Table 20 Caregiver-focused prevention for caregivers of children and adolescents (< 18 years)

Jones et al. [84]

Open trial (pilot)

Children at-risk of AN

n = 46 (12 at risk (R), 22 at high-risk (HR), 12 ED diagnosed)

Parents Act Now (P@T or Elternals Therapeuten E@T-the German version): based on first phase of family-based treatment. 6 online sessions (6 weeks), moderated by ED experts. Includes discussions, journals related to weight, eating, and exercise, videos, and 2 phone calls for individualized feedback. Sessions focused on activating parental concern, empowering parents to take action, providing education and practical approaches for intervening in problematic behaviours, and providing guidance about ongoing monitoring and maintenance of progress

Feasibility, acceptability,

PvA scale, WCS, EDE-Q, EDE,

EDI-2, FMPS, RSES

HR parent participants logged on more frequently and viewed more sessions than R parents

19 parents completed post-assessment and rated the overall program quite favourably, and reported that they would highly recommend the program. Overall improvements in those in R and HR categories: improvements in risk factors and early symptoms between initial screening and post-assessment; participants remained stable or increased in ideal body weight and reported decreased ED attitudes and behaviours

Jacobi et al. [85]

RCT

Children at-risk of Anorexia Nervosa

n = 32 (E@T)

n = 34 (control)

Elternals Therapeuten E@T-the German version: based on first phase of family-based treatment. 6 online sessions (6 weeks), moderated by ED experts. Includes discussions, journals related to weight, eating, and exercise, videos, and 2 phone calls for individualized feedback. Sessions focused on activating parental concern, empowering parents to take action, providing education and practical approaches for intervening in problematic behaviours, and providing guidance about ongoing monitoring and maintenance of progress

Expected body weight % change, WCS, EDE, EDI-2

Low intervention acceptance/use, but participating parents rated the program quite favorably as “good” and would recommend to other parents. Of the primary outcomes, only 1 significant difference between the intervention and the control group was found: between preintervention and 12-month FU, girls of the intervention group gained significantly more weight more quickly as indicated by change in percentage of EBW compared with girls in the control group. Parent-reported reasons for unwillingness to participate: The majority of these parents responded that they did not perceive the identified risk factors and early symptoms in their daughters as problematic and participation in a preventive intervention not necessary

Bruning Brown et al. [86]

Controlled trial

Females in high school physical education/ health class

Students: n = 102 SB

n = 51 comparison

Parents: n = 22 intervention n = 47 waitlist control

Student Bodies student intervention: structured 8-week internet- and cognitive-behavioural based intervention including an asynchronous, moderated discussion group and psychoeducation

Student Bodies parent intervention: unstructured web-based program that parents had 4 weeks to complete; includes an online discussion group. Program encourages parents to accept variations in weight and shape and to discourage negative attitudes and behaviors

EDI (drive for thinness and bulimia subscales), EDE-Q (weight, shape, and restraint subscales), WCS, Knowledge Test, PACS

Students using the program reported significantly reduced eating restraint and had significantly greater increases in knowledge than did students in the comparison group from baseline to post-assessment. No significant differences at 3-month follow-up. Parents in the intervention significantly decreased their overall critical attitudes toward weight and shape compared to parents in control group from baseline to post intervention (note: parents did not do 3-month follow-up like students did)

Diedrichs et al. [87]

RCT

Mothers who identified body image issues among daughters

n = 53 dyads (website-unstructured)

n = 57 dyads (website-tailored)

n = 48 dyads (assessment-only control)

Dove Self Esteem Project Website: online information hub designed to provide mothers with information and tools to help foster positive body image among their daughters and themselves. Website-unstructured condition: mothers browsed the website without guidance. Website-tailored condition: mothers were provided with a written personalized pathway that guided them. Control: assessment only, did not view website nor receive a website link

BES (appearance esteem and weight esteem subscales), SATAQ-3,

Perceived Sociocultural Pressures Scale,

Social Comparison to Models and Peers scale, RSES, frequency of mother-daughter conversations about body image, negative affect, maternal pressures, help seeking behaviours, adherence

Daughters in both website conditions had significantly engaged in more self-reported conversations with their daughters about body image at post-exposure and 6-week follow-up. At 12-month follow-up, mothers in the website-tailored condition were almost 3 times as likely than controls and just over 2.5 times more likely than mothers in the website-unstructured condition to report that they had sought additional support around body image for their daughters. Daughters whose mothers viewed the website had higher self-esteem and reduced negative affect at 6-week follow-up (not maintained at 12 months). There were no differences on daughters’ body image, and risk factors among mothers or daughters, at post-exposure or follow-up. Tailoring website content appeared beneficial