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Cited by 89Eating Disorders and BehaviorsBody Image and Dysmorphia StudiesImpact of Technology on Adolescents

Outcomes of a Cluster Randomized Controlled Trial of the SoMe Social Media Literacy Program for Improving Body Image-Related Outcomes in Adolescent Boys and Girls

Open access
Gordon, Chloe S., Jarman, Hannah K., Rodgers, Rachel F., McLean, Siân A., Slater, Amy, Fuller-Tyszkiewicz, Matthew, Paxton, Susan J.·2021·Nutrients
DOI 10.3390/nu13113825PMC PMC8674763
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Abstract

Although the negative effect of social media use among youth on body image and eating concerns has been established, few classroom-based resources that can decrease these effects through targeting social media literacy skills have been developed. This study aimed to test the efficacy of SoMe, a social media literacy body image, dieting, and wellbeing program for adolescents, through a cluster randomized controlled trial. Participants (n = 892; Mage = 12.77, SD = 0.74; range 11–15; 49.5% male) were randomized by school (n = 8) to receive either weekly SoMe (n = 483) or control sessions (lessons as usual; n = 409) over 4 weeks in their classroom. Participants completed surveys at four timepoints (baseline, 1-week post-intervention, and 6- and 12-month follow-up) assessing body dissatisfaction, dietary restraint, strategies to increase muscles (primary outcomes), self-esteem and depressive symptoms (secondary outcomes), and internalization of appearance ideals and appearance comparison (exploratory outcomes). Modest positive intervention effects were found in dietary restraint and depressive symptoms at 6-month follow-up in girls but few positive effects emerged for boys. The findings provide only preliminary support for a social media literacy intervention, but suggest the usefulness of both identifying those who benefit most from a universally delivered intervention and the need to refine the intervention to maximize intervention effects.

AI snapshot

Written from the paper’s full text.

TL;DR

This cluster RCT tested the SoMe social media literacy program in 892 Australian adolescents and found only modest, mixed intervention effects. Girls showed small benefits for dietary restraint and depressive symptoms at 6-month follow-up, while boys showed few positive effects and some unexpected weaker declines in dietary restraint and drive for muscularity.

Key findings

  • In the full sample, the only group-by-time difference was for drive for increased muscularity: the overall decline from baseline to 12 months was weaker in the intervention group than control (d = 0.19); a similar pattern appeared among completers (d = 0.27).
  • Among girls, the control group slightly increased dietary restraint from baseline to 6-month follow-up while the intervention group reduced symptoms (d = 0.24); increases in depressive symptoms were also weaker in the intervention group (d = 0.22).
  • Among boys, dietary restraint declined from baseline to 12 months in both groups but less so in the intervention group (d = 0.23); the intervention group increased drive for muscularity while controls declined (d = 0.29), and the intervention group increased self-esteem while controls declined at 6 months (d = 0.29).
  • No significant intervention effects were found for body dissatisfaction, self-esteem, depressive symptoms, internalization, or appearance comparison in the full sample.

Methods

  • Two-arm cluster RCT in eight schools in Victoria, Australia; Grade 7 and 8 students (n = 892; Mage = 12.77, SD = 0.74; range 11–15; 49.5% male) were randomized by school/grade to SoMe (n = 483) or control lessons as usual (n = 409), with surveys at baseline, 1-week post-intervention, and 6- and 12-month follow-up.
  • SoMe consisted of four 50-min classroom lessons over 4 weeks targeting social media literacy, body image, dieting, and wellbeing, delivered by trained facilitators.
  • Main analyses used intention-to-treat linear mixed models in Stata 16, with multiple imputation (50 imputations) for missing data; effect sizes were standardized mean differences.

Limitations

  • The paper states sample attrition was high at approximately 30% at 12-month follow-up, though full-sample and completer analyses showed the same pattern, and future research would benefit from follow-up beyond 1 year.
  • The paper reports only modest effects overall, with few positive effects among boys and some unexpected findings, suggesting the intervention may need refinement, larger dose, booster sessions, or different delivery.
  • Evident from the text: the intervention was brief and universal, and the authors note possible low participant engagement/motivation, difficulty applying critical thinking skills at ages 12–13, and possible limitations of external facilitator delivery.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.3390/nu13113825

Cites

79 of 79 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 33 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    For the total sample, the intervention was not associated with improvements in self-esteem relative to the control group.

