JMIR Publications

ABSTRACT

Background:

Body dissatisfaction is a global public health issue negatively impacting young people’s mental and physical wellbeing, underscoring an urgent need to develop early interventions. Emerging evidence suggests that microinterventions are acceptable and effective in delivering mental health interventions. Given the popularity of video games amongst young people, the gaming world holds great promise for housing body image microinterventions. As such, we developed Super U Story, a stand-alone, self-paced, narrative-based adventure video game for the popular gaming platform, Roblox, grounded in the Tripartite Influence Model of body dissatisfaction and basic tenets of positive body image.

Objective:

This trial evaluated the effectiveness of a purpose-built Roblox video game on US children and adolescents’ state and trait body image and related outcomes.

Methods:

A sample of 1059 US-based girls and boys (43.4% girls) aged 9-13 years (mean 10.9, SD 1.36) from diverse ethnic, socioeconomic, and geographic backgrounds were recruited online via a research agency into a 3-arm, web-based parallel randomized controlled trial. Participants were assigned to an intervention group, active control group (a Roblox game called Rainbow Friends 2 Story (Color Story)), or attention control group (online word search). Participants completed self-report assessments at baseline (1 week preintervention and before randomization), immediately before and after the intervention testing phase, and 1 week postintervention. Outcomes included state measures of body satisfaction (primary outcome), mood, and body functionality, and trait measures of body esteem, body appreciation, internalization of appearance ideals, and social media literacy. Data were evaluated using repeated measures ANCOVA controlling for baseline. Engagement and acceptability data were collected.

Results:

Relative to the active control, intervention participants showed improved state body satisfaction (F(1, 694)=5.196, P=.023, η_p^2=.007), but not in comparison to the attention control. State mood, state body functionality, internalization of appearance ideals, and social media literacy showed no significant effects. Relative to the intervention group, the active control showed improved trait body esteem (F(1, 663)=5.398, P=.020, η_p^2=.008) and body appreciation (F(1, 663)=6.078, P=.014, η_p^2=.009). Exploratory analyses found age and gender did not moderate effects. We were unable to examine dose-response effects. Acceptability scores were good. Self-report engagement data suggested participants experienced highly variable and often low-dose exposure.

Conclusions:

This large-scale, fully powered trial is the first to assess the effectiveness of a Roblox-based body image intervention. Overall, playing Super U Story did not cause harm; however, evidence is lacking to suggest it improved body image. Learnings are discussed, including psychoeducation as an intervention technique, ‘chocolate-covered broccoli’ phenomena (ie, losing players who recognise thinly disguised educational messages), and measuring intervention engagement. Clinical Trial: ClinicalTrials.gov NCT05669053; https://clinicaltrials.gov/study/NCT05669053