Pilot trial assessing acceptability, feasibility, and preliminary effects of a body image intervention for adolescents in rural Nicaragua

School-based interventions to promote body esteem and media literacy are a cost-effective way to improve body image and foster resilience against appearance pressures across diverse socio-economic contexts. We developed a culturally adapted intervention to promote body esteem and media literacy and piloted it in a two-arm semi-randomized controlled trial. Nicaraguan adolescents in two schools were allocated to receive a four-session, facilitator-delivered, school-based intervention that focused on critiquing appearance ideals, recognizing manipulated images, reducing social comparisons and resisting appearance pressures. Participants in two schools were allocated to the waitlist control condition. A total of 122 adolescents (77 girls, M_age= 13.7, SD = 1.55, range 11-18) answered questionnaires about body satisfaction, internalization of general and athletic ideals, sociocultural pressures, physical appearance comparison and eating attitudes before and one week after the intervention/control period; and completed open-ended questions at six-week follow-up. Throughout the program, they provided both qualitative and quantitative feedback after each session. Additional feedback was gathered from participants, observing teachers, and facilitators during focus groups at post-test to evaluate the program's acceptability and feasibility. The intervention demonstrated good acceptability and feasibility. Participants showed improvements at post-test for perceived reality of social media and athletic internalization. Key learning points were retained at six-week follow-up. Our culturally adapted body image intervention is a feasible, acceptable, and promising tool to increase body esteem and media literacy in Nicaragua. These results suggest that after careful cultural adaptation, school-based body image interventions can be used in a variety of different cultural and socio-economic contexts.