Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Jun 2, 2022
Date Accepted: Apr 10, 2023
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
It was like talking to my best friends: A randomised controlled trial evaluation of a scalable body image and mental health chatbot among Brazilian adolescents
ABSTRACT
Background:
Accessible, cost-effective and scalable mental health interventions are limited, particularly in low-middle income countries (LMIC) where disparities between mental health needs and services are greatest. Micro-interventions (brief, standalone, digital approaches) aim to provide immediate reprieve and/or enhancements in mental health states and offer a novel and scalable framework for embedding evidence-based mental health promotion techniques into digital environments.
Objective:
This two-armed, fully remote, pre-registered randomised controlled trial (RCT) assessed the impact of a body image chatbot containing micro-interventions in Brazil. Body image is a global public mental health issue that increases risk of severe health issues, including depression and self-harm.
Methods:
Geographically diverse Brazilian adolescents aged 13-18 (N = 1715; 52.5% girls) were randomised into the chatbot or an assessment only control condition, and completed online self-assessments at baseline post-intervention, 1-week and 1-month follow-up. Primary outcomes were mean change in state (chatbot entry and post-techniques) and trait-body image (pre- and post-intervention), with secondary outcomes the mean change in mood and body image self-efficacy between assessment time-points. This trial was registered with ClinicalTrials.gov (NCT04825184; https://clinicaltrials.gov/show/NCT04825184).
Results:
Chatbot users experienced improvements in primary (state [d = .30, [.50-.70] and trait body image [d range = .10 [.01–.18] – .26 [.13–.32]) and secondary outcomes (state [d =.28 [.41–. 61] and trait positive affect [d range = .15 [.03–.27] – .23 [.08–.37], negative affect [d range = -.16 [-.30–-.02] – -.18 [-.33–-.03], self-efficacy [d range = .14 [.63–5.63] – .19 [1.70–7.04]), relative to the control condition. Intervention benefits were moderated by baseline levels of concerns (e.g., higher concern experience greatest benefits), but not gender.
Conclusions:
This is the first large-scale RCT assessing micro-interventions among Brazilian adolescents and a body image chatbot intervention more broadly. It offers a blueprint for accessible and scalable digital approaches that address disparities between health care needs and provisions in LMIC. Clinical Trial: NCT04825184; https://clinicaltrials.gov/show/NCT04825184
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