Expert Peer Facilitation of the EVERYbody Project

Expert Peer Facilitation of the EVERYbody Project: A Randomized-controlled Evaluation of a Diversity-focused, Dissonance-based, Universal Body Image Program for College Students

In-person intervention activities halted in March 2020 due to COVID-19; follow-up data collection of active participants completed online in June 2020.

The third trial of the EVERYbody Project explored the efficacy of using expert peer leaders to deliver the two-session, inclusive, group body image intervention compared to a time-matched video and expressive writing group through three-month follow-up. Expert peer leaders were college students with lived and/or academic expertise who were screened for facilitation readiness through a two-day training.

The first two trials of the EVERYbody Project demonstrated that a gender-inclusive, diversity-focused, dissonance-based group body image intervention could improve eating disorder risk factors among college students, particularly when the two session program was delivered by individuals with expertise (faculty or staff with body image expertise). When peer interventionists were used (college students with body image interest who completed a two-day training before facilitating groups), the effects of the EVERYbody Project were diminished. Although peer facilitation is commonly used for delivering dissonance-based body image interventions, an open training peer facilitation model (where all students who are trained are eligible to deliver the intervention) may not be the most beneficial for leading inclusivity-focused body image groups. The current trial of the EVERYbody Project (Trial 3) explores a novel strategy to implement this program using expert peer facilitators. College students with lived or academic expertise in both body image and diversity topics were recruited to complete a two-day training. The training included practice and feedback on the two session intervention content as well as training on inclusive facilitation. Following the training, peer leaders completed a facilitation readiness self-evaluation and were evaluated by trainers for facilitation expertise. Only students who passed the expertise threshold were invited to facilitate EVERYbody Project groups. The expert peer facilitation of the EVERYbody Project was compared to a time-matched two session passive video and expressive writing intervention. College students within a university in the Pacific Northwest United States were invited to participate in the group intervention (universal intervention target, gender inclusive). Outcome assessment included a comparison of changes in eating disorder risk factors and symptoms across randomization conditions from pre-post intervention through three-month follow-up. Program satisfaction was assessed at post-intervention and program application was assessed post-intervention and at three-month follow-up.

After signing up for a specific time slot, participants were randomized in blocks of 20 to the EVERYbody Project or video comparison condition (two blocks of 10 participant slots were available in each time slot)

This gender inclusive, dissonance-based body image program was created from focus group feedback. Based on the Body Project, the program retains key dissonance activities while expanding the inclusivity focus (e.g., expanding the gender focus, exploring diversity within appearance ideals, critically discussing the impact of limited diversity representation in cultural appearance norms). Around 10% of content from the previous trial was modified to form the current intervention. Changes focused on enhancing diversity-focused content. College students with body image content interest completed two days (16 hours) of training on the program manual, group management, and conducting inclusive conversations. Post training, students self-assessed their facilitation readiness and were evaluated by two trainers on facilitation expertise. Peer leaders with sufficient expertise were invited to facilitate EVERYbody Project groups.

Video + expressive writing groups were facilitated by a peer leader following a detailed script. This intervention was designed as an active but low-dissonance comparison condition. Participants viewed two separate documentary movies related to gender and/or appearance-related pressures (one during each session): (1) The Illusionists, and (2) The Mask You Live In. Participants engaged in a brief (10 minute) reflective writing exercise after each film. In order to keep dissonance low, participants were told that their reflections would not be shared with anyone and they were not turned in. Peer facilitators received brief (1 hour) training on the video group manual.

Eating disorder symptoms were assessed with an 8-item version of the Eating Disorders Examination Questionnaire (EDEQ). The 8-item version of the EDEQ yields a Global score (average across all 8 items).

The Satisfaction and Dissatisfaction with Body Parts Scale (SDBPS) assessed satisfaction and dissatisfaction with nine parts of the body that are commonly endorsed as concerning (e.g., stomach, thighs, hips). The average score was used in this study (average across all 9 items).

The two Internalization subscales of the Sociocultural Attitudes Toward Appearance Questionnaire-4 (SATAQ-4) assess internalized cultural messages surrounding appearance and attractiveness. The two internalization subscales were combined for this study (average across all 10 items), following prior research. This survey was assessed at all outcome time points (Survey 1, 2, and 3), plus midway through the intervention (following Session 1 of the program).

Negative affect was assessed with 20 items from the fear, guilt, and sadness subscales of the Positive and Negative Affect Schedule-Revised (PANAS-X). The average of all 20 items was used in this study.

A series of feedback questions were used to gauge satisfaction with the EVERYbody Project after the second session (based on prior research). These questions included four Likert scale items about enjoyment (e.g., "I enjoyed the EVERYbody Project") rated from 1 (strongly disagree) to 5 (strongly agree) as well as open-ended questions (e.g., "Was any part of the EVERYbody Project particularly helpful/useful? If so, which part and why?") These questions were administered as a part of the post-intervention survey (Survey 2). At post-intervention (Survey 2) and three-month follow-up (Survey 3), three questions gauged application of information learned in the program (e.g., "How often do think about the things you learned in the EVERYbody Project?" rated on a scale from 1 (not at all) to 5 (all the time).

Inclusion Criteria: Current college student enrolled at institution where research was taking place 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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