Evaluating the effectiveness and acceptability of two positive body image media micro-interventions among children aged 4-6 years old - a study protocol

Background: Children's online media perpetuates appearance idealised images and can negatively impact the way children feel about their own and other people's bodies (e.g., weight bias) at a young age. The development and evaluation of body image interventions for young children to counteract this, are scarce. There is a need for prevention efforts to nurture the development of positive body image among this group to help mitigate potential body image concerns in later childhood. Media-based approaches promoting positive body image messages have shown preliminary efficacy. In collaboration with industry partners, we have developed two positive body image media micro-interventions (a 15-minute episode and a music video) to be evaluated in a fully powered RCT.

Methods: We aim to recruit 440 children between the ages of 4 and 6 years to be randomised into one of four conditions: (i) 15-minute episode intervention, (ii) 15-minute episode control, (iii) 3-minute music video intervention, or (iv) 3-minute music video control. This study will be conducted face-to-face, whereby children and a parent attend a media screening session and children complete pre-and post-intervention measures of positive body image and weight bias. Both the child and parent will watch their assigned media, together on a tablet device. Due to their age, children will complete outcome measures with a trained moderator in a play-based interview pre-intervention (T1), immediately post-intervention (T2) and one-week follow up (T3). A corresponding parent will complete a questionnaire on intervention acceptability at T2, and re-watch of their assigned media at T3. The primary outcome will be the change in body appreciation, and secondary outcomes include change in functionality appreciation and weight bias. Exploratory analyses will determine any effect of gender (girls vs. boys), year group (reception vs. year 1) dosage or delayed effects. Moderator fidelity will be also assessed.

Discussion: This study will evaluate two positive body image micro-interventions among children 4-6 years old. These interventions have the potential to bolster children's positive body image and reduce weight bias. A dissemination plan is in place with project stakeholders such that the interventions can reach millions of children worldwide.

Trial registration: The trial is registered with Clinical Trial.gov, Ref number: NCT06146647.