Girls-only vs. mixed-gender groups in the delivery of a universal wellness programme among adolescents: A cluster-randomized controlled trial

Reut Agam-Bitton, Wiessam Abu Ahmad, Moria Golan, Reut Agam-Bitton, Wiessam Abu Ahmad, Moria Golan

Abstract

Background: Investigation of the optimal setting for body image prevention programmes is important to maximize the outcomes of such programmes.

Objectives: We examined the preferred setting for a school-based wellness programme called "In Favour of Myself".

Methods: A total of 259 girls (mean 13.82±0.64 years) were divided into a girls-only intervention group, a mixed-gender intervention and a waiting list control group. The participants completed self-report questionnaires at baseline, post-intervention (2 months) and at follow-up (3 months) examining changes in self-esteem, media literacy, body image and risk factors for eating disorders. The intervention group participants also completed a satisfaction questionnaire.

Results: Both intervention groups demonstrated statistically significant improvements in identifying advertising strategies (p<0.01) compared with the controls, with the girls-only arm (p<0.001) showing better results. Compared with the girls-only arm and the control group, the mixed-gender group demonstrated statistically significantly greater improvements in the internalization of pressure for thinness (p<0.004), the body-esteem appearance subscale (p<0.025) and body-esteem body-weight subscale (p<0.012) as well as reductions in their perceived current body silhouettes and in the gap between their current and ideal body image (p<0.003). Body dissatisfaction was increased following the programme, although not in a statistically significant manner, with the worst negative effect observed in the girls-only arm. All other differences among the study arms did not show statistically significant differences. Mediation models revealed that body-esteem was directly mediated by group, with statistically significant mediation only in the mixed group. Current body image was mediated indirectly by group through media literacy (i.e., recognizing advertisement strategies and internalization of pressure for thinness), with statistical significance only in the mixed-gender arm compared with the girls-only arm. Higher programme satisfaction was reported in the mixed-gender group (91%) vs. the girls-only groups (79%).

Conclusions: These outcomes provide preliminary evidence indicating the superiority of a mixed-gender setting compared with a girls-only setting for delivering prevention programmes to 13- to 14-year-old adolescents to enhance their media literacy, positive self-esteem and body image.

Trial registration: NCT02653586.

Conflict of interest statement

We have the following interests: The program was initiated and is sponsored by “The Dove Self Esteem Fund” and “Unilever Israel”. There are no patents, products in development or marketed products to declare. This does not alter our adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Fig 1. A flow diagram of the…
Fig 1. A flow diagram of the participants.
Fig 2. Change over time in the…
Fig 2. Change over time in the gap between current and ideal body image (mean and SD).
Fig 3. Mediation model for body-esteem (weight…
Fig 3. Mediation model for body-esteem (weight subscale).
Fig 4. Mediation model for current body…
Fig 4. Mediation model for current body image.

