Peer-Led Dissonance-Based Eating Disorder Prevention: The Feasibility, Acceptability, and Effectiveness of Involving Parents in a Program Targeting High School Girls

Abstract

BACKGROUND: Dissonance-based programs that focus on reducing eating disorder risk factors have consistently demonstrated positive outcomes. Recent findings suggest that peer-led dissonance-based prevention may be effective with high school students. As the attitudes of adults can heighten vulnerability to eating disorders, it may be beneficial to involve parents in prevention efforts. No research to date has investigated the effectiveness of combining peer-led dissonance-based eating disorder prevention with an “environmental” approach involving parents. OBJECTIVES: The current study aimed to: 1) replicate preliminary findings suggesting that peer-led dissonance-based programs are effective in reducing eating disorder risk factors among high school students, and 2) investigate the feasibility and acceptability of including a pilot parent education component. METHODS: Participants were recruited from two private, all-girls schools in Hawai‘i. Peer leaders (n = 12) attended 8 hours of training on the 4-hour group intervention prior to delivering the program to students (n = 48) during health and/or psychology classes. Parents from one school were invited to attend a 1.5-hour education session. Participants completed assessment measures at baseline, post-intervention, and three-month follow-up. RESULTS: Findings revealed significant reductions in thin-ideal internalization, restrained eating, body dissatisfaction, and eating disorder psychopathology following the intervention, with a number of improvements maintained at three-month follow-up. Sessions were delivered with high levels of adherence to the manual; however, considerable variability in facilitation skills was observed across student leaders. Although the parents of 23 students were invited to attend the parent session, only 5 participated; thus, analyses examining the impact of the parent session on students were not possible. All of the parents who attended expressed concern about the eating or weight of one of their children. Post-intervention acceptability ratings indicated that the programs were well received. IMPLICATIONS: Findings contribute to the data supporting the viability of training high school students to deliver dissonance-based prevention. Although outcomes suggest that further research evaluating peer-delivery is warranted, professional-delivered dissonance-based programs remain the “gold-standard” for eating disorder prevention among high school students. Recruiting parents proved to be highly challenging, consistent with previous research, and may not be a feasible direction for future eating disorder prevention efforts.