    “Contrary to our hypotheses, for the total sample, the intervention was not associated with improvements in body dissatisfaction, dietary restraint, self-esteem, depressive symptoms, internalization, or comparisons relative to the control group.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The missing data mechanism is missing at random.
    • Rests on an assumption: The control condition (lessons as usual) did not include content that would improve the same outcomes as the SoMe intervention.
    • Rests on an assumption: The intervention was delivered with sufficient fidelity to produce the intended effects.
  • Findingown data

    In the full sample, drive for muscularity declined from baseline to 12-month follow-up overall (b = −1.31, p < 0.001).

    “Although there was a decline in drive for muscularity from baseline to 12-month follow-up for the sample overall (b = −1.31, p < 0.001)”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The missing data mechanism is missing at random.
    • Rests on an assumption: The control condition (lessons as usual) did not include content that would improve the same outcomes as the SoMe intervention.
    • Rests on an assumption: The intervention was delivered with sufficient fidelity to produce the intended effects.
  • Findingown data

    For the total sample, the intervention was not associated with improvements in depressive symptoms relative to the control group.

    “Contrary to our hypotheses, for the total sample, the intervention was not associated with improvements in body dissatisfaction, dietary restraint, self-esteem, depressive symptoms, internalization, or comparisons relative to the control group.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The missing data mechanism is missing at random.
    • Rests on an assumption: The control condition (lessons as usual) did not include content that would improve the same outcomes as the SoMe intervention.
    • Rests on an assumption: The intervention was delivered with sufficient fidelity to produce the intended effects.
  • Findingown data

    In the full sample, the decline in drive for muscularity from baseline to 12-month follow-up was weaker for individuals in the intervention arm than in the control arm.

    “unexpectedly, this decline was weaker for individuals in the intervention arm of the study.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The missing data mechanism is missing at random.
    • Rests on an assumption: The control condition (lessons as usual) did not include content that would improve the same outcomes as the SoMe intervention.
    • Rests on an assumption: The intervention was delivered with sufficient fidelity to produce the intended effects.
  • Findingown data

    Among girls, increases in depressive symptoms from baseline to the 6-month follow-up were weaker for girls in the intervention arm than in the control arm (d = 0.22).

    “Second, increases in depressive symptoms experienced for the sample overall from baseline to the 6-month follow-up were weaker for girls in the intervention arm than the control arm (d = 0.22).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The missing data mechanism is missing at random.
    • Rests on an assumption: The control condition (lessons as usual) did not include content that would improve the same outcomes as the SoMe intervention.
    • Rests on an assumption: The intervention was delivered with sufficient fidelity to produce the intended effects.
  • May combine two claims. 16
  • Classified as probably not a substantial claim. 13

  • May combine two claims.

    Findingown data

    Among girls, the control group slightly increased in dietary restraint from baseline to the 6-month follow-up, whereas the intervention group exhibited reduced symptoms (d = 0.24).

    “First, whereas the control group slightly increased in dietary restraint from baseline to the 6-month follow-up, the intervention group exhibited reduced symptoms (d = 0.24).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The missing data mechanism is missing at random.
    • Rests on an assumption: The control condition (lessons as usual) did not include content that would improve the same outcomes as the SoMe intervention.
    • Rests on an assumption: The intervention was delivered with sufficient fidelity to produce the intended effects.

  • May combine two claims.

    Findingown data

    Among boys, the intervention group exhibited an increase in drive for muscularity from baseline to the 12-month follow-up, while the control group showed a decline (d = 0.29).

