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Table 2 Intervention development process

From: Evaluating the effectiveness and acceptability of two positive body image media micro-interventions among children aged 4–6 years old – a study protocol

May 2023 - July 2023.

Literature Review

Ìý

• Body image research in early childhood remains a relatively underexplored area. Longitudinal studies highlight that from age 3 years children express negative attitudes towards others [7], at age 4–5 years display relatively positive body image but by age 6 a large proportion (up to 70%) report signs of body dissatisfaction [9].

• Three successful strategies (a storybook, a theatre production and short animations) to foster positive body image among young children were identified [45,46,47].

• Media micro-interventions have demonstrated their efficacy in improving body image among children [46,Ìý48] and are suited to young children’s limited attention span. They are also cost-effective.

• A comprehensive overview of body image and related measures among young children were collated, which indicated limited availability of appropriate measurement tools.

• Based on our literature review, bolstering positive body image and reducing weight bias were identified as the focus of our interventions.

July-September 2023.

Public Involvement (PI)

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• PI experts (children, parents, teachers and a body image expert specialising in young children) were recruited with the aim of informing the research protocol.

Parents and Teachers:

• In relation to media viewing habits, parent interviews indicated young children typically watched TV and online videos for 15–20 min (i.e., short episodes) and enjoyed interactive programmes focused on learning. Parents indicated some interest in co-watching children’s media with their child.

• With regard to how children talk about bodies, teachers and parents said children talk about bodily functions or its physicality (e.g., they can run fast). Some were able to provide examples of instances where children have made negative comments about how others look (specifically in relation to skin shade, or weight). Children talking negatively about their own bodies and how they look was less frequent.

• Parents and teachers also provided feedback on aspects of the proposed research design to ensure processes were age appropriate, acceptable, and practical. This included giving the research team direction on how to question children on the topic of body confidence, under what conditions we should show the intervention, and how long we can expect to keep young children engaged.

Children:

• Potential outcome measures were tested among the children’s PI group through three rounds. Based on the teams’ (NC, HS and KG) observations during these sessions, refinements to the wording, number of items and response scales were made. A final shortlist of questionsÌýwas determined.

• Final versions of the materials and outcome measures were reviewed by two teachers.

• Final adjustments included adding a sense-check question into the interview schedules (e.g., ‘Oh you’ve stood there, so you think X’) and final tweaks to the instructions (e.g., changing ‘does that make sense to you?’ to ‘Does that sound OK to you?’).

July-September 2023.

Intervention Format

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• Moonbug Entertainment identified 4–6-year-olds as key consumers of Blippi content.

• Initially, Moonbug Entertainment presented the idea of developing a 60-minute ‘movie’. However, after reviewing viewership data from Moonbug Entertainment’s team and initial insights from PI work, short episodes and music videos were chosen as appropriate intervention formats forÌýtesting.

July – August 2023.

Intervention Messaging

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• Two key themes under the umbrella of positive body image [1,Ìý51] were established: (1) functionality appreciation – e.g., focusing on what the body can do, as opposed to its appearance [52, 53] and (2) acceptance of diverse appearances – e.g., recognising that people come in various shapes and sizes, and everyone is of equal worth.

• It was decided that positive body image psycho-educational messaging would be delivered both explicitly (i.e., through the lines in the 15-minute episode script and music lyrics) and implicitly (i.e., via casting and additional special effects graphics). This is an effective learning strategy for young children [40].

July – August 2023.

Creative Concepts

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• Moonbug Entertainment developed the initial concept of a ‘talent show’ whereby children meet various experts (e.g., magician, inventor, and dancer) and together they explore and discover how wonderful their bodies are in a fun and creative way.

• The music videos are also based on the talent show; to supplement the 15-minute episode and each one includes positive body image messaging.

July 2023 – November 2023.

15-minute Episode Script and Song Lyric Development

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• The development of the scripts and music lyrics was an iterative process between all stakeholders.

• For the episodes, an initial storyboard outline and narrative was developed by Moonbug Entertainment and reviewed by the researchÌýteamÌý(NC, KG, HS, HW). Once all stakeholders were aligned, a full script was written with the aim to promote positive body image in a fun and interactive way, incorporating the two themes identified above.

• An example editÌýto the script:Ìýchanging the lines ‘there’s a fun dance move that might be better suited to your body…’ to ‘there’s a fun dance move that you might enjoy more [or] that suits your style more’ to avoid the implication that certain body types are better suited to certain dance moves.

• In tandem, outlines for 8 music videos were drafted. Each one represented a key theme within the umbrella of positive body image and represented a different style of music (e.g., pop, rock). An additional 9th song was developed for the purpose of the storyline of the Talent Show but did not include key messages on body image.

August 2023 – September 2023.

Casting

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• In line with principles of Positive Body Image Theory [1,Ìý53] and to disrupt gender and appearance stereotypes typically seen in children’s media [16], it was essential that actors were diverse in body size and shape, ethnicity, and gender.

• To reinforce the key messaging in the script, the cast (both adults and children) modelled body acceptance and appreciation by portraying their bodies positively, talking positively about their bodies and appreciating what it can do for them [38].

• Once casting briefs were finalised and sent out, auditions were held, all stakeholders reviewed the casting shortlist, and selections were made for six additional characters ( in addition toÌýthe shows' two main characters, Blippi and Meekah).

• Actors were deliberately cast to show a range of body sizes, including those that are not typically represented in mainstream media (e.g., the KID DANCER, will be a boy in a larger body, disrupting gender andÌýbody-type stereotypesÌýseen in children’s media and INVENTOR EXPERT will be a Black woman in a larger body, disrupting gender stereotypes).

September 2023.

Pre-Production

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• Moonbug Entertainment hosted a virtual table read of the script (via video conferencing) for the fourÌýepisodes . The actors who play Blippi and Meekah read the script aloudÌýalongside members of Moonbug Entertainment who filled in other roles. Collaborators (fromÌýDove and authors NC and HW) watched and had opportunity to make notes andÌýrecommend changesÌýafter the event

• The primary purposeÌýof the table read was to ascertain episode length. The script was too long thus it was streamlined slightly.

October 2023 – November 2023.

Production

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• The episodes and the first five music videos were shot in LA, USA over ten days. Shooting included four locations, one for each scene.

• The last author and research lead (NC) attended each day and consulted on the delivery of the script to ensure key messages were delivered and emphasised.

• A second two-day shoot was held for the remaining four music videos.

October -November 2023.

Post-Production

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• Children are visual learners [40] therefore it was important to supplement the content of the script and lyrics withÌýadditional visuals. These included special effect overlay graphics (e.g., when talking about noses, different shapes and sizes of noses will pop up on the screen) and colourful word pop ups (e.g., ‘body’).

• Close-to-final versions of each media were delivered towards the end of November 2023, for the pilot study to take place.

• Final versions will be delivered at the end of December 2023/beginning of 2024.