Trial Review

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Trial registered on ANZCTR


Registration number
ACTRN12618001408279
Ethics application status
Approved
Date submitted
17/08/2018
Date registered
22/08/2018
Date last updated
22/08/2018
Type of registration
Prospectively registered

Titles & IDs
Public title
Reel2Real: Evaluation of an online social media literacy program to decrease body dissatisfaction in young adults
Scientific title
Enhancing social media literacy with a web app to decrease body dissatisfaction in young adults : A randomised controlled trial of the Reel2Real intervention.
Secondary ID [1] 295780 0
None
Universal Trial Number (UTN)
Trial acronym
R2R
Linked study record

Health condition
Health condition(s) or problem(s) studied:
Body dissatisfaction 309198 0
Disordered eating 309199 0
Depressed mood 309200 0
Condition category
Condition code
Mental Health 308069 308069 0 0
Eating disorders

Intervention/exposure
Study type
Interventional
Description of intervention(s) / exposure
The Reel2Real intervention is a web-based application, consisting of three modules, targeted at young adults with elevated body dissatisfaction, and designed to increase critical thinking about social media, including from commercial, celebrity, and peer sources. Participants complete the activities individually through the web-based application (ideally on laptop, PC or tablet rather than mobile) at their own leisure, in a place of their choosing, with 48 hours between the completion of a module and the next module becoming available. Participants will be encouraged to complete one module per week with email or other reminders from the research team.

The program addresses: 1) relevant domains of media literacy, not just the unrealistic nature of media images, as is common to most programs; 2) multiple forms and sources of pressure present on social media including imagery and text, and peers and celebrities; 3) aspects related to both viewing and contributing to social media; and 4) the use of social media as a tool to escape or change the appearance-focused culture. Modules and topics are outlined below.

The intervention is based on theories of media literacy as they apply to body dissatisfaction. Experimental research based on these theories have found support for increasing media literacy reducing body dissatisfaction and eating disorder symptoms. Proposed relationships of each social media literacy component to media literacy are outlined in the Table below.


Reel2Real: Modules and topics

Module 1: Social media is a “highlight reel”, not “real” life
Approximate time to complete: 20 minutes.

Module 1 has three primary messages, with several activities, aimed at improving identified components of social media literacy. Each is described below, with the specific component/s of media literacy addressed listed in brackets and italicised.

Message/Concept 1: Social media images are manipulated. (Realism scepticism, Techniques)
Social media images are manipulated, and that this manipulation is believable. Thus, it is common for people to mistake such images for reality.

Activities: Spotting the difference between posed and edited images, quiz about editing/image manipulation, video about editing apps, spotting whether an image has been edited or not, reflection quiz on the effects of image manipulation/editing on self and body image.

Message/concept 2: Selectivity (Similarity scepticism, Omission, Filter)
People select the most interesting, exciting, attractive or unique aspects of their lives to post about; and most people do not post pictures from their “everyday”/regular lives.

Activities: Video about life on social media vs. real life, categorising images into the type seen on social media vs not seen on social media (i.e. selected/interesting photos versus everyday life), identifying the “social media” image from three images of the same person, reflection on own selectivity habits on social media, completing a storyboard with an “everyday life” image versus a social media (selective) image.

Message/Concept 3: Social media portrays appearance ideals (Attention, internalisation)
Social media portrays appearance ideals that are not accurate depictions of reality; and that these are present in most forms of social media. These appearance ideals are often the result of image manipulation and selection.

Activities: Videos about appearance ideals across cultures and time periods, identifying who portrays appearance ideals and on which social media platforms, identifying time and effort involved in posting selfies.

Overall: By the end of Module 1, participants will have a better understanding of the way images on social media are unrealistic, and that trying to live up to appearance ideals can be effortful and have a negative impact on body image and self-esteem. Participants complete an activity at the end of the module, which involves challenging themselves to be aware of selectivity or manipulation of images, and change their own posting behaviour to counteract the selectivity and manipulation of social media images.

Module 2: Intent and impact of social media
Approximate time to complete: 25 minutes.

Module 2 has two primary messages aimed at improving identified components of social media literacy. As with Module 1, each is described below.

Message/concept 1: Intent of people posting (Target, Influence, Profit)
Social media posts always have an intent behind them (e.g., to portray self as attractive, creative, funny, intelligent). This intent is often a deliberate effort. In particular, the focus on influence, or an intent to make money, is addressed.

Activities: Video about social media influencers, identifying intent behind social media images, choosing an image to post/not post within a specific context (e.g., post in a private snapchat to a friend versus post where an employer might see it), quiz about influencers on social media, identifying sponsored social media images.

Message/concept 2: Social comparison (Similarity scepticism, Attention, Appearance comparisons)
Social media is an environment that encourages social comparison (i.e., comparing one’s appearance, lifestyle, etc with others). This type of comparison can result in negative feelings, but can be reduced through being mindful about the way others post, and reducing time using social media that encourages social comparison.

Activities: Video about negative impact of social comparison, quiz about time spent engaging in social comparison that displays results as a pie chart (i.e., attempting to show how much time on social media is unhelpful/negative for the person), identifying situations likely to result in fear of missing out (FOMO), quiz about strategies to reduce social comparison.

