1. Implications for future studies
Supporting adolescents struggling with appearance-altering conditions: the feasibility of using online psychosocial intervention ( ) in primary care.
Williamson H1, Hamlet C1, White P1, Cadogan J2, Marques E3, Perera R 4
& Harcourt D1.
1Centre for Appearance Research, University of the West of England, Bristol, UK, 2University Hospital Bristol NHS Trust, Bristol, UK, 3School of Social and Community Medicine, University of Bristol & the National Institute for Health Research (NIHR), 4Pembroke Road Surgery, Bristol Clinical Commissioning Group, Bristol, UK.
Background
Approx. 1 in 44 young people (YP) have a visible difference (disfigurement) to their face or body1 (e.g. craniofacial & skin conditions, treatment side-effects & scarring).
Irrespective of cause, severity or location2, 30-50% struggle to cope with the psychosocial consequences of looking different & experience BI dissatisfaction, low self-esteem, social anxiety & reduced aspirations3.
In collaboration with YP & health professionals, the Centre for Appearance Research has developed (YP Face IT (YPF)), an online intervention for affected YP aged experiencing distress, teasing or bullying4 . YPF uses cognitive behavioural therapy & social skills training & has 7 x mins weekly sessions & booster session 6 weeks later.
YPF has interactive activities, multimedia, online journal & automated text reminders:
Aims & Objectives
Results
Is it acceptable & feasible to conduct an RCT to evaluate YP Face IT (YPF) as an adjunct to treatment as usual (TAU) in a primary care setting?
Numbers of eligible participants recruited via GP practices.
Adherence /retention to treatment & outcome measures.
YP’s/parent experiences of study design (inc. of YPF & TAU).
Choice of, & ability to collect, health economic data.
Primary Outcome measures, Body Esteem & Social Anxiety Scales.
Secondary outcome measures: Social Skills , Self-perception, Perceived Stigmatisation questionnaires.
YP data up to 6 months reported. Awaiting 12 month (inc. health economic) data.
Recruitment
47 YP randomised: 23 YPF, 24 TAU.
Variety of conditions/injuries (e.g. craniofacial & skin conditions, facial palsy, scarring).
Compliance
52% of those allocated to YPF completed all sessions.
89% of YP completed 26 week outcome measures.
Safeguarding
No safeguarding issues from data collected on YPF website (e.g., online journal).
33% of all participants (equal across groups) reported deliberate self-injury (question in outcome measure). Clinical psychologist monitored/referred to GP.
TAU
Alternative support inadequate.
Acceptability
GPs preferred recruitment via mass mall out.
All other aspects of the study’s design acceptable –parents disappointed with TAU understood necessity.
YPF well-received.
Summary of impact of group on primary outcome measures
13 weeks:
Measures performed well & future selection assured.
Aiming for improved Body Esteem & lower Social Anxiety.
Improvements differed depending on whether YP in YPF or TAU group when factoring in baseline scores (level of adjustment) & engagement (number of sessions).
Within YPF group: Body Esteem Scale (BES) baseline (p= .032) & engagement (p=.022) positively associated with BES; ‘Fear of Negative Evaluation’ (FNE) subscale of Social Anxiety Scale baseline (p=.001) & engagement (p=.014) associated with FNE (positively & negatively respectively).
26 weeks:
Baseline BES not predictive of BES (p=.695), but engagement positively associated BES (p<.001).
Baseline FNE not predictive of FNE (p=.735), but engagement negatively associated with FNE (p=.013)
Improvements/no change in other measures not reported.
Method
Recruitment
15 GP practices: Posters, in-consultation, letters to those with appearance-altering condition using READ codes. Response poor & task challenging (e.g. READ codes inaccurate). Advisory groups recommended mass mail out from 4 practices to all 12-17yr olds, with success.
Charities (e.g. advertised to their members.
YP randomised to YPF or TAU.
Supervision
Safeguarding protocol evaluated. 6 trained GP/nurses recruited & trained to monitor YP in YPF group
Quantitative data collection & analysis
Online outcome measures completed by YP +/- 1 parent/carer at baseline, 13, 26 and 52 weeks. Analysed using descriptive & exploratory inferential statistics.
Nested Qualitative Component
Selection of YP, parents and GPs interviewed. Data analysed using thematic analysis.
Implications for future studies
Feasible to recruit YP using mass mail out.
RCT design with TAU as a control acceptable.
No evidence that YPF does harm.
YPF may improve psychosocial outcomes in those poorly adjusted at baseline with high levels of engagement.
Randomised controlled trial of YPF is justified.
Limitations
Participants not blinded to allocation could lead to reporting bias.
NB: study not powered sufficiently for multiple tests on data (open to claims of data torture/false findings etc.), analyses used to determine primary outcome measure & subsequent analysis plan . P-values describe data rather than confirm effects.
References: 1) Changing Faces (2010)The Face Equality Campaign: The Evidence. The incidence and prevalence of disfigurement. Available from: [Accessed 5th December 2012]
2) Moss, T.P., The relationships between objective and subjective ratings of disfigurement severity, and psychological adjustment. Body image, 2(2). 3) All Parliamentary Group on Body Image: Reflections on body image, Parliamentary Report, UK: (Retrieved 16th August 2012). 4) Williamson, H., Griffiths, C., & Harcourt D. (2015) Using a participatory action approach to design and evaluate the acceptability of YP Face IT: an online psychosocial intervention for adolescents struggling with appearance-altering conditions or injuries. Health Psychology Open, 2(2) 1-12.
The current study is independent research funded by the National institute for Health Research’s Research for Patient Benefit. The views expressed in this presentation are those of the author(s) & not necessarily those of the NHS, the National Institute for Health Research or the Department of Health.
The Centre for Appearance Research, University of the West of England. Tel: