An exploration of having social media influencers deliver a first-line digital intervention to improve body image among adolescent girls: A qualitative study.

Social media influencers are popular among adolescents and could offer a unique way to reach young people at scale with body image interventions. This study explored girls' and influencers' views on having influencers deliver body image interventions through vlogs (video blogs) and to gain insight into their preferred format, content, and views on factors that encourage engagement with vlogs. Twenty-one UK based participants were recruited. Three online focus groups were conducted with adolescent girls (n = 16) aged 14-18 years and one with influencers (n = 5) aged 24-33 years, who had a collective following of over 1.5 million subscribers across social media platforms. Data were analysed using reflexive thematic analysis and four themes were generated: Choosing an influencer whose messages and core values are aligned with the topic of body image; the importance of influencer authenticity and personal experience; collaborating on content creation with mental health professionals; and the need for long-form (i.e., 10-20 min) content to address serious topics. Findings suggest having influencers deliver body image interventions to young people could be a useful approach. Results highlight the need to engage with end users from the outset of intervention development to increase the likelihood of intervention effectiveness and engagement.

A cognitive dissonance body image intervention 'Free Being Me' delivered by guide leaders to adolescent girl guides in India: A pilot and acceptability trial.

This pilot study assessed the acceptability and pre-post intervention effects of a cognitive dissonance-based body image intervention, Free Being Me, delivered by Guide leaders to adolescent girls in India. Girls aged 11-14 years (Mage = 12.6, N = 117), who were members of the national scouting and guiding association of India, received the intervention across five weekly 1-hour group sessions. The primary outcome (body esteem) and secondary outcomes (self-esteem, internalisation of appearance ideals, negative and positive affect, and life disengagement) were measured pre-intervention and immediately post-intervention. The intervention was acceptable. Adolescent girls reported high levels of comfort (89%), enjoyment (90%), and perceived importance (92%) with suggestions for improvement including more interactive activities. Facilitator adherence and competence delivering Free Being Me was rated good. Significant within-groups pre-post intervention improvements in body esteem (Cohen's d = 0.28) and reductions in internalisation of appearance ideals (Cohen's d = 0.49) were identified. No changes to self-esteem, negative or positive affect, or life disengagement were observed. This study suggests that Free Being Me is acceptable for community-based delivery and Guide leader format with promising pre-post intervention effects. Going forward, a randomised controlled trial is necessary to make confident interpretations on the effectiveness of Free Being Me.

Exploring the experiences and psychosocial support needs of informal carers of men with breast cancer: a qualitative study.

PURPOSE: The provision of practical and emotional support for men who have been diagnosed with breast cancer in the UK falls primarily on their partners, close family members or friends. However, informal carers' experiences are omitted from the research literature. Therefore, the present study aimed to explore the care-giving experiences of informal carers (ICs) of men with breast cancer in the UK and identify psychosocial support needs and preferences. METHODS: Semi-structured interviews, conducted on the telephone or via online video calls, explored ICs' experiences of providing support, the psychosocial issues they faced and the impact of the illness on themselves and their relationship with the patient. They were also asked about any support previously offered to them, in addition to their support preferences. Twelve ICs participated (11 females, 1 male), and 9 were spouses. Interview transcripts were analysed with reflexive thematic analysis using NVIVO software. RESULTS: Four key themes were identified: "The impact of caring", "Lack of awareness", "Isolated and alone" and "Making a difference". CONCLUSIONS: The physical, emotional, financial and social impact of providing emotional and practical care and support for a man diagnosed with breast cancer can be considerable. ICs may experience significant levels of distress and often feel isolated. Greater awareness and more research is needed to better understand the psychosocial impact and support needs for ICs of men with breast cancer. There is an evident necessity to address their information needs and offer sources of support throughout the cancer journey.

A longitudinal study investigating positive body image, eating disorder symptoms, and other related factors among a community sample of men in the UK.

