Publications from the Centre for Appearance Research (CAR)

Approximately 1 in 5 people in the UK are currently living with a visible difference, for example, scarring. Evidence suggests that an increasing number of adults are using decorative tattooing to camouflage and/or decorate scarring. However, literature on the motivations and potential benefits of this is limited and more research into the impact of tattooing on psychosocial wellbeing is needed. This PhD explored the use of decorative tattooing as a form of scar camouflage and/or decoration, to understand the psychosocial motivations from the perspectives of adults with tattoos and scarring, drawing also on the perspectives of tattoo artists and the general UK population. Through an interdisciplinary mixed method sequential design, the PhD utilised semi-structured interviews, incorporating photo-elicitation, and survey data to investigate the breadth of the topic through an interpretivist lens, adding new knowledge to both the visible difference and tattooing literature. The direction of this thesis was developed by drawing on key lines of enquiry within each respective study to inform the next, enabling the thesis to map key findings across all studies. Study one investigated the lived experiences of 15 individuals who had used decorative tattooing to camouflage and/or decorate scarring. Study two built upon these findings through interviewing 14 tattoo artists with experience of tattooing scarring and study three examined broader population perceptions of scars and tattoos through an online survey, assessing 180 responses. Overall, the research indicated that decorative scar tattoos can be a tool for re-defining relationships with scarring and identity, potentially as an alternative to more conventional methods. Decorative tattoo artists play a significant role in shaping individual experience, however, training allowing them to provide additional support may be beneficial. General perceptions vary between experiences of tattoos and/or scarring and the broader societal perceptions of both scars and tattoos remain complex. While tattoos appear to have more sociocultural acceptability than visible scarring, the navigation of tattooed identity is highly influenced by cultural contexts, and scars often remain stigmatised. Each study identified how findings supported and contradicted existing literature, making recommendations for future research, including the potential for decorative tattooing to aid existing visible difference support and highlighting routes for best practice for decorative tattoo artists. Ultimately, calling for a broader recognition of the transformative potential of decorative tattooing, with the view to inspire more inclusive discourses and practices within academic and cultural domains.

Objective: A two-arm cluster randomized controlled trial evaluated the impact of Body Confident Athletes (BCA) on girls’ (N = 568, 11–17 years) body image, sports enjoyment, and affect. Method: Sports organizations were randomly allocated (1:1) into either an intervention (BCA; k = 29) or waitlist control condition (k = 33). Girls and coaches in the intervention condition completed three 60-min sessions over three consecutive weeks. Primary outcomes were the immediate and short-term changes in girls’ body esteem, with secondary outcomes assessing changes in girls’ body appreciation, self-objectification, attuned self-care, sports enjoyment, and affect. Results: Girls in the BCA condition reported significant small improvements in body esteem, body appreciation, attuned self-care, self-objectification, and negative affect at postintervention, with several effects either maintained (attuned self-care at 1-month follow-up [T3], but not at 3-month follow-up [T4]) or reemerging at later follow-up points (body esteem and self-objectification at T4, but not at T3). Effects were not maintained for body appreciation or negative affect, nor did effects emerge for sports enjoyment or positive affect. Coaches were effective interventionists (i.e., 80% accuracy), with most girls comprehending key intervention messages (85.1%). Conclusion: BCA is the first coach-led positive body image intervention designed for girls in sport. The findings of the current trial show that BCA is a scalable body image intervention accurately delivered by sport community members, resulting in immediate and short-term improvements in girls’ body image.

