Forbes, Jody Anne (2021) Extending body image intervention from daughters to mothers: a two-part evaluation of parallel school-based body image interventions for mothers and daughters in an independent school for girls. PhD thesis, Victoria University.

Abstract

Body dissatisfaction is a significant concern with severe and persistent consequences. Thus, there is a need for effective prevention and early intervention strategies that can be delivered in a timely and efficient manner, such as within the context of schools by teachers. There have been calls within the field for researchers to evaluate existing interventions under diverse conditions prior to global dissemination, and adopt an ecological approach by extending interventions to include parents. The project included two consequative studies conducted two-years apart. The first study aimed to identify effective intervention strategies for improving body image outcomes in Year 8 girls. Heeding calls for rigorous and independent evaluation of existing programs under varied conditions, Study 1 aimed to replicate the UK school-based body image program Dove Confident Me (DCM) among a selective population of adolescent girls in Australia. Expanding on Study 1, Study 2 aimed to improve body image outcomes for both Year 8 girls and their mothers. The second study evaluated a modified version of DCM alongside an investigation of Raising Confident Girls (RCG), a school- based 3-session seminar delivered to mothers. Further, the thesis aimed to understand factors contributing to improved parental uptake in body image programs and to examine whether extending classroom-based interventions to include mothers enhances the effectiveness of outcomes in daughters. Study 1, involving teacher delivery of DCM to Year 8 students (n=198) attending an independent girls’ school in Australia, hypothesized that compared to the control group (n=208), girls receiving DCM would report significant improvements in body image and psychosocial outcomes, alongside reduced severity of known eating disorder risk factors and behaviours. Multilevel mixed modeling analyses revealed significant intervention effects for social comparison and sociocultural pressure, but not in the direction hypothesized. A lack of teacher confidence with delivery, limited student engagement with the UK version of the program, and poor student-teacher relationship due to a timetable issue were highlighted as areas for improvement. Study 2, answered calls within the body image field to develop both etiological and ecological programs by conducting a second replication of a modified version of DCM and the addition of a parental intervention Raising Confident Girls (RCG) delivered to mothers. The modified DCM program was delivered to Year 8 students (n=242) and outcomes were compared with a control group (n=354). Despite significant improvements in acceptability and engagement ratings, the modified DCM program did not improve body image outcomes for participants. Interestingly, the intervention group reported a significant increase in both internalization of the thin-ideal and perceived sociocultural pressure following participation in the intervention. Raising Confident Girls (RCG), was delivered to Year 8 mothers (n=69) and outcomes were compared with a control group (n=51). Multilevel mixed modelling analyses revealed that mothers who participated in RCG reported significantly greater body esteem and body appreciation compared to the control group. Further, as predicted, participation in RCG improved a mother’s knowledge, confidence and skills parenting an adolescent girl, and improved her positive role modeling for her daughter with respect to body image. Receiving high acceptability ratings, strong engagement and low attrition rates, the RCG program appeared successful in overcoming long held difficulties with engaging parents in body image interventions. Finally, Study 2 examined whether students completing DCM benefited from having their mother attend RCG. Students whose mothers participated in RCG demonstrated a significant change in appearance-based talk at 3-month follow-up compared to students whose mothers were not involved in RCG. Additionally, there were noticeable improvements in a number of body image outcomes from pre-test to post-test for the group of students whose mothers attended RCG, however none of these findings reached significance. The study offered valuable insights towards increasing our understanding of transfer of parent intervention outcomes to daughters. The findings of the thesis contribute knowledge to the field of research regarding body-image intervention for adolescent girls and their mothers, in addition to providing practical insights for schools intending to implement body image interventions. Specifically, the study draws attention to the complexities of global dissemination and the limitations of using selective and universal programs interchangeably. The thesis highlights that while researchers are experts in etiological theory, school personnel are experts regarding their community. Cognizant of this, researchers are encouraged to work together with school personnel to develop school-based resources malleable in content and design, but robust enough to sustain effectiveness when adapted to suit diverse school environments. While the findings add to the growing body of research supporting task-shifting facilitation of body image programs to teachers, findings suggest that a strong student-teacher relationship and perceived credibility and competence of facilitator can be as essential as content of program. The thesis provides deeper insight into improving parental engagement in body image interventions delivered within the school context. Specifically, the findings emphasize the importance of tailoring the intervention to suit the needs of the parent group and suggest that the process of delivering a parent program is as important as the content of the intervention. Finally, the study reveals that providing an intervention to mothers alongside a classroom-based intervention for students enhances outcomes for daughters. Overall, the thesis supports the premise of extending classroom-based body image interventions to include parents, and identifies a number of recommendations for further research.

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