Comparison With Previous Work
RECRUITMENT
This is the third RCT to report small immediate and sustained improvements in young people’s state- and trait-based body image following engagement with a microintervention [With respect to intervention adherence and user engagement, less than half (327/858, 44% of participants) of those randomized into the intervention group used the chatbot. Of these, the majority (258/327, 79% of participants) completed the minimum intervention dose of one microintervention technique, with an average of 5 techniques completed over the 72-hour intervention period. There was also a preference for the woman avatar, Dandara, with most girls and boys opting to receive guidance from her, relative to her counterpart, Gabriel. These engagement levels [First, with respect to engagement levels, in 2 comparable microintervention [Second, with respect to gender preferences of the avatar, a small body of research has examined the role of gender in body image interventions, particularly the gender of the intervention facilitator [The current attrition rates and patterns are also comparable with the abovementioned trials [First, Brazil passed the General Data Protection Law in 2018, with policies coming into effect in February 2020. These laws require parents to read, sign, and upload information and consent forms to a secure portal for identity verification before their child’s participation. This process requires parents to have good literacy skills, and without literacy skills, they are unable to engage with and comprehend the research materials, thus restricting adolescents’ participation. The recruitment methods were adjusted based on stakeholder feedback, with an information video provided alongside the written content. However, parents were still required to sign and upload consent forms. Second, to streamline the recruitment and onboarding processes, communication with participants was conducted primarily through automated processes (eg, email), with little to no contact between participants and the researchers or a recruitment agency. Third, during the informed consent phase, participants were advised that they would receive compensation at study completion; however, according to Brazilian ethics, the amount was not disclosed until study completion (eg, at the 1-month follow-up). Collectively, these methodological features and the general nature of digital interventions likely explain the current attrition rates.Overall, previous and present findings indicate that microinterventions are an effective intervention for young people; however, they may serve different purposes depending on the severity of a participant’s concern. From a stepped-care approach, microinterventions may serve as a stand-alone approach for young people with milder concerns (eg, offered to young people during a moment of body image distress) or as an adjunctive approach to those participating in longer traditional body image interventions (eg, offered to young people ahead of talking therapy to increase motivation and self-efficacy). Unfortunately, to date, a stepped-care model for the eHealth of body and eating concerns has not been formally conceptualized and warrants consideration. Finally, given the growing literature on microinterventions, a systematic review and meta-analysis of this intervention model are both timely and necessary. Specifically, the review should provide a comprehensive overview of extant mental health microinterventions and analyze different intervention and trial features to determine those associated with greater engagement, adherence, and effectiveness.