    “Second, contrary to expectations, the intervention group exhibited an increase in drive for muscularity from baseline to the 12-month follow-up, while the control group showed a decline in this behavior (d = 0.29).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The missing data mechanism is missing at random.
    • Rests on an assumption: The control condition (lessons as usual) did not include content that would improve the same outcomes as the SoMe intervention.
    • Rests on an assumption: The intervention was delivered with sufficient fidelity to produce the intended effects.

  • May combine two claims.

    Findingown data

    Among boys, dietary restraint behaviors reduced from baseline to the 12-month follow-up for both groups, but this effect was weaker for the intervention arm (d = 0.23).

    “First, whereas dietary restraint behaviors reduced from baseline to the 12-month follow-up for both groups, unexpectedly, this effect was weaker for the intervention arm (d = 0.23).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The missing data mechanism is missing at random.
    • Rests on an assumption: The control condition (lessons as usual) did not include content that would improve the same outcomes as the SoMe intervention.
    • Rests on an assumption: The intervention was delivered with sufficient fidelity to produce the intended effects.

  • May combine two claims.

    Findingown data

    Among boys, the intervention group showed an increase in self-esteem from baseline to the 6-month follow-up, whereas self-esteem scores declined for the control group (d = 0.29).

    “Third, as predicted, the intervention group showed an increase in self-esteem from baseline to the 6-month follow-up, whereas self-esteem scores declined for the control group (d = 0.29).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The missing data mechanism is missing at random.
    • Rests on an assumption: The control condition (lessons as usual) did not include content that would improve the same outcomes as the SoMe intervention.
    • Rests on an assumption: The intervention was delivered with sufficient fidelity to produce the intended effects.

  • May combine two claims.

    Findingown data

    Among girls, participants in the intervention group reported a reduction in dietary restraint at 6-month follow-up, whereas the control condition indicated increased dietary restraint.

    “When the intervention effects were examined among girls, participants in the intervention group reported a reduction in dietary restraint at 6-month follow-up, whereas the control condition indicated increased dietary restraint.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    For boys, the sample reported overall reductions in dietary restraint from baseline to 12-month follow-up, but declines were weaker in the intervention group relative to control.

    “First, although the sample reported overall reductions in dietary restraint from baseline to 12-month follow-up, declines were weaker in the intervention group relative to control.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Both intervention effects among girls were evident only from baseline to 6-month follow-up and were not maintained at 12-month follow-up.

    “However, both intervention effects were only evident from baseline to 6-month follow-up indicating that effects were not maintained at 12-month follow-up.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    For boys, the intervention group demonstrated increased self-esteem from baseline to 6-month follow-up, while the control group declined.

    “Further, the intervention group demonstrated increased self-esteem and drive for muscularity from baseline to 6-months and 12-month follow-up, respectively, while the control group declined.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    For boys, the intervention group demonstrated increased drive for muscularity from baseline to 12-month follow-up, while the control group declined.

    “Further, the intervention group demonstrated increased self-esteem and drive for muscularity from baseline to 6-months and 12-month follow-up, respectively, while the control group declined.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Participants in the control group were less likely to report English as their primary language spoken at home than those in the intervention group at baseline.

    “Participants in the control group were significantly younger, less likely to come from public schools, and less likely to report English as their primary language spoken at home.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    No baseline differences between groups were found for BMI, gender distribution, Indigenous status, or whether participants completed all surveys.

    “No differences between groups were found for BMI, gender distribution, Indigenous status, or whether participants completed all surveys.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    The main analyses were conducted on an intention-to-treat basis, with participant data included as per initial intervention group allocation.

    “The main analyses were undertaken using Stata version 16 and conducted on an intention-to-treat basis, with participant data included as per initial intervention group allocation.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Missing data were handled using multiple imputations with 50 imputations in all models.

    “Therefore, missing data were handled using multiple imputations (MI) with 50 imputations in all models.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    The present study used a randomized controlled trial design.

    “The present study has a number of strengths, including the randomized controlled trial design, a diverse sample of adolescents from a range of school demographics (including both state and private secondary schools), and a longer follow-up period than previous social media literacy interventions.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Scale scores were marked as missing for adolescents who responded to less than 70% of items on a scale.

