The Impact of an Artificial Intelligence Chatbot on Brazilian Adolescents' Body Image

NCT04825184 | Completed

• 1 other identifier: HAS.19.12.090
• Study Type: interventional
• Target: 1,715
• Locations: 1 country
• Sites: 1

Brief Summary

High prevalence of body and eating concerns in Brazilian populations is well-documented, with risk observed across the lifespan. Prevalence rates of body dissatisfaction range between 26.6 - 56% and 10.7- 36% for adolescent girls and boys, respectively (1, 2, 3). The prevalence of these disordered attitudes and behaviours are mirrored in older populations, and have shown to manifest within family units (6). Further, Brazilian consumer trends reflect these attitudes and behaviours, with it being the leading country in diet pill consumption and aesthetic surgeries, and second in the world for total aesthetic procedures (i.e., surgical and non-surgical), with 2.27 million procedures conducted annually (8). Despite the scope of body and eating concerns, few evidence-based interventions have been developed and tested for Brazilian populations and even fewer are accessible, scalable or cost-effective. Harnessing technology to deliver evidence-based care is a key focus for researchers. Micro-interventions (brief, low intensity, self-administered interventions), offer an alternative to traditional, intense interventions that may be unsuitable for milder concerns. Body image micro-interventions have proven effective at providing immediate and short-term improvements in body image among women (9). To date, body image micro-interventions have been developed and evaluated among high-income, White, English-speaking samples, with little research exploring how this intervention model may cater to other cultures and countries. The aim of the present study is to conduct a randomised controlled trial (RCT) to evaluate the immediate and short-term impact of a chatbot on Brazilian adolescents' body image, affect and body image self-efficacy. Primary outcomes include immediate and short-term changes in state- and trait-based body image, respectively. Secondary outcomes include immediate changes in state-based affect and short-term changes in trait affect and body image self-efficacy. The chatbot intervention is designed to target sociocultural risk and protective factors for body image using eight, brief therapeutic techniques derived from several evidence-based theories, including media literacy, cognitive behaviour theory and positive body image. The chatbot was developed through a collaboration between Dove (Unilever), United Nations Children's Fund (UNICEF), The Centre for Appearance Research, and Talk 2 U. The comparison control condition will be assessment only. This is informed by a care as usual framework; whereby, Brazilian adolescents are not currently offered body image prevention or intervention resources at school or within the community. To undertake this project, 2800 adolescent girls and boys will be recruited through an external research agency. Participants will be randomised to either the chatbot or assessment only conditions. Those in the intervention condition, will be encouraged to engage with the chatbot over a 72-hour period, where they will be assessed on state-body satisfaction and affect immediately before and after completing an intervention technique. All participants will be assessed on trait body image, affect and body image self-efficacy at baseline, post-intervention (72-hours) and at one-week and one-month follow-ups. At completion of the one-month follow-up, all participants will receive a debrief form, outlining the study aims and objectives, and additional resources for body and eating concerns. Those in the assessment only condition will be invited to engage with the chatbot; however, their engagement will not be monitored or assessed. Lastly, to compensate participants for their time, they will receive an electronic voucher to the value of approx. US$25 and US$21, for the intervention and control condition, respectively.

Conditions

Body Image

Keywords

Body image; Adolescents; Brazil; Prevention; Micro-intervention

Outcome Measures

Primary Outcomes (2)

• Change in state body satisfaction

  Measured via a 11-point Likert scale (0 = not at all satisfied; 10 = very satisfied).

  Immediately pre-intervention and immediately post-intervention (change)

• Change in trait body image

  Brazilian version of the Body Esteem Scale for Adolescents and Adults (BESAA; 13); a 23-item scale, comprising of three subscales: appearance esteem, weight esteem and attribution. Responses are scored on a 5-point Likert scale (1 = never to 5 = always).

  Baseline, post-intervention (72-hours following baseline assessment), one-week follow-up (7-days following post-intervention assessment) and one-month follow-up (28-days following post-intervention assessment).

