School-Based Interventions Improve Body Image and Media Literacy in Youth: A Systematic Review and Meta-Analysis

The Journal of Primary Prevention https://doi.org/10.1007/s10935-021-00660-1 LITERATURE REVIEW School‑Based Interventions Improve Body Image and Media Literacy in Youth: A Systematic Review and Meta‑Analysis Martina Kurz1 · Jenny Rosendahl1 · Johanna Rodeck1 · Julia Muehleck1 · Uwe Berger1 Accepted: 11 December 2021 © The Author(s) 2021 Abstract Body ideals conveyed by the media and by body comparisons often result in body dissatisfaction, which can cause risky health behaviours and eating disorders, especially in adolescents. We conducted a meta-analytic review of existing school-based interventions designed to enhance media literacy in order to reduce body dissatisfaction and to promote a positive body image. We included controlled trials examining children and adolescents from grade five to nine (age 10–15 years) after a manual search and a comprehensive literature search using PsycINFO, Medline, Web of Science, and CENTRAL. We computed average weighted effect sizes (Hedges’ g) with the help of a random effects model and identified seventeen different programme evaluations with 7392 participants. We found a significantly larger effect on positive body image and media literacy in the intervention compared to control groups. However, heterogeneity was substantial for both outcomes. Results suggest that media literacy interventions have the potential to improve media literacy and reduce body dissatisfaction. Interventions that worked with the principle of induction of cognitive dissonance were the most effective. Keywords Media literacy · Body dissatisfaction · Prevention program · Systematic review · Meta-analysis Martina Kurz and Jenny Rosendahl have Shared First-Authorship. * Uwe Berger 1 Institute of Psychosocial Medicine and Psychotherapy, University Hospital Jena of the Friedrich-Schiller-University Jena, Stoystr. 3, 07740 Jena, Germany 13 Vol.:(0123456789) The Journal of Primary Prevention Introduction The media are omnipresent for young people, especially in the form of social media such as Instagram, TikTok, SnapChat, and Facebook. According to previous research, 12–25 year olds spend an average of 3.7 h online each day, with social media being checked at least once a day by 96% (Albert et al., 2019). In the pandemic year 2020, online media consumption among young people increased to an average of 4.3 h per day (Rathgeb & Schmid, 2020). This high consumption may result in problems with self-esteem or certain mental health risks, e.g., eating disorders, caused by the exposure itself and/or by the effects of the specific content. Thus, the content of the media can lead to negative comparisons between one’s own appearance and that of others or even discrimination, stigmatisation, and shaming (Latner et al., 2014). This may reduce self-esteem and influence body image or concerns about one’s weight (Sikorski et al., 2016). The impact of social feedback is further increased by the fact that many social media users communicate not only with text messages, but also photos and videos (Carter et al., 2017). The link between body image, weight concerns, and the development of eating disorders (EDs) has proven to be particularly problematic for young people (McKnight Investigators, 2003; Wertheim et al., 2009; Wilksch, & Wade, 2010). EDs are one of the most common mental illnesses in adolescence. Based on DSM-5 criteria (American Psychiatric Association, APA, 2013), the lifetime prevalence of clinically relevant EDs in girls and women is about 5.5%, whereas boys and men are affected by less than one percent. Although depression (5.8%) and anxiety disorders (19.5%) are more common over the lifetime, EDs develop, and are more prevalent, in adolescence and young adulthood (Wagner et al., 2017). Additionally, subthreshold EDs (which do not meet all diagnostic criteria) occur considerably more frequently, with a prevalence rate of 14% among adolescents (Nagl et al., 2016). One common characteristic of EDs is body image disorder (synonyms: body schema disorder, shape disturbance), which also occurs often in body dysmorphic disorder (Dingemans et al., 2012; DSM-5, APA, 2013). Body image disorder manifests as body dissatisfaction in the form of excessive concerns about external appearance. Body image describes a person’s perception of his or her own body in terms of attractiveness and aesthetics. Important factors influencing body image are emotions, attitudes, and comparisons with others (Cash, 2011). A negative body image is associated with low self-esteem, especially in adolescents, and is also associated with health-compromising behaviours, such as dieting, lower levels of physical activity, or binge eating (Neumark-Sztainer et al., 2006; Tiggemann, 2005). Hence, interventions to strengthen a positive body image and reduce body dissatisfaction are often found in prevention programmes for EDs (Chua et al., 2019) and explicitly recommended for anorexia nervosa (Junne et al., 2019). The onset of anorexia nervosa is as early as 12–15 years (Steinhausen & Jensen, 2015). Thus, primary preventive interventions, at the latest, should begin at this age. Although outside the scope of the present paper, programmes targeting older adolescents would need to be oriented toward secondary prevention and 13 The Journal of Primary Prevention have different (e.g., more eating disorder-specific) content than primary prevention interventions. To date, most ED-related interventions have been classroombased, in an attempt to reach all youth (Watson et al., 2016). In general, media literacy interventions aim to equip people with the skills needed to become critical consumers of media. Central to the influence of media on body image is the internalisation of the ideal of slimness; a culturally and socially promoted standard that equates beauty and attractiveness with slimness. ED prevention programs aim to challenge the slimness ideal and to reduce unhealthy appearancebased perceptions and ED symptoms (Levine & Harrison, 2009). Interventions often focus on the presentation of body images and recognition of image manipulation, for example, through software or lighting effects to make a person look slim. Such interventions also support distancing from media content that poses a threat to one’s own positive body image, such as photos of extremely thin models (Tylka, 2012). However, media literacy prevention programmes for the prevention of EDs have also featured images containing athletic or thin ideals, which can also lead to increased body dissatisfaction (Robinson et al., 2017) or to a lower assessment of one’s own attractiveness (Sherlock & Wagstaff, 2018). Previous meta-analyses reported the general potential of promoting media literacy to reduce eating disorder risk factors (Bergsma & Carney, 2008; Jeong et al., 2012; Le et al., 2017; Watson et al., 2016). The systematic review by McLean et al. (2016a) specifically addressed the role of media literacy in connection with body dissati (...truncated)