    “Scale scores were marked as missing for adolescents who responded to less than 70% of items on a scale.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Grade 7 and 8 cohorts within each participating school were randomly assigned to one of two conditions: intervention or control.

    “Grade 7 and 8 cohorts within each participating school were randomly assigned to one of two conditions: intervention or control.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Blocked randomization was conducted using an online program.

    “Blocked randomization was conducted using an online program.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Interventions that contain some elements of media literacy have shown promise in improving body image and reducing internalization of appearance ideals among adolescents.

    “Interventions that contain some elements of media literacy have also shown promise in improving body image and reducing internalization of appearance ideals among adolescents [49,50,51,52,53].”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [49] Lee, 2017, Feasibility and acceptability of a prevention program for eating disorders (Me, You and Us) adapted for young adolescents in Korea, Eat. Weight Disord.—Stud. Anorex. Bulim. Obes. source

      Not checked in the free run.

    • cites [50] Dunstan, 2017, An evaluation of a body image intervention in adolescent girls delivered in single-sex versus co-educational classroom settings, Eat. Behav. source

      Not checked in the free run.

    • cites [51] Sharpe, 2013, Feasibility, acceptability and efficacy of a school-based prevention programme for eating disorders: Cluster randomised controlled trial, Br. J. Psychiatry source

      Not checked in the free run.

    • cites [52] Espinoza, 2013, Prevention programme for eating disturbances in adolescents. Is their effect on body image maintained at 30 months later?, Body Image source

      Not checked in the free run.

    • cites [53] McLean, 2017, A pilot evaluation of a social media literacy intervention to reduce risk factors for eating disorders, Int. J. Eat. Disord. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Premisecitation

    In the context of a universal intervention, small effects are not unexpected.

    “Although the effects were small, this is not unexpected in the context of a universal intervention [40].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [40] Yager, 2013, What works in secondary schools? A systematic review of classroom-based body image programs, Body Image source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Social media literacy has been found to be protective against body dissatisfaction among young women but not men.

    “Social media literacy has been found to be protective against body dissatisfaction among young women but not men [54], so it is possible that interventions designed to enhance social media literacy will be less effective among boys.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [54] Tamplin, 2018, Social media literacy protects against the negative impact of exposure to appearance ideal social media images in young adult women but not men, Body Image source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The research protocol was approved by the La Trobe University Human Ethics Committee and the Victorian Department of Education and Training.

    “The research protocol was approved by the La Trobe University Human Ethics Committee (HEC17-020) and the Victorian Department of Education and Training (2017_003388).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Preliminary testing found that all random effects for school were close to zero, and in some instances failed to converge, so no adjustment for school was applied in the final analyses.

    “Preliminary testing was conducted to evaluate clustering effects of school, but all random effects for school were close to zero, and in some instances failed to converge. Accordingly, no adjustment for school was applied in the final analyses.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Prior social media literacy intervention studies were limited by their brief (or lack of) follow-up assessments, and only one included adolescent boys.

    “However, these studies were limited by their brief (or lack of) follow-up assessments, and only one [55] included adolescent boys.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [55] Bell, B.T., Taylor, C., Paddock, D., and Bates, A. (2021). Digital bodies: A controlled evaluation of a brief classroom-based intervention for reducing negative body image among adolescents in the digital age. Br. J. Educ. Psychol., e12449. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Clinical eating disorders have a higher prevalence among girls than boys.

    “Furthermore, although clinical eating disorders affect all genders, they continue to have a higher prevalence among girls [6], so the fact that SoMe was successful in reducing dieting among girls, albeit with a small effect, is therefore noteworthy.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [6] McLean, S.A., Rodgers, R.F., Slater, A., Jarman, H.K., Gordon, C.S., and Paxton, S.J. (2021). Clinically significant body dissatisfaction: Prevalence and association with depressive symptoms in adolescent boys and girls. Eur. Child Adolesc. Psychiatry, 1–12. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    This trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12617000137392).

    “This trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12617000137392; www.anzctr.org.au; accessed on 25 January 2017).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Even small effects of the intervention may have scalable benefits.

