Centre for Appearance Research, University of the West of England, Bristol, United Kingdom.
Federal Institute of Education, Science and Technology of Southeast of Minas Gerais, Barbacena, Brazil.
JMIR Mhealth Uhealth. 2023 Jun 19;11:e39934. doi: 10.2196/39934.
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.
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.
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.
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.
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.
Clinicaltrials.gov NCT04825184; http://clinicaltrials.gov/ct2/show/NCT04825184.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s12889-021-12129-1.
在中低收入国家，可及、经济实惠且可扩展的心理健康干预措施有限，尤其是在这些国家，心理健康需求与服务之间的差距最大。微干预措施（即简短、独立或数字化方法）旨在提供即时缓解和改善心理健康状况，并为将基于证据的心理健康促进技术嵌入数字环境提供新颖且可扩展的框架。身体意象是一个全球性的公共卫生问题，会增加年轻人出现更严重的精神和身体健康问题的风险。将身体意象微干预措施嵌入数字环境是为年轻人提供即时和短期缓解以及保护他们免受社交媒体负面影响的一种途径。
本 2 臂、完全远程和预先注册的随机对照试验评估了包含微干预措施的身体意象聊天机器人对巴西青少年的状态和特质身体意象以及相关幸福感结果的影响。
来自巴西各地的 13-18 岁青少年（901/1715，52.54%为女孩）被随机分配到聊天机器人或仅评估对照组，并在基线、干预时间框架结束后以及 1 周和 1 个月随访时完成基于网络的自我评估。主要结果是状态（在聊天机器人进入时和完成微干预技术时）和特质身体意象（干预前后）的平均变化，次要结果是在评估时间点之间的情感（状态和特质）和身体意象自我效能的平均变化。
大多数进入聊天机器人的参与者（258/327，78.9%）完成了≥1 个微干预技术，参与者在 72 小时的干预期间平均完成了 5 个技术。聊天机器人用户在主要（状态：P<.001，Cohen d=0.30，95%CI 0.25-0.34；和特质身体意象：P=.02，Cohen d 范围=0.10，95%CI 0.01-0.18，到 0.26，95%CI 0.13-0.32）和次要结果的各个时间点均表现出较小但显著的改善（状态：P<.001，Cohen d=0.28，95%CI 0.22-0.33；特质积极情感：P=.02，Cohen d 范围=0.15，95%CI 0.03-0.27，到 0.23，95%CI 0.08-0.37；消极情感：P=.03，Cohen d 范围=-0.16，95%CI -0.30 至 -0.02，至 -0.18，95%CI -0.33 至 -0.03；和自我效能：P=.02，Cohen d 范围=0.14，95%CI 0.03-0.25，至 0.19，95%CI 0.08-0.32），与对照组相比。干预效果受到基线关注水平的调节，但不受性别影响。
这是第一项评估巴西青少年身体意象的大型随机对照试验。干预脱落率很高（531/858，61.9%），反映了更广泛的数字干预文献；讨论了参与障碍。同时，研究结果支持新兴文献表明微干预和聊天机器人技术是可接受和有效的基于网络的服务提供。本研究还为满足中低收入国家卫生保健需求与服务之间的差距提供了一种可及、经济实惠和可扩展的数字方法蓝图。
Clinicaltrials.gov NCT04825184；http://clinicaltrials.gov/ct2/show/NCT04825184。
国际注册报告标识符（IRRID）：RR2-10.1186/s12889-021-12129-1。