Emerging research suggests that positive body image-an overall love and respect for one's body- may be a protective factor for eating disorder (ED) symptoms. This study aimed to explore the relationships between positive body image, ED symptoms, and related factors among men across time. A community sample of 440 British men completed questionnaires at Time 1 and Time 2 (1 year later). Linear models showed that, unexpectedly, positive body image at Time 1 did not predict change in ED symptoms at Time 2, and ED symptoms at Time 1 did not predict change in positive body image at Time 2. However, positive body image at Time 1 did predict increased appearance satisfaction and decreased appearance-ideal internalisation at Time 2. Increased positive body image at Time 2 was only predicted by appearance satisfaction at Time 1. Although no evidence for a longitudinal relationship between positive body image and ED symptoms was found, positive body image did predict change in established risk factors for disordered eating among men. Future research on positive body image and eating behaviour among men could be improved by including assessments of muscularity-oriented and adaptive eating behaviours.

'They were aware of who I was as a person': Patients' and health professionals' experiences of using the PEGASUS intervention to facilitate decision-making around breast reconstruction.

OBJECTIVE: Many women choose to have breast reconstruction after mastectomy; however, decision-making can be difficult and expectations are often unmet. The PEGASUS intervention (Patient Expectations and Goals: Assisting Shared Understanding of Surgery) was developed to support shared decision-making by helping women and healthcare professionals to clarify and discuss their individual expectations around surgery. This study aimed to explore patients' and health professionals' experiences of using the intervention and its implementation. METHODS: Forty interviews were conducted with participants in a large scale, multi-site trial of the effectiveness of PEGASUS, from 'intervention' (n=16) and 'usual care' groups (n=11), and healthcare professionals (n=13). Data were analysed using thematic analysis. RESULTS: 'Usual care' participants described feeling overwhelmed in decision-making ('bombarded'), often using their own research to break down information ('process of elimination'). In contrast, intervention group participants described PEGASUS providing focus ('focus amongst the frenetic'), and increased connection with clinicians ('more than a number'). Healthcare professionals described increased focus on patient priorities ('shifting focus'), but stressed the need for whole team buy-in ('collective commitment'). CONCLUSIONS: The PEGASUS intervention offered a qualitatively different experience to individuals considering breast reconstruction, with potential to enhance patients' and healthcare professionals' feelings of shared decision-making and patient-centred care. TRIAL REGISTRATION: ISRCTN 18000391 (https://doi.org/10.1186/ISRCTN18000391) 27/01/2016.

Contralateral Prophylactic Mastectomy (CPM) and the clinical consultation: A snapshot of UK healthcare professionals' views and experiences.

OBJECTIVES: Increasing numbers of women are undergoing Contralateral Prophylactic Mastectomy (CPM) in the UK. However, professional guidelines suggest CPM does not offer oncological benefit to the majority of women with breast cancer. Whilst research has explored women's motivations for seeking CPM, this study aimed to address a gap in the literature by investigating healthcare professionals' (HCPs) experiences and attitudes of caring for women considering CPM. MATERIALS AND METHODS: HCPs involved in the care of women considering CPM were invited to complete an online survey concerning: the process and management of decision-making, their attitudes towards CPM provision and challenges they faced in CPM provision. RESULTS: Fifty-eight HCPs completed the survey. Respondents felt that perceived future breast cancer risk was women's most common motivation for CPM. Fifty-four percent of respondents agreed patients should be offered the choice of CPM for risk reduction if they are at increased clinical risk. Fifty-one percent agreed patients should be offered the choice of CPM as a means of achieving symmetry, and 19% agreed that women should be offered CPM for reasons related to risk-reduction, if they were not thought to be at an increased clinical risk. Patients' understanding of risks versus benefits was seen as the greatest challenge facing HCPs. CONCLUSION: Many respondents were hesitant to explore CPM with all patients in their care, reflecting current service restrictions and their own beliefs around CPM. These findings highlight the need for exploration of patient's perspectives on this process and a review of care provision and information available related to CPM.

Women's initial experiences of their appearance after mastectomy and/or breast reconstruction: A qualitative study.