    “Given the far-reaching negative impacts of social media use among adolescents, even small effects may have scalable benefits.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Social media use among adolescents has far-reaching negative impacts.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Social media has been described as difficult to disengage from, reflecting the potency of the algorithms and functionalities that engage users.

    “Relatedly, social media has been described as difficult to disengage from, reflecting the potency of the algorithms and the functionalities that engage users [74].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [74] Montag, C., Lachmann, B., Herrlich, M., and Zweig, K. (2019). Addictive features of social media/messenger platforms and freemium games against the background of psychological and economic theories. Int. J. Environ. Res. Public Health, 16. source

      Not checked in the free run.

27 of 27

  • The paper relies on this without support.

    The missing data mechanism is missing at random.

    “Therefore, missing data were handled using multiple imputations (MI) with 50 imputations in all models.”

  • The paper relies on this without support.

    The control condition (lessons as usual) did not include content that would improve the same outcomes as the SoMe intervention.

    “Participants in the intervention condition received four lessons delivered during class time over 4 weeks while the control condition received lessons as usual.”

  • The paper relies on this without support.

    The intervention was delivered with sufficient fidelity to produce the intended effects.

    “The intervention was delivered by trained facilitators who each received two half-day training workshops run by one of the authors who developed the intervention. In addition, each facilitator observed a session of the intervention being delivered by one of the authors. Finally, facilitator manuals were used to ensure consistency in lesson delivery across classes.”

  • The paper relies on this without support.

    The sample of schools and students is representative of the broader adolescent population.

    “Eight schools in Victoria, Australia, of which five were public and three independent, participated in this research.”

  • The paper relies on this without support.

    Demand for social media body image interventions for adolescents is high.

    “Demand for social media body image interventions for adolescents is high.”

  • The paper relies on this without support.

    Social media use among adolescents has far-reaching negative impacts.

    “Given the far-reaching negative impacts of social media use among adolescents, even small effects may have scalable benefits.”
6 of 6

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Conflicting descriptions of the randomization unit

    Minor

    The abstract says participants were randomized by school, but the methods say Grade 7 and 8 cohorts were randomized within each school. These describe different units of randomization for the trial.

1 of 1

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Related

Authors
Gordon, C. S., Jarman, H. K., Rodgers, R. F., McLean, S. A., Slater, A., Fuller-Tyszkiewicz, M., & Paxton, S. J.
Affiliations
  • La Trobe University (AU)
  • Northeastern University (US)
  • University of the West of England (GB)
  • School of Psychology, Deakin University, Geelong, VIC 3220, Australia
Corresponding author
Jarman, Hannah K.
ORCID
Venue
Nutrients
Publisher
MDPI AG
Published
2021-10-27
Volume
13
Issue
11
Pages
3825
ISSN
2072-6643 (ISSN-L)
DOI
10.3390/nu13113825
PMC
PMC8674763
OpenAlex
W3210539104
Cited by
89
References
79
Citations by year
2026: 22 · 2025: 25 · 2024: 25 · 2023: 9 · 2022: 7 · 2021: 1
FWCI
7.16
Type
journal article
Language
en
Open access
Licence
Locations
  • Nutrients (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Victoria University Research Repository (Victoria University) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Figshare (submittedVersion, cc-by)
  • La Trobe University (cc-by)
Funders
Australian Research Council (DP170100709)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
  • Social Sciences › Psychology › Clinical Psychology › Body Image and Dysmorphia Studies
  • Social Sciences › Sociology and Political Science › Impact of Technology on Adolescents
Keywords
social media literacy, body image, adolescents, eating concerns, dietary restraint, body dissatisfaction, self-esteem, depressive symptoms, appearance ideals, appearance comparison, classroom intervention, sex differences
MeSH terms
Literacy, Body Dissatisfaction, Internet-Based Intervention, Adolescent, Feeding and Eating Disorders, Body Image, Child, Depression, Diet, Feeding Behavior, Female, Humans, Male, Surveys and Questionnaires, School Health Services, Self Concept, Students, Cluster Analysis, Social Media

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