based affect, trait self-efficacy and treatment adherence.

DISCUSSION

This research is the first to develop an evidence-informed body image chatbot for Brazilian adolescents, with the proposed efficacy trial aiming to provide support for accessible, scalable and cost-effective interventions that address disparities in body image prevalence and readily available resources.

TRIAL REGISTRATION NUMBER

NCT04825184 , registered 30th March 2021.

The effectiveness of brief animated films as a scalable micro-intervention to improve children's body image: A randomised controlled trial

Creating media to counteract the plethora of media and advertising that perpetuates negative body image is a scalable public health strategy that can be achieved through innovative micro-interventions. This study examined the immediate and short-term (one-week follow-up) impact of viewing brief, evidence-informed animated films on young people's body image, media literacy, and self-efficacy in addressing appearance teasing. The animations were co-created through a partnership among academics, a personal care brand's social mission, and a children's television channel. Participants aged 7-14 (N = 1329, 49 % girls) were randomised into one of three viewing conditions: Appearance Teasing & Bullying, Media & Celebrities, or a non-appearance-related animation. Contrary to predictions, all three animations were comparably effective at eliciting intervention effects. For girls and boys aged 7-10, all three animations immediately improved state body satisfaction (+boys aged 11-14; Cohen's ds = .60-.71) and led to sustained improvements in trait media literacy (+girls aged 11-14; ds = .38-.61), sensitivity to appearance teasing (+boys aged 11-14; ds = .35-.48), and willingness to ignore appearance teasing (7-10 years only; ds = .34-.74) at one-week follow-up. Findings indicate that children's media is an effective medium for developing micro-interventions.