References

    1. Robins RW & Trzesniewski KH. Self-esteem development across the lifespan. Curr Dir Psychol Sci 2005;14:158–162.
    1. Levine MP, Smolak L. The role of protective factors in the prevention of negative body image and disordered eating. Eat Disord 2016;24: 39–46. doi:
    1. Yager Z, Diedrichs PC, Ricciardelli LA, Halliwell E. What works in secondary schools? A systematic review of classroom-based body image programs. Body Image 2013;10:271–281. doi:
    1. Wilson SJ, Lipsey MW. School-based interventions for aggressive and disruptive behavior: update of a meta-analysis. Am J Prev Med 2007;33:S130–S143. doi:
    1. Effeney G, Carroll A, Bahr N. Self-regulated learning: key strategies and their sources in a sample of adolescent males. AJEDP 2013;13:58–74.
    1. Golan M, Hagay N, & Tamir S. Gender related differences in response to “In Favor of Myself”, wellness program to enhance positive self & body image among adolescents. PLoS One 2014;9:e91778 doi:
    1. Dunstan CJ, Paxton SJ, McLean SA. An evaluation of a body image intervention in adolescent girls delivered in single-sex versus co-educational classroom settings. Eat Behav 2016; doi:
    1. Kilpela LS, Blomquist K, Verzijl C, Wilfred S, Beyl R & Becker CB. The body project 4 all: a pilot randomized controlled trial of a mixed‐gender dissonance‐based body image program. Int J Eat Disord 2016;49:591–602. doi:
    1. Watson HJ, Joyce T, French E, Willan V, Kane RT, Tanner-Smith EE et al. Prevention of eating disorders: A systematic review of randomized, controlled trials. Int J Eat Disord 2016;49(9): 833–62. doi:
    1. Golan M, Hagay N & Tamir S. The effect of “In Favor of Myself”: preventive program to enhance positive self and body image among adolescents. PLoS One 2013;8: e78223 doi:
    1. Rosenberg M. Society and the adolescent self-image Princeton, NJ: Princeton University Press; 1965.
    1. Markland D & Oliver EJ. The Sociocultural Attitudes Towards Appearance Questionnaire-3: a confirmatory factor analysis. Body Image 2008;5:116–121. doi:
    1. Garner DM. Eating Disorder Inventory–2 professional manual Odessa, FL: Psychological Assessment Resources; 1991. Hansen B. New York City epidemics and history for the public. In: Harden VA, Risse GB, editors. AIDS and the historian. Bethesda: National Institutes of Health; 1991. pp. 21–28
    1. Stunkard AJ, Sørensen T & Schulsinger F. Use of the Danish adoption register for the study of obesity and thinness In: Kety SS, Rowland LP, Sidman RL & Matthysse SW, editors. The genetics of neurological and psychological disorders. New York: Raven Press; 1983. pp. 115–120
    1. Mendelson BK, Mendelson MJ & White DR. Body-esteem scale for adolescents and adults. J Persy Assess 2001;76:90–106.
    1. Schafer J.L. Multiple imputation: a primer. Stat Methods Med Res 1999;8(1):3–15. doi:
    1. Montoya AK & Hayes AF. Two condition within-participant statistical mediation analysis: A path-analytic framework. Psychol Methods 2017;22:6–27. doi:
    1. Agam R, Tamir S, & Golan M. Gender differences in respect to self-esteem and body image as well as response to adolescents’ school-based prevention programs. J Psychol Clin Psychiatr 2015;2:92–99.
    1. Al-Bahrani M, Aldhafri S, Alkharusi H, Kazem A & Alzubiadi A. Age and gender differences in coping style across various problems: Omani adolescents' perspective. J Adolesc 2013;36:303–309. doi:
    1. Lawler M & Nixon E. Body dissatisfaction among adolescent boys and girls: the effects of body mass, peer appearance culture and internalization of appearance ideals. J Youth Adolesc 2013;40: 59–71.
    1. Ciao AC, Loth K, Neumark-Sztainer D. Preventing eating disorder pathology: common and unique features of successful eating disorders prevention programs. Curr Psychiat Rep 2016;16(7): 453.
    1. Stice E, Becker CB, Yokum S. Eating disorders prevention: Current evidence-base and future directions. Int J Eat Disord 2013;46:478–85. doi:
    1. Weigel A. Gumz A, Uhlenbush N, et al. Preventing eating disorders with an interactive gender-adapted intervention program in schools: study protocol of a randomized controlled trial. BMC Psychiatry 2015;15:21 doi:
    1. Lereya ST, Eryigit-Madzwamuse S, Patra C, Smith JH & Wolke D. Body-esteem of pupils who attended single-sex versus mixed-sex schools: a cross-sectional study of intra sexual competition and peer victimization. J Adolesc 2014;37:1109–1119. doi:
    1. Signorella ML & Bigler RS. S ingle-sex schooling: bridging science and school boards in educational policy. Sex Roles 2013;69: 349–355.
    1. Mora M, Penelo E, Gutiérrez T, Espinoza P, González ML & Raich RM. Assessment of two school-based programs to prevent universal eating disorders: media literacy and theatre-based methodology in Spanish adolescent boys and girls. Scientific World Journal. 2015;2015:328753 doi: Epub 2015 Feb 23.
    1. Richardson SM & Paxton SJ. An evaluation of a body image intervention based on risk factors for body dissatisfaction: a controlled study with adolescent girls. Int J Eat Disord 2010;43:112–122. doi:
    1. Gumz A, Weigel A, Daubmann A, Wegscheider K, Romer G. and Löwe B. Efficacy of a prevention program for eating disorders in schools: a cluster-randomized controlled trial. BMC Psychiatry 2017;17:293–306. doi:
    1. Schmitt DP & Allik J. Simultaneous administration of the Rosenberg self-esteem scale in 53 nations: exploring the universal and culture-specific features of global self-esteem. J Pers Soc Psychol 2005;89:623–642. doi:
    1. Wichstrom L. Harter's Self-Perception Profile for Adolescents: reliability, validity, and evaluation of the question format. J Pers Assess 1995;65:100–116. doi:
    1. Cousineau TM, Franko DL, Trant M, Rancourt D, Ainscough J, Chaudhuri A & Brevard J. Teaching adolescents about changing bodies: randomized controlled trial of an internet puberty education and body dissatisfaction prevention program. Body Image 2010;7:296–300. doi:
    1. Neumark-Sztainer DR, Friend SE, Flattum CF, Hannan PJ, Story MT, Bauer KW & Petrich CA New moves—preventing weight-related problems in adolescent girls: a group-randomized study. Am J Prev Med 2010;39:421–432. doi:
    1. Webb HJ & Zimmer‐Gembeck MJ. The role of friends and peers in adolescent body dissatisfaction: a review and critique of 15 years of research. J Res Adolesc 2014;24:564–590.
    1. O’Donnell A, Wallace P, & Kaner E. From efficacy to effectiveness and beyond: what next for brief interventions in primary care? Front Psychiatry 2014;5:113 doi:
    1. Franko DL, Cousineau TM, Rodgers RF & Roehrig JP. BodiMojo: Effective internet-based promotion of positive body image in adolescent girls. Body Image 2013;10: 481–488 doi:

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