PMID- 37335604 OWN - NLM STAT- MEDLINE DCOM- 20230621 LR - 20230714 IS - 2291-5222 (Electronic) IS - 2291-5222 (Linking) VI - 11 DP - 2023 Jun 19 TI - Using Chatbot Technology to Improve Brazilian Adolescents' Body Image and Mental Health at Scale: Randomized Controlled Trial. PG - e39934 LID - 10.2196/39934 [doi] LID - e39934 AB - 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. CI - (c)Emily L Matheson, Harriet G Smith, Ana C S Amaral, Juliana F F Meireles, Mireille C Almeida, Jake Linardon, Matthew Fuller-Tyszkiewicz, Phillippa C Diedrichs. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org), 19.06.2023. FAU - Matheson, Emily L AU - Matheson EL AUID- ORCID: 0000-0001-9692-0597 AD - Centre for Appearance Research, University of the West of England, Bristol, United Kingdom. FAU - Smith, Harriet G AU - Smith HG AUID- ORCID: 0000-0001-8801-798X AD - Centre for Appearance Research, University of the West of England, Bristol, United Kingdom. FAU - Amaral, Ana C S AU - Amaral ACS AUID- ORCID: 0000-0003-2485-9111 AD - Federal Institute of Education, Science and Technology of Southeast of Minas Gerais, Barbacena, Brazil. FAU - Meireles, Juliana F F AU - Meireles JFF AUID- ORCID: 0000-0001-8396-6449 AD - Department of Family and Community Medicine, School of Community Medicine, University of Oklahoma Health Science Center, Tulsa, OK, United States. FAU - Almeida, Mireille C AU - Almeida MC AUID- ORCID: 0000-0003-1290-0826 AD - Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Brazil. FAU - Linardon, Jake AU - Linardon J AUID- ORCID: 0000-0003-4475-7139 AD - School of Psychology, Deakin University, Geelong, Victoria, Australia. FAU - Fuller-Tyszkiewicz, Matthew AU - Fuller-Tyszkiewicz M AUID- ORCID: 0000-0003-1145-6057 AD - Center for Social and Early Emotional Development, Deakin University, Burwood, Victoria, Australia. FAU - Diedrichs, Phillippa C AU - Diedrichs PC AUID- ORCID: 0000-0001-5028-4134 AD - Centre for Appearance Research, University of the West of England, Bristol, United Kingdom. LA - eng SI - ClinicalTrials.gov/NCT04825184 PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't DEP - 20230619 PL - Canada TA - JMIR Mhealth Uhealth JT - JMIR mHealth and uHealth JID - 101624439 SB - IM MH - Female MH - Humans MH - Adolescent MH - Male MH - *Mental Health MH - *Body Image MH - Brazil MH - Delivery of Health Care/methods MH - Self Efficacy PMC - PMC10337468 OTO - NOTNLM OT - Brazil OT - adolescent OT - body image OT - chatbot OT - microintervention OT - mobile phone OT - randomized controlled trial COIS- Conflicts of Interest: JL was supported by the National Health and Medical Research Council Investigator Grant (APP1196948). PCD is an independent consultant to the mental health policy and programing team on Instagram (owned by Meta, the parent company of Facebook Messenger) and Dove (Unilever). All other authors declare no other conflicts of interest. EDAT- 2023/06/19 13:08 MHDA- 2023/06/21 06:42 PMCR- 2023/06/19 CRDT- 2023/06/19 11:54 PHST- 2022/06/02 00:00 [received] PHST- 2023/04/10 00:00 [accepted] PHST- 2022/12/21 00:00 [revised] PHST- 2023/06/21 06:42 [medline] PHST- 2023/06/19 13:08 [pubmed] PHST- 2023/06/19 11:54 [entrez] PHST- 2023/06/19 00:00 [pmc-release] AID - v11i1e39934 [pii] AID - 10.2196/39934 [doi] PST - epublish SO - JMIR Mhealth Uhealth. 2023 Jun 19;11:e39934. doi: 10.2196/39934.