Hoosier Sport Re-Social: a protocol for developing a biopsychosocial body satisfaction intervention in rural Indiana

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Abstract
Background: Body dissatisfaction is a growing concern among adolescent females, particularly those living in rural communities where access to supportive mental and physical health resources is limited. High levels of social media use and low engagement in structured physical activity are linked to negative body image, elevated anxiety, and reduced overall well-being in this population. The Hoosier Sport Re-Social intervention was developed to address these challenges by integrating sport participation, social media literacy, and mental skills training in a community-based program designed for adolescent girls. Methods: This study follows the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidelines and is structured around three aims. First, we will conduct a cross-sectional study with adolescent girls in grades 6 through 9 to examine the relationship between body satisfaction, physical activity levels, and social media use. Second, we will develop the Hoosier Sport Re-Social intervention using a co-design process that actively involves adolescents, parents, and school staff to ensure relevance and feasibility. Finally, we will conduct a mixed-methods pilot study in two rural middle and high schools to assess feasibility and acceptability. The intervention will be implemented within physical education and health classes over a 6-week period. Primary outcomes will include feasibility indicators such as recruitment, retention, fidelity, and participant engagement. Secondary outcomes will include measures of body satisfaction and social media literacy, while exploratory outcomes will examine changes in psychosocial factors and physical literacy. Discussion: This study will provide important insights into the acceptability and practicality of delivering a biopsychosocial, school-based intervention targeting body dissatisfaction among rural adolescent girls. Findings will inform future efforts to scale the program and evaluate its effectiveness in improving mental, physical, and cognitive health outcomes. Trial registration: This trial was prospectively registered with ClinicalTrials.gov (NCT06556719).

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