OBJECTIVE: Surgical procedures intended to treat breast cancer or reduce risk of developing the disease typically result in changes to appearance and scarring of the breast area, and any donor sites. The longer-term impact of these changes on body image and quality of life are well documented, but research in this field has failed to explore women's initial experiences of their appearance after surgery. This study used a qualitative approach to gain insight and better understand the experiences of women at this time point in their treatment pathway. METHODS: Women (n=128) who had undergone mastectomy and/or breast reconstruction following a diagnosis of breast cancer or to reduce their risk of developing the disease completed an online survey. Open-ended questions asked participants about their experiences when seeing the postsurgical appearance of their breast/breast area (and donor site, if relevant) for the first time, and the support available to them. RESULTS: Thematic analysis generated four key themes: "preparedness and support," "first thoughts and emotions," "loss and grief," and "the reaction of others." CONCLUSIONS: There was considerable variability in women's experiences. Some felt prepared and emotionally supported at this time, whilst others felt this element of care was missing. The findings suggest that there is a need to ensure all women are informed and have the necessary support when looking at the results of their surgery for the first time. Areas for improvement were proposed, including preoperative discussions, increased preparation and support. This could potentially contribute to better patient outcomes overall.

"It felt like unfinished business, it feels like that's finished now": Women's experiences of decision making around contralateral prophylactic mastectomy (CPM).

OBJECTIVE: Increasing numbers of women in the United Kingdom are choosing to have a contralateral prophylactic mastectomy (CPM) after diagnosis of breast cancer. Whilst research suggests that many experience high rates of psychological well-being after CPM, professional guidelines suggest CPM is "not required" for the majority of unilateral breast cancer patients, and some individuals consider the surgery to be controversial. Existing research has explored patients' reasons for seeking CPM; however, little is known about their experiences of decision making. This study aimed to investigate women's experiences of decision making around CPM in the United Kingdom. METHODS: Semistructured qualitative interviews were conducted with 27 women, recruited through breast cancer support charities. All participants had CPM in the United Kingdom after a diagnosis of unilateral breast cancer, ductal carcinoma in situ (DCIS), or invasive ductal carcinoma. Data were analysed using thematic analysis. RESULTS: Two main themes were generated from the analytic process: "sanity check" ("battling for CPM," "feeling stigmatised," "seeking similar others") and "reclaiming the body" ("being true to self," "moving forward"). Women described defending their decision to have CPM, concerns that their thoughts about surgery may be considered "abnormal," and seeking support from peers. The decision to have CPM was discussed in terms of their future relationship with their body and moving forward after cancer. CONCLUSIONS: This study highlights the importance of interactions with health care professionals in the decision-making experience, the role of peer support, and the need to fully understand the potentially complex and multifaceted nature of each woman's decision to seek CPM.

Body appreciation in British men: Correlates and variation across sexual orientation.

Investigations of positive body image among men and across various social identities are lacking, and could contribute to a more complete understanding of the construct, including how positive body image can be improved. This study addressed this gap by investigating correlates of body appreciation - a key facet of positive body image - in men, and testing whether levels of body appreciation vary across sexual orientation. Data from a British community sample of 439 men (Mage = 39.13) showed that body appreciation inversely correlated with conformity to masculine norms and upward appearance-based social comparisons, and positively correlated with physical activity. Body appreciation was lower among sexual minority compared to heterosexual men, and athletic appearance-ideal internalisation and upward appearance-based social comparisons mediated this relationship. Replicating prior research among men, body appreciation positively correlated with body satisfaction, and inversely correlated with perceived appearance pressures from media and eating pathology. These findings have implications for interventions addressing body image among men.

A Systematic Review of the Effectiveness of Acceptance and Commitment Therapy (ACT) for Body Image Dissatisfaction and Weight Self-Stigma in Adults.

Body image dissatisfaction (BID) and weight self-stigma are prevalent and associated with physical and psychological ill-health. Acceptance and Commitment Therapy (ACT) is increasingly employed for both, yet little is known about its effectiveness. Searches of 12 databases identified six studies using online, face-to-face or self-help ACT interventions for BID or weight self-stigma, of varying duration and intensity. Their effectiveness and quality were evaluated. Two reported improved BID, three improved weight self-stigma, and one reported no impact on weight self-stigma. Methodological issues (small sample sizes, lack of allocation concealment, attention control and long-term follow up) impacted the validity of findings. Due to the small number of studies and poor study quality, the effectiveness of ACT for BID and weight self-stigma remains unclear. Nonetheless findings suggest psychological flexibility may facilitate reduction in BID and weight self-stigma and indicate that brief online as well as lengthy face-to-face delivery may be useful. Suggestions for further research are made.

