Using Chatbot Technology to Improve Brazilian Adolescents' Body Image and Mental Health at Scale: Randomized Controlled Trial.

BACKGROUND: Accessible, cost-effective, and scalable mental health interventions are limited, particularly in low- and middle-income countries, where disparities between mental health needs and services are greatest. Microinterventions (ie, brief, stand-alone, or digital approaches) aim to provide immediate reprieve and enhancements in mental health states and offer a novel and scalable framework for embedding evidence-based mental health promotion techniques into digital environments. Body image is a global public health issue that increases young peoples' risk of developing more severe mental and physical health issues. Embedding body image microinterventions into digital environments is one avenue for providing young people with immediate and short-term reprieve and protection from the negative exposure effects associated with social media. OBJECTIVE: This 2-armed, fully remote, and preregistered randomized controlled trial assessed the impact of a body image chatbot containing microinterventions on Brazilian adolescents' state and trait body image and associated well-being outcomes. METHODS: Geographically diverse Brazilian adolescents aged 13-18 years (901/1715, 52.54% girls) were randomized into the chatbot or an assessment-only control condition and completed web-based self-assessments at baseline, immediately after the intervention time frame, and at 1-week and 1-month follow-ups. The primary outcomes were mean change in state (at chatbot entry and at the completion of a microintervention technique) and trait body image (before and after the intervention), with the secondary outcomes being mean change in affect (state and trait) and body image self-efficacy between the assessment time points. RESULTS: Most participants who entered the chatbot (258/327, 78.9%) completed ≥1 microintervention technique, with participants completing an average of 5 techniques over the 72-hour intervention period. Chatbot users experienced small significant improvements in primary (state: P<.001, Cohen d=0.30, 95% CI 0.25-0.34; and trait body image: P=.02, Cohen d range=0.10, 95% CI 0.01-0.18, to 0.26, 95% CI 0.13-0.32) and secondary outcomes across various time points (state: P<.001, Cohen d=0.28, 95% CI 0.22-0.33; trait positive affect: P=.02, Cohen d range=0.15, 95% CI 0.03-0.27, to 0.23, 95% CI 0.08-0.37; negative affect: P=.03, Cohen d range=-0.16, 95% CI -0.30 to -0.02, to -0.18, 95% CI -0.33 to -0.03; and self-efficacy: P=.02, Cohen d range=0.14, 95% CI 0.03-0.25, to 0.19, 95% CI 0.08-0.32) relative to the control condition. Intervention benefits were moderated by baseline levels of concerns but not by gender. CONCLUSIONS: This is the first large-scale randomized controlled trial assessing a body image chatbot among Brazilian adolescents. Intervention attrition was high (531/858, 61.9%) and reflected the broader digital intervention literature; barriers to engagement were discussed. Meanwhile, the findings support the emerging literature that indicates microinterventions and chatbot technology are acceptable and effective web-based service provisions. This study also offers a blueprint for accessible, cost-effective, and scalable digital approaches that address disparities between health care needs and provisions in low- and middle-income countries. TRIAL REGISTRATION: Clinicaltrials.gov NCT04825184; http://clinicaltrials.gov/ct2/show/NCT04825184. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s12889-021-12129-1.

The Body Esteem Scale for Adults and Adolescents: Translation, adaptation and psychometric validation among Brazilian adolescents.

A lack of rigorously validated body image measures for use among adolescents is hampering research in Brazil. This study aimed to validate a Brazilian Portuguese version of the Body Esteem Scale for Adults and Adolescents (BESAA; Mendelson et al., 2001). The BESAA was forward and back translated from English into Brazilian Portuguese before examining its factor structure, reliability, and validity among 475 adolescents (50.3% girls) aged 13 - 18 years (Mage = 15.35) from various regions across Brazil. Exploratory factor analysis identified an 18-item three-factor solution, with Appearance-Positive, Appearance-Negative, and Weight subscales. The removal of five problematic items led to a psychometrically robust model, invariant across gender and age, and was verified using confirmatory factor analysis. Test re-test reliability and internal consistency were good-to-excellent across all three factors (Cronbach's a =0.85,.88, and.89). Concurrent validity was established through significant correlations with body dissatisfaction. Convergent validity was demonstrated via significant correlations with positive and negative affect. This Brazilian Portuguese version of the BESAA is a valid, reliable, and psychometrically robust measure of body image suitable for administration among adolescents in Brazil.

