JMIR Publications

ABSTRACT

Background:

Body dissatisfaction is a global issue, particularly among adolescent girls and young women. Effective body image interventions exist but face barriers to scaling up, particularly in lower- and middle-income countries, such as Indonesia, where a need exists.

Objective:

This study evaluated the acceptability and efficacy of Warna-Warni Waktu, a social media-based, fictional six-episode video series supplemented with self-guided online activities designed to improve body image among young Indonesian women. We hypothesized Warna-Warni Waktu would increase trait body satisfaction and mood and decrease internalization of appearance ideals and skin shade dissatisfaction relative to the waitlist control condition. Additionally, we anticipated improvements in state body satisfaction and mood immediately after watching each video.

Methods:

We conducted an online two-arm randomized controlled trial (intervention vs waitlist control) among 2000 Indonesian women aged 15 to 19 years recruited by telephone via an Indonesian research agency. Block randomization was performed with a 1:1 allocation. Participants and researchers were not concealed from the randomized arm. Participants completed self-report assessments of trait body satisfaction (primary outcome), internalization of appearance ideals, mood, and skin shade dissatisfaction (secondary outcomes) at baseline (pre-randomization), 1 day post-intervention (T2), and 1 month post-intervention (T3). They also completed state measures of body satisfaction and mood immediately before and after watching each video. Data were evaluated using linear mixed models with an intent-to-treat analysis. Adherence to the intervention was tracked, and acceptability questions were posed at T2.

Results:

In total, 1847 young Indonesian women participated. Relative to the control condition (n=923), the intervention group (n=924) showed reduced internalization of appearance ideals at T2 (F1, 1758=40.56, P<.001, partial η2=0.022) and T3 (F1, 1782=54.03, P<.001, partial η2=0.03), as well as reduced skin shade dissatisfaction at T2 (F1, 1744=8.05, P<.01, partial η2=0.005). Improvements in trait body satisfaction occurred in the intervention group at T3 (F1, 1781=9.02, P<.01, partial η2=0.005). This finding was completely mediated by the change scores in internalization between T1 and T2 (indirect effect: β=.03, 95% CI 0.017-0.041; direct effect: β=.03, P=.13), consistent with the Tripartite Influence Model of body dissatisfaction. No significant effects were found for trait mood. Dependent sample t tests found each of the videos was effective at improving state body satisfaction and mood. Cumulative analyses found significant and progressive improvements in pre- and post-state body satisfaction and mood scores. Intervention adherence was good; participants watched an average of 5.2 videos (SD=1.66). Acceptability scores were high on understandability, enjoyment, age-appropriateness, usefulness, and likelihood to recommend the intervention.

Conclusions:

Warna-Warni Waktu is an effective eHealth intervention to reduce body dissatisfaction among young Indonesian women. A dissemination plan is in place for Warna-Warni Waktu to reach hundreds of thousands of young Indonesian women initially through paid social media advertising. Clinical Trial: ClinicalTrials.gov, NCT05383807, https://clinicaltrials.gov/ct2/show/NCT05383807; ISRCTN, ISRCTN35483207, https://www.isrctn.com/ISRCTN35483207; International Registered Report Identifier (IRRID), PRR1-10.2196/33596