School-based versus after-school delivery of a universal wellness programme – A randomized controlled multi-arm trial

Positive self-image and body image as well as high self-esteem and media literacy are considered protective factors against health-compromising behaviours. Investigation of the optimal setting for body image prevention programmes is important to maximize outcomes from such programmes. Most universal wellness programmes are school based and thus delivered to a “captive” population. Only a few reports have been published about wellness programmes delivered in after-school settings, and none of them compared delivery after school to delivery in a school-based setting. To assess the acceptability, feasibility and efficacy of an interactive wellness preventive programme (In Favour of Myself) when delivered in a school-based setting versus an after-school setting. A randomized controlled multi-arm trial with 224 adolescent girls aged 13–15 years old was conducted. There were 102 girls participating in the after-school setting and 102 girls in the school-based setting. The programme contained nine 90-minute lessons, delivered weekly over 2 months. An intention-to-treat assessment was performed three times: at baseline, at the programme's conclusion (two months) and at follow-up (3 months). At programme termination and follow-up, the impact of In Favour of Myself was higher among participants in the after-school setting than in the school-based setting with respect to advertisement strategies, media pressure, gap between current and ideal body image, drive for thinness and self-esteem. This study provides support for a community-led approach to promote health behaviours, an approach that currently is a significant feature of health improvement policy and practice. •This is the first randomized controlled study providing evidence that an after-school setting has a better impact than a school-based setting in delivering a universal wellness prevention programme.•The 13- to 14-year-old adolescents in the after-school setting demonstrated superior scores in respect to knowledge about advertisement strategies, internalizing media pressure, the gap between current and ideal body image, drive for thinness and self-esteem.•This study provides support for a community-led approach to promote health behaviours, an approach that currently is a significant feature of health improvement policy and practice.