Evaluating a body image school-based intervention in India: A randomized controlled trial

Comics as a body image intervention among adolescents in Indian Hindi medium schools: insights from an acceptability study

“…This study is one of the first to consider a comics-based body image intervention and reiterates the importance of exploring acceptability of interventions during their development and evaluation (Craig et al ., 2008 ; Eldridge et al ., 2016 ). The findings align with research that found story-telling interventions to improve body image and mental health (Branscum et al ., 2013 ; Lewis-Smith et al ., Under review ). While one comics-based intervention has targeted body image concerns previously within its content, it did not examine improvements in body image or target risk factors (Gauvin et al ., 2021 ).…”

“…Therefore, the present intervention is the first to be based on fictional characters and storylines, aiming to improve body image and related outcomes. To the authors' knowledge, only one previous mixed-gender body image intervention has been evaluated among Indian adolescents (Garbett et al ., 2021 ; Lewis-Smith et al ., Under review ), which is not suitable for lower socio-economic regions of India. Therefore, the indicated acceptability of the present intervention responds to the mental health provision calls in India.…”

“…This is likely due to the teaching methods in the Indian education system, which seldom promote critical thinking (Bulsara, 2015 ). These findings align with the Confident Me evaluation, where strong acceptability and efficacy were likely due to the intervention's explicit messaging (Garbett et al ., 2021 ; Lewis-Smith et al ., Under review ). This suggests that Indian students require more directional and explicit cues when engaging with interventions, providing important implications for the design of future ‘edutainment’-based interventions for Indian adolescents.…”

“…All recommended edits are being incorporated to ensure that the teacher guide best supports teachers to deliver the intervention. As demonstrated by the high facilitator acceptance and fidelity ratings from the evaluation of Confident Me , which led to the intervention's effectiveness up to 3 months later (Garbett et al ., 2021 ; Lewis-Smith et al ., Under review ), teachers' acceptance and comprehension of the teacher guide are crucial for successful intervention delivery.…”

“…Government, teachers, parents and students have argued for school-delivered mental health support (Strategy Handbook, 2014 ; Parikh et al ., 2019 ), as schools provide an ideal environment for cost-effective and large-scale intervention delivery (Yager et al ., 2013 ; Chua et al ., 2020 ). In response to this, an evidence-based mixed-gender body image intervention, Confident Me , was culturally adapted and found to be effective in Indian private schools (Garbett et al ., 2021 ; Lewis-Smith et al ., Under review ). However, whilst offering promise to higher socio-economic regions of India, Confident Me's acceptability and implementation in lower socio-economic areas may be limited.…”