Secondary Outcomes (5)

• Change in state affect

  Immediately pre-intervention and immediately post-intervention (change)

• Change in trait affect

  Baseline, post-intervention (72-hours following baseline assessment), one-week follow-up (7-days following post-intervention assessment) and one-month follow-up (28-days following post-intervention assessment).

• Change in body image self-efficacy

  Baseline, post-intervention (72-hours following baseline assessment), one-week follow-up (7-days following post-intervention assessment) and one-month follow-up (28-days following post-intervention assessment).

• Total acceptability of the intervention

  Through intervention completion, over the course of 72-hours.]

• Total intervention adherence

  Through intervention completion, over the course of 72-hours.

Study Arms (2)

Body image chatbot

EXPERIMENTAL

The artificial intelligence chatbot, Topity, is designed to target sociocultural risk and protective factors for body image using eight therapeutic techniques derived from several evidence-based theories, including media literacy, cognitive behaviour theory and positive body image. The intervention aims to engage users in techniques that teaches users how to 1) Critically analyse and evaluate media content to reduce vulnerability to negative media influences (i.e., media literacy theory; 10); 2) Identify and challenge unhelpful thinking styles and behaviours that perpetuate body image distress (i.e., cognitive behaviour theory; 11); and 3) Appreciating the features, functions and health of the body, beyond it's appearance (i.e., positive body image theory; 12). Users will be assessed on state body satisfaction and affect before and after engaging with a technique to assess the immediate impact of the micro-intervention.

Behavioral: Body image chatbot

Assessment only

NO INTERVENTION

The comparison control condition will be assessment only. This is informed by a care as usual framework; whereby, Brazilian adolescents are not currently offered online body image prevention or intervention resources at school or within the community.

Interventions

Body image chatbot BEHAVIORAL

See arm/group description.

Also known as: Topity

Body image chatbot

Eligibility Criteria

• Age: 13 Years - 18 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64)

You may qualify if:

• Those aged 13-18 years old; Portuguese speaking; Brazilian resident; and, have access to Facebook Messenger.

You may not qualify if:

• N/A

Sponsors & Collaborators

• University of the West of England: lead
• Unilever R&D: collaborator
• UNICEF: collaborator
• Talk 2 U: collaborator
• Instituto Federal Sudeste de Minas Gerais: collaborator
• Deakin University: collaborator

Study Sites (1)

Toluna

São Paulo, Brazil

Location

Related Publications (19)

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  PMID: 32022158 BACKGROUND

• Silva SUD, Barufaldi LA, Andrade SSCA, Santos MAS, Claro RM. Nutritional status, body image, and their association with extreme weight control behaviors among Brazilian adolescents, National Adolescent Student Health Survey 2015. Rev Bras Epidemiol. 2018 Nov 29;21(suppl 1):e180011. doi: 10.1590/1980-549720180011.supl.1. English, Portuguese.

  PMID: 30517462 BACKGROUND

• Abdalla S, Buffarini R, Weber AM, Cislaghi B, Costa JC, Menezes AMB, Goncalves H, Wehrmeister FC, Meausoone V, Victora CG, Darmstadt GL. Parent-Related Normative Perceptions of Adolescents and Later Weight Control Behavior: Longitudinal Analysis of Cohort Data From Brazil. J Adolesc Health. 2020 Jan;66(1S):S9-S16. doi: 10.1016/j.jadohealth.2019.09.007.

  PMID: 31866039 BACKGROUND

• Trindade AP, Appolinario JC, Mattos P, Treasure J, Nazar BP. Eating disorder symptoms in Brazilian university students: a systematic review and meta-analysis. Braz J Psychiatry. 2019 Mar-Apr;41(2):179-187. doi: 10.1590/1516-4446-2018-0014. Epub 2018 Oct 11.

