10.4225/03/59116211dd376
Laura Tirlea
Laura
Tirlea
Self-esteem, body esteem and body image: Exploring effective solutions for ‘at risk’ young women
Monash University
2017
adolescents
girls
children
self-esteem
body image
self-efficacy
disordered eating
eating disorders
health promotion
community health
intervention
prevention research
dieting
Applied Psychology
Health Promotion
Mental Health
Epidemiology
Health and Community Services
2017-05-09 06:30:39
Thesis
https://bridges.monash.edu/articles/thesis/Self-esteem_body_esteem_and_body_image_Exploring_effective_solutions_for_at_risk_young_women/4929668
<p>Low self-esteem and dissatisfaction with weight and looks
is common amongst young people. Particularly for girls, low self-esteem and
poor body image have been identified to be risk factors for development of
eating disorders. This thesis sought to answer two broad aims. The first aim
was to explore if a specific group based intervention (“Girls on the Go!”
program), led by health professionals and delivered from a community setting
increased self-esteem and related self-perceptions and behaviours in ‘at risk’
school age girls compared to no intervention. The second aim was to identify if
interventions designed to improve self-esteem of girls improve their
self-esteem compared to no interventions. Five key studies comprised this
project. </p>
<p><i>Study 1</i> was a retrospective investigation of
an existing pre- program/ post-program evaluation dataset of the “Girls on the
Go!” program collected over the first 8 years of program provision at Greater Dandenong
Community Health Services. Participants were 176 girls (age range 10-17) from
15 programs (each comprising 7-11 girls).The program was successful in
improving self-esteem (<i>p</i><0.001),
self-confidence (<i>p</i><0.001) and
satisfaction with body image (<i>p</i><0.001).
This retrospective audit did not encompass comparison against a randomly
selected control group. A randomised control trial methodology allowed for such
comparison and this constituted the aim of <i>Study
2</i> and <i>Study 3</i>.</p>
<p> For <i>Study 2</i> and <i>Study 3</i> participants were girls between 10 and 17 years of age from
12 schools, either high school participants for <i>Study 2</i> or primary school participants for <i>Study 3</i>. Eligibility criteria for girls to be referred to the
“Girls on the Go!” program and also to be included in the study were: poor or
negative body image, low self-esteem, inactivity in sports and exercise, poor
diet, or being overweight or underweight. Both <i>Study 2</i> and <i>Study 3</i> were
stepped-wedge cluster randomised controlled trial of the “Girls on the Go!” program
intervention that used the waiting list for the program to generate the control
condition. Measurements were made using <i>Rosenberg Self-Esteem Scale</i>, <i>Clinical Interview Assessment</i>, <i>Self-Efficacy</i><i> Scale</i> (included:
<i>Mental Health</i> and <i>Physical Health Self-Efficacy</i> Scales), <i>Body Esteem Scale</i>, and the <i>Dutch Eating Behavio</i><i>u</i><i>r Questionnaire</i><i>
</i><i>for
Children</i>.
Outcomes were compared between groups using linear mixed models,
suitable for analyzing longitudinal data where there is likelihood of missing
data or loss to follow-up. Data was
clustered by school to account for dependency between observations from
students from the same school.
The intervention led to a significant increase
(<i>p</i> < .05) in self-esteem and
self-efficacy (mental and physical health self-efficacy subscales), for both
primary and secondary school-aged participants and reduced dieting behaviours (secondary school participants). These gains were retained after 6 months
of follow-up.</p>
<p>The aim of <i>Study 4</i> was to explore
whether the effect of “Girls on the Go!” intervention was consistent
across
high school and primary school participant girls from <i>Study 2 </i>and <i>Study 3.</i> A
participant-level meta-analysis was conducted. Participant level meta-analysis allowed
for a more powerful and reliable examination of treatment effects across high
school and primary school participants from the two studies. Pooled data
analysis findings indicate that exposure to the intervention had a positive and
equal impact on participants’ self-esteem and self-efficacy including mental
health self-efficacy and physical health self-efficacy. Interaction
effects revealed self-esteem, physical health self-efficacy and mental health
self-efficacy scores did not change from the time they completed the program to
the subsequent
follow up assessments, which indicated medium to long term stability of
these measures as a result of the intervention.</p>
<p>The objectives of <i>Study
5</i> were to systematically identify and synthesise evidence of effectiveness
from randomised trials of interventions aimed at improving self-esteem and
related outcomes (body satisfaction, dieting, physical activity self-efficacy)
amongst girls, and to identify characteristics of programs that are more
effective. A literature
search was conducted up to November 2015. Six papers were eligible for
inclusion. Most interventions (except Tirlea et
al., 2016) were implemented in the school environment and adopted either
a direct or indirect self-esteem component to enhance self-esteem and prevent
disordered eating. Most studies’ interventions were mainly facilitated by
trained teachers, (except Tirlea et al., 2016)
targeted at universal audiences of mixed genders and ranging in age between
13.06 to 15.84 years old. The pooled effect size, using the lower and upper
ICC, for self-esteem were 0.27 (95%
Confidence Intervals [CI], 0.16, 0.38), and at
short term follow up for self-esteem were 0.21 (95% CI, 0.06, 0.37) for body satisfaction were 0.22 (95% CI, 0.11,
0.34) and physical health self-efficacy was 0.29 (95% CI, 0.14, 0.44) respectively.
These results support the implementation
of interventions aimed at increasing levels of self-esteem. </p>
<p>The clinical implications of studies 1-4 are that
providing preventive health services to young women at risk of disordered
eating and other health concerns can potentially be achieved using a holistic
program such as “Girls on the Go!” that focuses on promoting self-esteem,
health and well-being. The results of study 5 (systematic review and meta-analyses) demonstrated there is support for the implementation of interventions aimed at
increasing levels of self-esteem in girls. There was a trend for
interventions that have a self-esteem component to also improve body satisfaction. </p>
<p>Little research has investigated the role of
self-esteem and self-esteem interventions effectiveness to prevent negative
consequences associated with poor self-esteem. This thesis provided a summary
of existing literature of self-esteem risk factors and self-esteem
interventions effectiveness. The present evaluation results provide evidence base for the “Girls on the Go!” program effectiveness and suggests that a
health education program that promotes positive change in how one thinks about
the self and their body may achieve the healthy lifestyle changes needed to
maintain a long and happy life free of eating disorders.</p>