Assessing the effectiveness of interventions to support patient decision making about breast reconstruction: A systematic review.

BACKGROUND: Decision making about breast reconstruction (BR) following a diagnosis of breast cancer, Ductal Carcinoma in Situ (DCIS), or to reduce future breast cancer risk, is difficult and complex. This paper systematically reviews interventions aiming to support patients facing the option of BR, and assesses their effectiveness in improving a range of patient outcomes. METHODS: Ten databases were searched for articles published up to October 2017 that evaluated interventions to support patient decision making about BR within controlled trials. All included studies were assessed for methodological quality. Descriptive analyses of patient outcomes within included studies were performed. RESULTS: The search yielded 3291 articles. Eight studies met the inclusion criteria resulting in the evaluation of seven distinct interventions (n = 1212). Six studies were assessed to be of weak methodological quality, with one of moderate and one of strong quality. Three out of five interventions demonstrated a reduction in decisional conflict (ds = 0.26-0.69) and two out of three interventions resulted in reductions in decisional regret (ds = 0.27-3.69) at various time points. Treatment choice was altered in two of five studies. There were no changes in patient-reported anxiety levels, whilst the impact on depression was mixed. In all studies which reported on it, improvements in patient satisfaction and involvement in decision making were found. CONCLUSIONS: Few interventions are currently available. Whilst some findings are encouraging, improvements on patient outcomes are mixed. Further research should focus on the development and evaluation of effective interventions.

A study protocol of the effectiveness of PEGASUS: a multi-centred study comparing an intervention to promote shared decision making about breast reconstruction with treatment as usual.

BACKGROUND: Increasingly, women elect breast reconstruction after mastectomy. However, their expectations of surgery are often not met, and dissatisfaction with outcome and ongoing psychosocial concerns and distress are common. We developed a patient-centered intervention, PEGASUS:(Patients' Expectations and Goals: Assisting Shared Understanding of Surgery) which supports shared decision making by helping women clarify their own, individual goals about reconstruction so that they can discuss these with their surgeon. Our acceptability/feasibility work has shown it is well received by patients and health professionals alike. We now need to establish whether PEGASUS improves patients' experiences of breast reconstruction decision making and outcomes. The purpose of this study is, therefore, to examine the effectiveness of PEGASUS, an intervention designed to support shared decision making about breast reconstruction. METHODS: A multi-centered sequential study will compare the impact of PEGASUS with usual care, in terms of patient reported outcomes (self-reported satisfaction with the outcome of surgery, involvement in decision making and in the consultation) and health economics. Initially we will collect data from our comparison (usual care) group (90 women) who will complete standardized measures (Breast-Q, EQ5D -5 L and ICECAP- A) at the time of decision making, 3, 6 and 12 months after surgery. Health professionals will then be trained to use PEGASUS, which will be delivered to the intervention group (another 90 women completing the same measures at the time of decision making, and 3, 6 and 12 months after surgery). Health professionals and a purposefully selected sample of participants will be interviewed about whether their expectations of reconstruction were met, and their experiences of PEGASUS (if appropriate). DISCUSSION: PEGASUS may have the potential to provide health professionals with an easily accessible tool aiming to support shared decision making and improve patients' satisfaction with breast reconstruction. Results of this study will be available at the end of 2019. TRIAL REGISTRATION: ISRCTN 18000391 (DOI 10.1186/ISRCTN18000391) 27/01/2016.

Consumer opinion on social policy approaches to promoting positive body image: Airbrushed media images and disclaimer labels.

Disclaimer labels on airbrushed media images have generated political attention and advocacy as a social policy approach to promoting positive body image. Experimental research suggests that labelling is ineffective and consumers' viewpoints have been overlooked. A mixed-method study explored British consumers' ( N = 1555, aged 11-78 years) opinions on body image and social policy approaches. Thematic analysis indicated scepticism about the effectiveness of labelling images. Quantitatively, adults, although not adolescents, reported that labelling was unlikely to improve body image. Appearance diversity in media and reorienting social norms from appearance to function and health were perceived as effective strategies. Social policy and research implications are discussed.