Scale development: ten main limitations and recommendations to improve future research practices.

The scale development process is critical to building knowledge in human and social sciences. The present paper aimed (a) to provide a systematic review of the published literature regarding current practices of the scale development process, (b) to assess the main limitations reported by the authors in these processes, and (c) to provide a set of recommendations for best practices in future scale development research. Papers were selected in September 2015, with the search terms "scale development" and "limitations" from three databases: Scopus, PsycINFO, and Web of Science, with no time restriction. We evaluated 105 studies published between 1976 and 2015. The analysis considered the three basic steps in scale development: item generation, theoretical analysis, and psychometric analysis. The study identified ten main types of limitation in these practices reported in the literature: sample characteristic limitations, methodological limitations, psychometric limitations, qualitative research limitations, missing data, social desirability bias, item limitations, brevity of the scale, difficulty controlling all variables, and lack of manual instructions. Considering these results, various studies analyzed in this review clearly identified methodological weaknesses in the scale development process (e.g., smaller sample sizes in psychometric analysis), but only a few researchers recognized and recorded these limitations. We hope that a systematic knowledge of the difficulties usually reported in scale development will help future researchers to recognize their own limitations and especially to make the most appropriate choices among different conceptions and methodological strategies.

Scale development: ten main limitations and recommendations to improve future research practices

Abstract The scale development process is critical to building knowledge in human and social sciences. The present paper aimed (a) to provide a systematic review of the published literature regarding current practices of the scale development process, (b) to assess the main limitations reported by the authors in these processes, and (c) to provide a set of recommendations for best practices in future scale development research. Papers were selected in September 2015, with the search terms “scale development” and “limitations” from three databases: Scopus, PsycINFO, and Web of Science, with no time restriction. We evaluated 105 studies published between 1976 and 2015. The analysis considered the three basic steps in scale development: item generation, theoretical analysis, and psychometric analysis. The study identified ten main types of limitation in these practices reported in the literature: sample characteristic limitations, methodological limitations, psychometric limitations, qualitative research limitations, missing data, social desirability bias, item limitations, brevity of the scale, difficulty controlling all variables, and lack of manual instructions. Considering these results, various studies analyzed in this review clearly identified methodological weaknesses in the scale development process (e.g., smaller sample sizes in psychometric analysis), but only a few researchers recognized and recorded these limitations. We hope that a systematic knowledge of the difficulties usually reported in scale development will help future researchers to recognize their own limitations and especially to make the most appropriate choices among different conceptions and methodological strategies.

Psychometric evaluation of the Sociocultural Attitudes Towards Appearance Questionnaire-3 among Brazilian young adults.

The objective was evaluating the psychometric properties of the Sociocultural Attitudes Towards Appearance Questionnaire-3 (SATAQ-3) among Brazilian young adults of both genders. The sample was composed by 506 undergraduate students (295 females and 211 males), aged between 17 and 29 years old. Exploratory and confirmatory factor analyses were used for construct validity (N = 506). Correlations between the SATAQ-3 scores and those of the Tripartite Influence Scale (TIS) and Body Shape Questionnaire (BSQ) were used for convergent validity. Reliability was assessed through internal consistency (α) and reproducibility (test-retest) through comparison of the means obtained at two different time points and through intra-class correlation. The scale presented a factor structure composed of five factors, replicated in the confirmatory factor analysis with satisfactory values for the measurements of adjustment to the model. Correlations with the BSQ and TIS scores were rho = .52 and rho = -.35, respectively. Cronbach's alpha coefficients were satisfactory, and their stability was demonstrated. Brazilian SATAQ-3 had good validity and reproducibility, being indicated for use in samples of Brazilian youths.