Online Expert Peer Facilitation of the EVERYbody Project

The EVERYbody Project-Connect: A Randomized-Controlled Study Comparing Active and Passive Inclusive Online Body Image Content for College Students

This randomized-controlled trial examines an online dissonance-based body image program for college students called the EVERYbody Project-Connect. The online (videoconferencing) intervention will be delivered using expert peer leaders in three 90-minute weekly sessions. Expert peer leaders for the EVERYbody Project-Connect are college students with lived and/or academic expertise within both body image and diversity and equity domains who are trained and screened for facilitation readiness. The comparison intervention is a passive, time-matched self-help condition using The Body Is Not An Apology Workbook by Sonya Renee Taylor. Both interventions explore diversity and representation within sociocultural body image pressures and provide tools for body acceptance. The study is open to all college students in a universal prevention and risk factor reduction framework. Outcomes will be assessed before and after the three weeks of intervention and at three-month follow-up.

To date, three completed trials of the EVERYbody Project demonstrate that a gender-inclusive, diversity-focused, dissonance based group program can improve eating disorder risk factors and body image among college students. Through active written and verbal exercises and discussion, students directly challenge the cultural messages that appearance should fit within a narrow set of "ideals," critiquing the diversity representation within appearance ideals and incorporating new strategies for body acceptance. Although peer (aka student to student) facilitation is commonly used for delivering dissonance-based body image interventions, an open training model (where all interested students are eligible to facilitate after training) may not be the most beneficial for leading inclusivity-focused body image groups. Research suggests that the EVERYbody Project is most effective when delivered by either (1) professional facilitators (faculty or staff with body image expertise), or (2) expert peer leaders (college students with lived or academic expertise in both body image and diversity topics who are screened for facilitation readiness during training). The current trial explores an online adaptation of this program. The EVERYbody Project-Connect was created from the original program after end-user piloting with college students. The resulting program consists of three 90-minute weekly sessions delivered by expert peer leaders over a secure videoconferencing platform. Expert peer facilitators will complete a 16-hour online training and be screened for facilitation readiness before being approved to lead the intervention. Participants will be randomized on a 1:1 basis to receive the EVERYbody Project-Connect or a time-matched, low-dissonance self-help workbook intervention. Participants in this comparison intervention will be provided with an online copy of The Body Is Not An Apology Workbook by author and activist Sonya Renee Taylor and given weekly assignment instructions (90 minutes of activities each week for three weeks). Workbook activities will be completed on their own as a passive self-help intervention. College students in the Pacific Northwest United States will be invited to participate in this study (universal intervention target, gender inclusive). Outcome assessment includes a comparison of changes in eating disorder risk factors, eating disorder symptoms, and related constructs across conditions over time (from pre- to post-intervention and through 3-month follow-up). Program satisfaction will be assessed at post-intervention, and program application will be evaluated both post-intervention and at follow-up.

Participants will be randomized on a 1:1 basis through survey software to the EVERYbody Project-Connect or the self-help workbook condition

Three weekly 90-minute online group sessions facilitated by expert peer leaders. Retains key dissonance activities and the inclusivity focus of the original EVERYbody Project (e.g., expanded gender focus, critically discussing the impact of limited diversity representation in cultural appearance norms). Additional activities were added, including an increased focus on body compassion (self-acceptance) and weight neutrality content to target weight bias. College students with body image interest and lived or academic diversity and advocacy experience will complete 16 hours of training to become expert peer leaders. Training includes observation, practice, and feedback on using the program manual and managing groups. Students will self-assess and be evaluated by the primary trainer on facilitation readiness. Only peer leaders with sufficient expertise will be invited to facilitate groups.

In this time-matched comparison intervention, participants will be provided with an online copy of The Body Is Not An Apology Workbook by author and activist Sonya Renee Taylor (2021). Weekly emails will assign workbook activities to complete on their own (90 minutes per week for three weeks). This low-dissonance comparison intervention covers many of the same topics within the EVERYbody Project-Connect (body acceptance and scrutinizing the diversity within body ideals) and its activities include reflective writing and drawing exercises to challenge media messages around bodies, identify systems of oppression underpinning body messages, challenge body stereotypes, and make peace with your own body. Activities within the workbook are considered low-dissonance since they will be done privately and not shared.

Internalization subscales from the Sociocultural Attitudes Toward Appearance Questionnaire-4 (SATAQ-4). Average of 10 items; higher scores indicate greater internalization of cultural messages surrounding appearance and attractiveness.

Satisfaction and Dissatisfaction with Body Parts Scale (SDBPS). Average of 9 items; higher scores equal greater dissatisfaction with nine body parts that are commonly endorsed as concerning (e.g., stomach, thighs, hips). The scale will be reverse scored from the original.

8-item version of the Eating Disorders Examination Questionnaire (EDE-Q8). Average of 8 items for Global Score; higher scores equal greater frequency and severity of disordered attitudes and behaviors over the past month.

Fear, guilt, and sadness subscales of the Positive and Negative Affect Schedule-Revised (PANAS). Average of 20 items; higher scores equal greater negative emotion.

Anti-fat attitudes scale (AFAS). Average of 5 items; higher scores equal greater negative stereotypes about fat people and fear of fat.

Interim assessment of weight bias after Week 1 of the 3-week interventions using the Anti-fat attitudes scale (AFAS). Change from baseline to Week 1 will be used to predict post-intervention and follow-up outcomes.

Interim assessment of internalization of appearance norms after Week 1 of the 3-week interventions using the Sociocultural Attitudes Toward Appearance Questionnaire-4 (SATAQ-4). Change from baseline to Week 1 will be used to predict post-intervention and follow-up outcomes.

Four Likert scale items about enjoyment (e.g., "I enjoyed the EVERYbody Project") averaged for total satisfaction score (higher score equals greater satisfaction). Three open-ended questions (e.g., "Was any part of the EVERYbody Project particularly helpful/useful? If so, which part and why?") coded for themes.

Three Likert questions to gauge the application of new information (e.g., "How often do you think about the things you learned in the EVERYbody Project?"). Items will be averaged for a total application score (higher scores equaling more frequent application). One open-ended question on the 3-month follow-up survey only to report any other ways the EVERYbody Project has impacted the participant recently.

Inclusion Criteria: Current college students (enrolled with university email address) Exclusion Criteria: None

Data and other materials will be made available following reasonable request to study Principal Investigator. All outcome data will be included in data sharing. Socio-demographic characteristics will be collapsed into broader categories to protect participant identity. Other study materials, including intervention manuals, will be housed on the Principal Investigator's Open Science Framework page, where URLs will be made publicly available.

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