Despite an increase in gym memberships, women are less active than men and little is known about the barriers women face when navigating gym spaces. This study explored women’s body image and experiences exercising in gyms. Two-hundred and seventy-nine women (84% current gym-goers; 68.1% White) completed an online mixed-methods survey. Thematic analysis of qualitative data produced four themes and nine subthemes: (1) “Never enough” ([perceived] judgement about appearance, [perceived] judgement about performance); (2) “Often too much” (self-criticism, clothing challenges); (3) “Always on display” (harassment and safety, fighting for space, the appearance contingency); and (4) “Sometimes empowered” (empowering places, empowering self). Qualitative and quantitative data showed that women often feel judged for their appearance and performance, leading to a persistent sense of inadequacy, as well as having to fight for space in the gym and to be taken seriously, while navigating harassment and unsolicited comments from men. Despite this, women showed signs of resistance towards gendered and appearance ideals permeating gym environments and some experienced empowerment through skill acquisition, breaking gender norms, and exercising in supportive environments. Based on our findings, we suggest a multi-level approach to tackling these barriers and creating more inclusive gym spaces for women.

Weight bias is highly prevalent in the fitness industry, posing significant challenges for fat people seeking to engage in health-promoting behaviours, such as physical activity. Despite small ideological shifts in the fitness industry towards more weight-inclusive practices, little is known about fitness professionals’ engagement with such approaches. The aim of the current study was to explore weight bias attitudes among weight-normative and weight-inclusive fitness professionals and factors influencing adoption of inclusive approaches. A mixed-methods survey was conducted among 120 fitness professionals (Mage=34 years; weight-inclusive n=62 [51.7%], weight-normative n=58 [48.3%]) to gather quantitative data on weight bias and attitudes towards working with fat people, and qualitative data on motivations, facilitators, and barriers to adopting weight-inclusive approaches. Weight bias was positively associated with negative attitudes towards working with fat people. Weight-inclusive fitness professionals reported higher empathy (d=–.86), size acceptance (d=–.79), critical health attitudes (d=–.91), and attribution complexity (d=–.78) and less negative attitudes towards working with fat people (d=.81) than weight-normative fitness professionals. Thematic analysis of qualitative data resulted in four higher-order themes: (1) “It’s what the science says”; (2) “It’s what the client wants”; (3) “It’s bad for business”; and (4) “I want to, but I don’t know how”. Fitness professionals who adopted weight-inclusive practices displayed less weight bias and less negative attitudes towards working with people in larger bodies. Qualitative findings highlighted multiple barriers that need to be addressed in order to encourage more fitness professionals to adopt weight-inclusive approaches.

Background Although mental health issues among Indonesian adolescents are of growing concern, a psychometrically valid measure of affect in Indonesia to inform related research and prevention and treatment efforts does not exist. Methods The present study’s aim was to culturally adapt and validate the widely used Positive and Negative Affect Schedule for Children (PANAS-C) among Indonesian adolescents. The original 30-item PANAS-C in English underwent forward and back translations to Bahasa Indonesia (the national language of Indonesia) followed by cognitive interviews with private and public school students ages 12–15 (n = 18). The adapted PANAS-C and measures to assess convergent validity were completed by 704 Indonesian adolescents from Greater Jakarta and the Javanese city of Surabaya (Mage = 13.56, SD = 0.906) (56.96% girls; 42.75% boys; 0.28% other). Most participants identified their ethnicity as Javanese (72.59%), Betawi (8.24%), or Sundanese (3.41%). Results Exploratory and confirmatory factor analyses were conducted, which resulted in 26 items with a two-factor structure consistent with the original PANAS-C: A 12-item Positive Affect subscale and a 14-item Negative Affect subscale. Internal consistency was satisfactory for the Positive Affect subscale (Cronbach’s alpha was 0.88; McDonald’s omega was 0.88) and excellent for the Negative Affect subscale (Cronbach’s alpha was 0.90; McDonald’s omega was 0.89). Test-retest reliability was acceptable for all items, and convergent validity was confirmed by significant correlations with measures of distress and well-being. Conclusion The adapted PANAS-C was found to be a reliable and valid measure of positive and negative affect that can be used with Indonesian adolescent girls and boys. This is the first validated measure of positive and negative affect for young people in Indonesia, which fills a need in mental health research and practice.