Effectiveness and feasibility of peer-delivered dissonance-based eating disorder prevention in high school girls

Ph.D. University of Hawaii at Manoa 2013.Includes bibliographical references.Objective: Dissonance-based eating disorder prevention programs utilize counterattitudinal exercises to challenge beliefs about the attainability of cultural beauty ideals. Research has demonstrated that dissonance-based prevention is effective in reducing eating disorder risk factors among adolescent and college-aged women. Programs can be delivered using professional providers (e.g., clinical psychologists) as well as endogenous providers (e.g., college-aged peer leaders, high school staff members). The aim of the current research was to investigate the feasibility of using younger peer leaders (i.e., high school girls) to deliver dissonance-based eating disorder prevention. Method: High school peer leaders across two studies (N=20) received 12 hours of training to deliver a manualized program to small groups of their peers. Study 1 (N=23) was a pilot trial to assess the feasibility and acceptability of the intervention. Study 2 (N=50) utilized a quasi-experimental, waitlist-controlled design to assess reductions in five established eating disorder risk factor outcomes: thin-ideal internalization, body dissatisfaction, eating pathology, dietary restraint, and negative affect. Half of participants received the intervention immediately and half participated after a two-week waitlist control period. All participants were assessed three months post-intervention. Results: Adherence to an age-adapted intervention manual was high in both studies. Feedback from participants across studies indicated the intervention was acceptable, enjoyable, and provided new information. Analysis of outcomes in Study 2 revealed significantly greater pre-post reductions in a majority of risk factors for those who received the intervention immediately compared to waitlist controls. Within-subject changes over time revealed significant pre-post reductions in a majority of risk factors that were sustained through 3-month follow-up, except for thin-ideal internalization, which returned to baseline levels. Some discrepancies were found in measures assessing similar outcomes. Discussion: These two studies are the first to examine the feasibility of using high school peer leaders to implement an empirically-supported, dissonance-based eating disorder prevention program. Results provide tentative support for using high school peer leaders to conduct this type of intervention. Limitations of the current research are discussed, and include a small sample size, short-term waitlist comparison, and brief follow-up period. Future research is needed to replicate these findings in larger, randomized trials