Overall: By the end of Module 2, participants should have an understanding of the way social media impacts their mood, and the intention (especially to influence and/or purchase) behind social media posts. Participants will also start to understand strategies that they can use to reduce social comparison, and to identify when the author of a post is trying to influence them. Participants will be asked to challenge themselves to use one strategy to reduce their exposure to social media that causes them to engage in social comparison.

Module 3: Contributing to a positive social media environment
Approximate time to complete: 20 minutes.
Module 3 has three primary concepts that are described below, along with activities.

Message/concept 1: Agency in shaping social media environment (Values, Scepticism about expectancies)
By default, a social media environment is often focused on appearance ideals and encourages social comparison; however, participants can view and interact with social media in a more positive way.

Activities: Reflective quiz on how much time is spent enjoying social media versus using it to appear more attractive or interesting to peers (responses populate graphs to display how much time is spent on social media for personal enjoyment), identifying social media accounts that improve or worsen mood and reflecting about how they can better interact with content that makes them feel good.

Message/concept 2: Beyond appearance: how to shape a social media environment that is not appearance focused, and is consistent with personal values. (Values, Attention)

Activities: Identifying personal values (e.g., kindness, bravery, humour) and reflecting on ways to portray these on social media, reflection on how to navigate content that can be problematic for mental health (e.g. if participants follow content about fitness, to be aware of accounts that promote appearance ideals and identify fitness accounts that focus on movement and enjoyment of fitness), summary reflection quiz on using social media and identifying strategies and skills to navigate social media environment in a more positive way.

Overall: By the end of Module 3, participants should have increased social media literacy overall. Participants will also be asked to challenge themselves to try a social media literacy strategy that they selected as “unlikely to do” in a reflective quiz (e.g., post about what they want to post, regardless of how many likes or comments they feel it will get).


Proposed media literacy components. (from McLean, Paxton, & Wertheim, 2016)

Media messages and images are unrealistic and inaccurate (MIP) Realism scepticism
Similarity of media messages and images to one's experiences (MIP) Similarity scepticism
Desirability of media portrayals (MIP) Desirability scepticism
Expectancies of positive outcomes (MIP) Scepticism about Expectancies
Authors create media messages for profit and or influence-a (MLF) Profit
Authors target specific audiences-a (MLF) Target
Messages contain values and specific points of view-b (MLF) Values
Different people interpret messages differently-b (MLF) Interpretation
Messages affect (influence) attitudes and behavioursb (MLF) Influence
Multiple production techniques are used-b(MLF) Techniques
Messages filter reality-c (MLF) Filter
Messages omit information-c (MLF) Omission

MIP = message interpretation process model (Austin & Meili, 1994).
MLF = Media Literacy Framework (Primack et al., 2006, Primack and Hobbs, 2009).

a Authors and audiences domain.
b Messages and meaning domain.
c Representation and reality domain.
Intervention code [1] 312110 0
Treatment: Other
Intervention code [2] 312111 0
Prevention
Comparator / control treatment
A wait-list control group will be used as a comparator for this randomised controlled trial. This choice of comparator is appropriate as there is no current standard web-based intervention for body dissatisfaction for young men and women within the social media context against which to compare the Reel2Real intervention.
Control group
Active

Outcomes
Primary outcome [1] 307058 0
Body dissatisfaction - mean scores on the weight and shape concerns subscale of the Eating Disorder Examination-Questionnaire and on the Drive for Muscularity scale.
Timepoint [1] 307058 0
Four weeks post-intervention commencement; three months post-intervention cessation.
Secondary outcome [1] 350510 0
Disordered eating - mean scores on the restraint subscale of the Eating Disorder Examination-Questionnaire and the Muscle Dysmorphia Inventory - Diet and Supplement subscales.
Timepoint [1] 350510 0
Four weeks post-intervention commencement; three months post-intervention cessation.
Secondary outcome [2] 350511 0
Depressed mood - mean scores on the Centre for Epidemiological Studies Depression Scale.
Timepoint [2] 350511 0
Four weeks post-intervention commencement; three months post-intervention cessation.

Eligibility
Key inclusion criteria
Age 18-25;
• Moderate levels of body dissatisfaction
o Assessed by self-report completion of the Weight Concerns Scale (Killen et al., 1994), completed by females or participants identifying as “other” gender but most closely identifying with feminine appearance ideals or the Male Body Image Concerns Scale (Weisman et al., 2014), completed by males or participants identifying as “other” gender but most closely identifying with masculine appearance ideals
o Weight concerns scale: moderate body dissatisfaction is indicated by a score of greater than or equal to 40 (scores for each item are standardised on a scale from 0-100 and the total score is the average of the standardised item responses). .
o Male Body Image Concerns Scale: moderate body dissatisfaction is indicated by a score of greater than or equal to 40. (scores for each item are standardised on a scale from 0-100 and the total score is the average of the standardised item responses).
Minimum age
18 Years
Maximum age
25 Years
Sex
Both males and females
Can healthy volunteers participate?
No
Key exclusion criteria
Not applicable

