Type: dissertation
Abstract: Body image develops as early as age three (Paxton & Damiano, 2017), and is associated with a plethora of harmful mental, physical and social consequences. Fortunately, body image is modifiable and can be improved through psychosocial interventions (Alleva et al., 2015). While early approaches (e.g., expert-led, school-based programmes) are efficacious, they are typically designed for adolescents, with very few body image interventions available for children (Guest et al., 2022). They also rely on resource-intensive, face-to-face delivery making large-scale implementation challenging and unsustainable. This is particularly problematic in LMICs where access to mental health provision, including body image professionals and training, is scarce. Consequently, many young people across the globe are left without access to body image intervention, even for mild concerns. These challenges are not unique to the body image field and coupled with the growing global burden of mental health concerns among young people, there have been calls to rethink how psychosocial interventions are delivered (Ramos et al., 2024). Without the development of simpler, more affordable and convenient ways to deliver services, shifting this narrative and ensuring effective body image support reaches those who need it, remains a significant challenge for the field.One potential solution is the application of disruptive innovation (Kazdin & Blase, 2011) to innovate and scale body image interventions and make them more accessible. Disruptive innovation seeks to transform the delivery of a product or a service (i.e., intervention) using innovation and novelty (Rotheram-Borus et al., 2012). Unlike dominant healthcare models in which services may undergo incremental improvements over time, disruptive innovations introduce entirely new approaches designed for scalability, with a primary aim of reaching underserved populations who have limited or no access to support. This approach has been largely unexplored in relation to body image.Disruptive innovations, often digital, are brought to where people already spend time (Kazdin, 2017) making them especially well-suited to young people who are “digital natives”. Children are accessing online media at increasingly younger ages with over a third under the age of seven using the internet for streaming or social media (Ofcom, 2025). Engagement in online spaces only increases with age and by age 18, 98% are online (Ofcom, 2025). This presents a unique opportunity to scale up evidence-based body image interventions through embedding them within online digital environments, including social media platforms, of which aspects can perpetuate negative body image. Digitalising body image psychoeducation and therapeutic techniques for online dissemination offers a scalable, cost-effective solution to overcome barriers associated with in-person care. And, given the increasing public and political debate about the safety and harms of online spaces for young people, it is timely to assess ways to positively disrupt this.To address this opportunity for innovation, this thesis presents nine publications which aimed to explore if and how disruptive interventions can improve young people’s body image and examine whether this approach can be applied to different populations through different modalities. Specifically, this thesis presents the development and evaluation of four digital body image ‘micro-interventions’ for young people aged 4–18 years old, which have been guided by the framework for developing and evaluating complex interventions (Skivington et al., 2021) and underpinned by established theories of positive and negative body image. Micro-interventions are brief, immediately actionable therapeutic tasks or content that provide in-the-moment symptom improvement (e.g., Meinlschmidt et al., 2016). Unlike typical standalone interventions, they are rooted within the context of an individual’s everyday life (Baumel et al., 2020). They can be easily embedded within digital platforms meaning they align neatly with the premise of disruptive innovation and aims of this thesis. Adopting this framework to address body image among children and young people is largely unchartered, highlighting the original contribution of this work. Further, this thesis advances understanding in under-researched cultural contexts like Brazil where limited body image resources for young people highlight the potential impact of digital innovation in geographically diverse, LMICs where disparities between mental health needs and services are greatest. Finally, it addresses research measurement issues which is an on-going challenge in this field.This thesis begins with a review of the existing literature on body image interventions, disruptive innovation and micro-interventions as an emerging technique for reach and scale (Chapter 2). It then outlines the research approach for this programme of work (Chapter 3), followed by critical commentaries of my nine publications (Chapter 4) related to the development and evaluation of micro-interventions purposely designed to disrupt children’s online media environments through ‘edutainment’. Edutainment merges educational content and entertainment media with the aim of influencing an individual’s knowledge, attitudes, and behaviours (Moyer-Guse, 2008). The RCT in Publication 1 demonstrated that embedding positive body image psychoeducation in children’s digital reading material (i.e., e-book) via a popular children’s cartoon series is an effective and acceptable way to improve children’s state body image via a brief intervention that does not need a facilitator (e.g., teacher). This is a first of its kind self-administered micro-intervention for children that can integrate seamlessly into their everyday lives; either through their regular media consumption or embedded within school environments.Findings from the e-book study inspired Publication 2 which aimed to disrupt younger children’s video media landscapes. Publication 2 presents the study protocol for the development of two digital micro-interventions (a music video and a 15-minute episode) for children 4–6 years, in collaboration with creative and industry partners. Children are an under-researched group in the body image literature, therefore this project involved extensive groundwork including Public Involvement interviews which I conducted with key stakeholders (parents, early year educators, children) to inform the intervention materials and research protocols. The results from the efficacy evaluation trial of these interventions are reported in Publication 3.Learnings from this work offered new insights into children’s body image and enabled my co-researchers and I to shape Publications 4 and 5. Publication 4 reports on a conceptual framework for understanding functionality appreciation, a core component of positive body image, in young children. Although scholars have advocated for such investigations, studies examining children’s positive body image are lacking. This work is important as without understanding key body image concepts in new populations, appropriate, scalable interventions cannot be developed and disseminated. Moreover, fostering positive body image and intervening at earlier stages is one strategy for building a healthier body image (Reid Chassiakos et al., 2016). To effectively capitalise on the use of technology as an intervention modality among children, it is essential to also gain a comprehensive understanding of how body image and related attitudes function in this demographic. Therefore, I led Publication 5 which explored the prevalence of weight biased attitudes among young children and is among the first studies to examine the relationship between these attitudes and positive body image, specifically body appreciation. Our framework from Publication 4 was then employed in Publication 3 as one of the outcome measures to assess the effectiveness of both interventions and is published open access. The final intervention, Publication 6, demonstrates that delivering psychoeducation through other forms of edutainment such as ‘playables’ (mini digital games embedded within larger apps) can immediately improve pre-adolescents’ body image, offering another avenue to disrupt harmful online environments.Disruptive innovation can also be exploited to reach individuals who may have previously lacked access to support. This is relevant to large geographically diverse or LMICs where infrastructural resources in the provision of mental health are limited. The final set of publications are conducted in Brazil where adolescents experience high levels of body dissatisfaction (Leal et al., 2020) but interventions to support this group are scarce. Body image interventions are predominantly developed in high-income, English-speaking countries meaning they may not be culturally appropriate for young people in Brazil. To progress this groundwork, Publications 7 and 9 outline the development and evaluation of a digital body image chatbot intervention specifically for this population which was then embedded within a social media platform. In tandem, I conducted Publication 8 to culturally adapt, translate, and validate the Body Esteem Scale for Adolescents and Adults (BESAA) for Brazilian adolescents to assist in the chatbot’s evaluation phase (Publication 9). This measure is the first validated tool to assess Brazilian adolescent’s holistic body image and is an important contribution to the wider field, allowing other researchers to examine, develop and evaluate much needed body image interventions for this population.Collectively, this thesis demonstrates how digital disruptive innovations have potential to address young people’s body image at scale. Chapter 5 synthesises the findings from this body of work, which highlights how universal interventions can be successfully self-administered to young people without the need of a mental hea
Author: Smith, Harriet
Institution: University of the West of England
Language: English
Subfield: Clinical Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W7204346243