  PMID: 30328965 BACKGROUND

• International Association for Aesthetic/Cosmetic Surgery. (2017). ISAPS International Survey on Aesthetic/Cosmetic Procedures Performed in 2017. ISAPS. https://www.isaps.org/wpcontent/uploads/2019/03/ISAPS_2017_International_Study_Cosmetic_Procedures_NEW.pdf

  BACKGROUND

• Fuller-Tyszkiewicz, M., Richardson, B., Lewis, V., Linardon, J., Mills, J., Juknaitis, K., ... & Ware, A. (2019). A randomized trial exploring mindfulness and gratitude exercises as eHealth-based micro-interventions for improving body satisfaction. Computers in Human Behavior, 95, 58-65.

  BACKGROUND

• Aufderheide, P. (1993). Media Literacy. A Report of the National Leadership Conference on Media Literacy. Aspen Institute, Communications and Society Program, 1755 Massachusetts Avenue, NW, Suite 501, Washington, DC 20036.7

  BACKGROUND

• Cash, T. F. (2002). Body image: Cognitive behavioral perspectives on body image. Body images: A handbook of theory, research, and clinical practice, 38-46.

  BACKGROUND

• Menzel, J. E., & Levine, M. P. (2011). Embodying experiences and the promotion of positive body image: The example of competitive athletics.

  BACKGROUND

• Mendelson BK, Mendelson MJ, White DR. Body-esteem scale for adolescents and adults. J Pers Assess. 2001 Feb;76(1):90-106. doi: 10.1207/S15327752JPA7601_6.

  PMID: 11206302 BACKGROUND

• Damásio, B. F., Pacico, J. C., Poletto, M., & Koller, S. H. (2013). Refinement and psychometric properties of the eight-item Brazilian positive and negative affective schedule for children (PANAS-C8). Journal of Happiness Studies, 14(4), 1363-1378.

  BACKGROUND

• Bandura, A. (1982). Self-efficacy mechanism in human agency. American psychologist, 37(2), 122.

  BACKGROUND

• McCusker J, Lambert SD, Cole MG, Ciampi A, Strumpf E, Freeman EE, Belzile E. Activation and Self-Efficacy in a Randomized Trial of a Depression Self-Care Intervention. Health Educ Behav. 2016 Dec;43(6):716-725. doi: 10.1177/1090198116637601. Epub 2016 May 13.

  PMID: 27179288 BACKGROUND

• Williams GC, Freedman ZR, Deci EL. Supporting autonomy to motivate patients with diabetes for glucose control. Diabetes Care. 1998 Oct;21(10):1644-51. doi: 10.2337/diacare.21.10.1644.

  PMID: 9773724 BACKGROUND

• Matheson EL, Smith HG, Amaral ACS, Meireles JFF, Almeida MC, Linardon J, Fuller-Tyszkiewicz M, Diedrichs PC. Using Chatbot Technology to Improve Brazilian Adolescents' Body Image and Mental Health at Scale: Randomized Controlled Trial. JMIR Mhealth Uhealth. 2023 Jun 19;11:e39934. doi: 10.2196/39934.

  PMID: 37335604 DERIVED

• Matheson EL, Smith HG, Amaral ACS, Meireles JFF, Almeida MC, Mora G, Leon C, Gertner G, Ferrario N, Suarez Battan L, Linardon J, Fuller-Tyszkiewicz M, Diedrichs PC. Improving body image at scale among Brazilian adolescents: study protocol for the co-creation and randomised trial evaluation of a chatbot intervention. BMC Public Health. 2021 Nov 20;21(1):2135. doi: 10.1186/s12889-021-12129-1.

  PMID: 34801002 DERIVED

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: Data analysts will be blinded to condition allocation (dummy coded) when conducting statistical analyses on primary and secondary trait outcomes; however, blind analyses cannot be conducted on primary and secondary state measures due to the within-group design. Two datasets will be created one for between group analyses with dummy coding, and a second dataset for within group analyses without dummy coding.
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: November 18, 2020
• First Posted: April 1, 2021
• Study Start: April 6, 2021
• Primary Completion: August 8, 2021
• Study Completion: August 8, 2021
• Last Updated: February 3, 2022

Record last verified: 2021-04

Data Sharing

• IPD Sharing: Will not share

Locations

BR (1)