Facilitating shared decision-making with breast augmentation patients: Acceptability of the PEGASUS intervention.

BACKGROUND: PEGASUS is an intervention to facilitate shared decision-making by helping prospective patients consider their expectations of surgery, so that surgeons have a clear understanding of their individual goals. To date, shared decision-making interventions within aesthetic surgery are lacking. The present mixed methods study therefore explored the acceptability of implementing PEGASUS into routine private practice with breast augmentation patients and aesthetic providers. METHOD: Seventeen women presenting for breast augmentation surgery from three practices received the PEGASUS intervention pre-operatively and completed a process evaluation post-operatively. Semi-structured interviews exploring 3 aesthetic providers' experiences of using PEGASUS were subjected to a thematic analysis, whilst a content analysis was conducted on the 77 goals identified by patients. RESULTS: The majority of patients reported that the PEGASUS intervention was relevant, helpful and useful, and they felt comfortable during it. Qualitatively, patients and aesthetic providers found that PEGASUS enabled them to reflect on and discuss about their expectations from surgery. Aesthetic providers discussed some of the issues and barriers associated with implementing PEGASUS in routine private practice, factors that must be considered prior to further evaluation. CONCLUSION: This study provides preliminary support for the acceptability of PEGASUS to breast augmentation patients and to aesthetic providers working in the private sector.

Body Image in Primary Schools: A pilot evaluation of a primary school intervention program designed by teachers to improve children's body satisfaction.

Body Image in the Primary School (Hutchinson & Calland, 2011) is a body image curriculum that is widely available but has not yet been evaluated. This study evaluates a set of 6 of the 49 available lessons from this curriculum. Seventy-four girls and 70 boys aged 9-10 were recruited from four primary schools in the UK. Schools were randomly allocated into the intervention condition, where students received 6hours of body image lessons, or to lessons as normal. Body esteem was significantly higher among girls in the intervention group, compared to the control group, immediately post intervention, and at 3-month follow-up. Moreover, girls with lowest levels of body esteem at baseline reported the largest gains. Internalization was significantly lower among boys in the control group compared to the intervention group at 3-month follow-up. The pattern of results among the control group raises interesting issues for intervention evaluation.

Psychosocial predictors, assessment, and outcomes of cosmetic procedures: a systematic rapid evidence assessment.

BACKGROUND: Recent breast implant complications led to a UK government policy review of the evidence concerning cosmetic interventions. We synthesised cosmetic intervention research evidence covering psychosocial factors associated with requesting procedures and psychological outcomes, effects of procedures on psychological outcomes, preintervention assessments for identifying those at risk, alternative therapy effectiveness, and issues in achieving informed consent. METHODS: Undertaking a systematic rapid evidence assessment, six databases and three journals were searched. Included studies were systematic reviews or primary studies of participants requesting cosmetic procedures; published 2002-2012; containing either psychological or psychosocial measures, a psychological outcome, or evaluation of informed consent. Reviewers independently assessed study eligibility, extracted data, and assessed quality, undertaking narrative synthesis. RESULTS: Methodological quality of the included 13 systematic reviews and 179 primary studies was low, with wide variation in psychosocial measures. Findings suggest several psychosocial factors (e.g., intimate partner violence) may be associated with requesting cosmetic surgery. Multiple factors (e.g., unrealistic expectations) may predict poor psychological outcomes. Current psychological screening tools focus predominantly on body dysmorphic disorder (BDD) symptoms. Psychological and pharmacological interventions are effective alternative BDD treatments. Patients and doctors bring different needs to informed consent discussions, inconsistently matched to those required by professional ethics, litigation risk, and facilitating profit. CONCLUSIONS: Systematically reviewing this literature for UK policy has highlighted that some groups may be at risk of poor post-cosmetic procedure outcomes. Practitioners and patients must explore reasons for seeking cosmetic procedures and discuss all potential results and alternative solutions. Future research should employ more robust methodologies to identify effects in those at risk, led by consensus on a core set of psychological outcomes.