Study design
Purpose of the study
Treatment
Allocation to intervention
Randomised controlled trial
Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Following screening, eligible participants will be asked to complete the baseline self-report assessment using Qualtrics online software.
Upon completion of the survey, web randomisation within Qualtrics will allocate participants to either the Intervention or Control groups. This will be neither be able to be modified by researchers nor be visible to participants. The outcome of the randomisation will be able to be viewed by the research team in survey responses from data downloaded from Qualtrics following assessment completion..
Thus, allocation will be completely unavailable, and thus concealed, from the research team and will only be known after participants have complete the baseline survey.
Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Simple randomisation, stratified by gender, using random allocation via online software, Qualtrics will be used as described above to generate random allocation to condition.
Masking / blinding
Open (masking not used)
Who is / are masked / blinded?



Intervention assignment
Parallel
Other design features
Phase
Not Applicable
Type of endpoint/s
Efficacy
Statistical methods / analysis
The number of participants required to achieve the study objectives was determined through power analysis.
Power analysis in GPower (Faul et al., 2007) with alpha = .05 and power = 80% to detect small effect sizes (f = .15), indicates that a minimum of 118 participants in each of the intervention and control groups will be required. This number is rounded up to 220 per group, for a total of 240 participants.

Intent-to-treat protocol with multiple imputation will account for missing data. Mixed between-within repeated measures analyses of variance will be conducted in which interaction effects (i.e., time by group effects) will be of primary interest to determine intervention efficacy. Dependent variables will be primary (body dissatisfaction) and secondary (disordered eating, depressive symptoms) outcomes. To examine effects of intervention engagement on primary and secondary outcomes, multiple regression will be used in which outcome variables will be regressed on duration of engagement and proportion of activities completed, controlling for baseline levels of outcome variables.
Analysis of mediation of change in outcomes at post-intervention and 3-month follow-up by change in mediators (social media literacy, internalisation of appearance ideals, and appearance comparison) from pre- to post-intervention will be conducted with mediation analyses using the PROCESS macro (Hayes, 2013).

Recruitment
Recruitment status
Not yet recruiting
Date of first participant enrolment
Anticipated
30/08/2018
Actual
Date of last participant enrolment
Anticipated
28/06/2019
Actual
Date of last data collection
Anticipated
31/10/2019
Actual
Sample size
Target
240
Accrual to date
Final
Recruitment in Australia
Recruitment state(s)
ACT,NSW,NT,QLD,SA,TAS,WA,VIC

Funding & Sponsors
Funding source category [1] 300370 0
Charities/Societies/Foundations
Name [1] 300370 0
Australian Rotary Health
Country [1] 300370 0
Australia
Primary sponsor type
Individual
Name
Dr Siân McLean
Address
Victoria University,
Footscray Park Campus
Ballarat Road,
Footscray, VIC, 8001
Country
Australia
Secondary sponsor category [1] 299820 0
None
Name [1] 299820 0
NA
Address [1] 299820 0
NA
Country [1] 299820 0
Other collaborator category [1] 280302 0
Individual
Name [1] 280302 0
Associate Professor Rachel Rodgers
Address [1] 280302 0
Department of Applied and Educational Psychology
Northeastern University, 360 Huntington Ave., Boston,
Massachusetts 02115, USA
Country [1] 280302 0
United States of America
Other collaborator category [2] 280303 0
Individual
Name [2] 280303 0
Professor Susan Paxton
Address [2] 280303 0
School of Psychology and Public Health,
La Trobe University,
Melbourne, Vic 3086
Country [2] 280303 0
Australia

Ethics approval
Ethics application status
Approved
Ethics committee name [1] 301182 0
Victoria University Human Research Ethics Committee
Ethics committee address [1] 301182 0
Ethics committee country [1] 301182 0
Australia
Date submitted for ethics approval [1] 301182 0
23/11/2017
Approval date [1] 301182 0
28/02/2018
Ethics approval number [1] 301182 0
HRE17-230

Summary
Brief summary
Trial website
Trial related presentations / publications
Public notes

Contacts
Principal investigator
Name 86130 0
Dr Siân McLean
Address 86130 0
Institute for Health and Sport
Victoria University
Ballarat Road
Footscray, VIC 8001
Country 86130 0
Australia
Phone 86130 0
+61399195867
Fax 86130 0
Email 86130 0
[email protected]
Contact person for public queries
Name 86131 0
Joanna Doley
Address 86131 0
Institute for Health and Sport
Victoria University
Ballarat Road
Footscray, VIC 8001
Country 86131 0
Australia
Phone 86131 0
+61399195516
Fax 86131 0
Email 86131 0
[email protected]
Contact person for scientific queries
Name 86132 0
Siân McLean
Address 86132 0
Institute for Health and Sport
Victoria University
Ballarat Road
Footscray, VIC 8001
Country 86132 0
Australia
Phone 86132 0
+61399195867
Fax 86132 0
Email 86132 0
[email protected]

No information has been provided regarding IPD availability


What supporting documents are/will be available?

No Supporting Document Provided



Results publications and other study-related documents

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