Nicole Paraskeva, Sharon Haywood, Jason Anquandah, Paul White, Mahira Budhraja, Phillippa C Diedrichs, Heidi Williamson

Abstract

Background: Body dissatisfaction is a global public health issue negatively impacting young people's mental and physical well-being, underscoring an urgent need to develop early interventions. Emerging evidence suggests that microinterventions are acceptable and effective in delivering mental health interventions. Given the popularity of video games among young people, gaming holds great promise for body image microinterventions. As such, we developed Super U Story, a stand-alone, self-paced, narrative-based adventure video game for the popular gaming platform Roblox grounded in the Tripartite Influence Model of body dissatisfaction and basic tenets of positive body image.

Objective: This trial evaluated the effectiveness of playing a purpose-built Roblox video game once on US children and adolescents' state and trait body image and related outcomes. Gameplay was capped at 30 minutes.

Methods: Overall, 1059 US-based girls and boys (n=460, 43.4% girls) aged 9 to 13 years (mean age 10.9, SD 1.36 years) from diverse ethnic, socioeconomic, and geographic backgrounds were recruited online via a research agency into a 3-arm, online, parallel randomized controlled trial. Participants were assigned to an intervention group, active control group (a Roblox game called Rainbow Friends 2 Story [Color Story]), or attention control group (web-based word search). Participants completed self-report assessments at baseline (1 week before the intervention and before randomization), immediately before and after intervention testing, and 1 week after the intervention. Outcomes included state measures of body satisfaction (primary outcome), mood, and body functionality and trait measures of body esteem, body appreciation, internalization of appearance ideals, and social media literacy. Data were evaluated using repeated-measure analysis of covariance controlling for baseline. Engagement and acceptability data were collected.

Results: Intervention participants showed improved state body satisfaction (F1,694=5.20; P=.02; ηp2=0.01) relative to the active control but not in comparison to the attention control. State mood, state body functionality, internalization of appearance ideals, and social media literacy showed no effects. Relative to the intervention group, the active control showed improved trait body esteem (F1,663=5.40; P=.02; ηp2=0.01) and body appreciation (F1,663=6.08; P=.01; ηp2=0.01). Exploratory analyses found that age and gender did not moderate the effects. We were unable to examine dose-response effects. Acceptability scores were good. Self-report engagement data suggested that participants experienced a highly variable and often low-dose exposure.

Conclusions: This large-scale, fully powered trial is the first to assess the effectiveness of a Roblox-based body image intervention, demonstrating the potential for disseminating microinterventions to children and adolescents on large and popular commercial platforms. Overall, playing Super U Story did not cause harm; however, evidence is lacking to suggest that it improved body image. Learnings are discussed, including psychoeducation as an intervention technique, "chocolate-covered broccoli" phenomena (ie, losing players who recognize thinly disguised educational messages), and measuring intervention engagement.

Trial registration: ClinicalTrials.gov NCT05669053; https://clinicaltrials.gov/study/NCT05669053.

評估Roblox電子游戲（超級U故事）在改善美國兒童和青少年身體形象方面的有效性：隨機(jī)對照試驗。

背景：身體不滿是一個全球性的公共衛(wèi)生問題，對年輕人的身心健康產(chǎn)生負(fù)面影響，因此迫切需要制定早期干預(yù)措施。新出現(xiàn)的證據(jù)表明，微干預(yù)在提供精神衛(wèi)生干預(yù)方面是可以接受和有效的。鑒于電子游戲在年輕人中的流行，游戲為身體形象微干預(yù)提供了巨大的希望。因此，我們基于身體不滿的三方影響模型和積極身體形象的基本原則，為流行的游戲平臺Roblox開發(fā)了《Super U Story》，這是一款獨(dú)立、自定節(jié)奏、基于敘述的冒險電子游戲。目的：本試驗評估玩過一次專門制作的Roblox視頻游戲?qū)γ绹鴥和颓嗌倌甑臓顟B(tài)和特征身體形象及其相關(guān)結(jié)果的有效性。游戲時間限制在30分鐘。方法：總體而言，通過一家研究機(jī)構(gòu)在線招募了1059名年齡在9至13歲（平均年齡10.9歲，標(biāo)準(zhǔn)差1.36歲）的美國女孩和男孩（n=460, 43.4%女孩），他們來自不同的種族、社會經(jīng)濟(jì)和地理背景，參與了一項3組、在線、平行隨機(jī)對照試驗。參與者被分配到干預(yù)組、積極控制組（游戲邦注：游戲名為《Rainbow Friends 2 Story》[Color Story]）或注意力控制組（基于網(wǎng)絡(luò)的單詞搜索）。參與者在基線（干預(yù)前和隨機(jī)化前1周）、干預(yù)測試前后和干預(yù)后1周完成自我報告評估。結(jié)果包括身體滿意度（主要結(jié)果）、情緒和身體功能的狀態(tài)測量，以及身體尊重、身體欣賞、外表理想內(nèi)化和社交媒體素養(yǎng)的特質(zhì)測量。數(shù)據(jù)評價采用重復(fù)測量分析的協(xié)方差控制基線。收集了敬業(yè)度和可接受性數(shù)據(jù)。結(jié)果：干預(yù)對象對國家主體滿意度提高(f1694 =5.20；P = .02點(diǎn);ηp2=0.01)，但與注意控制相比無顯著差異。國家情緒、國家身體功能、外表理想內(nèi)化和社交媒體素養(yǎng)沒有影響。與干預(yù)組相比，積極對照組的身體自尊顯著提高(f1663 =5.40；P = .02點(diǎn);ηp2=0.01)和身體欣賞(f1663 =6.08；P = . 01;ηp = 0.01)。探索性分析發(fā)現(xiàn)，年齡和性別并不能緩和這種影響。我們無法檢驗劑量-反應(yīng)效應(yīng)。可接受性得分很好。自我報告參與數(shù)據(jù)表明，參與者經(jīng)歷了高度可變且通常是低劑量的暴露。結(jié)論：這項大規(guī)模、全動力的試驗首次評估了基于roblox的身體形象干預(yù)的有效性，展示了在大型和流行的商業(yè)平臺上向兒童和青少年傳播微干預(yù)的潛力?？偟膩碚f，玩《超級U故事》并沒有造成傷害；然而，缺乏證據(jù)表明它能改善身體形象。書中討論了心理教育作為一種干預(yù)技術(shù)、“巧克力覆蓋的西蘭花”現(xiàn)象（即，失去能夠識別出幾乎不加掩飾的教育信息的玩家）以及測量干預(yù)參與度。試驗注冊：ClinicalTrials.gov NCT05669053；https://clinicaltrials.gov/study/NCT05669053。

本文章由計算機(jī)程序翻譯，如有差異，請以英文原文為準(zhǔn)。

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