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.

Introduction: This study aimed to explore UK healthcare professionals’ perspectives on support for male breast cancer patients and their informal carers, and to identify avenues for improvement. Methods: UK-based HCPs involved in the care of breast cancer patients (men and/or women) were invited to complete an online survey about their experiences of explaining diagnoses and treatment, perceptions of current support and areas for improvement. Data were analysed using descriptive statistics and qualitative content analysis. Results: Respondents (N = 62) reported providing a variety of resources and sources of practical and emotional support, but 81% found existing resources inappropriate and insufficient. Recommendations included increased availability of male-specific breast cancer information and support, and training for healthcare professionals working in this field. Conclusion: Increased psychosocial support and enhanced, gender-appropriate resources are crucial for supporting male breast cancer patients and their informal carers and reducing isolation. Healthcare professionals need access to training on this topic.

Objective Influencers have been used to deliver messaging in public health campaigns and have begun collaborating with researchers to deliver evidence-based content. Building on this approach, this study explored adolescent girls’ perspectives on influencers and utilising influencers to deliver body image and mental health interventions. Methods A mixed-methods study was conducted with 375 UK-based girls (Mage  =  15.39, SD = 1.63) to understand their experiences with influencers and their opinions about influencer-delivered body image and mental health interventions. Data were analysed quantitatively via descriptive statistics and qualitatively using inductive content analysis. Results Most participants expressed likeability, credibility, authenticity, and relatability were key influencer qualities when choosing to trust an influencer, whilst their ethnicity, gender, and body size were not important. In considering intervention development, the most salient factor in trusting an influencer about body image was that the influencer shared their own experiences. Participants preferred offline body image support (47%) versus online (38%); however, just over 60% agreed that influencer-delivered body image interventions were a good idea. The content analysis generated three main categories: ‘Influencer-delivered interventions would be helpful’ (53.5%), encompassing the offer of support and online environment as ideal; ‘influencer-delivered interventions would be unhelpful’ (28.1%), including influencers are not qualified and the toxicity of the internet; and ‘influencer qualities’ (18.3%), such as relatability. Conclusion Overall, adolescent girls thought an influencer-driven approach could be helpful in improving their body image and mental health. Caveats included that the influencer must be trustworthy, relatable, and authentic, which could encompass self-disclosure related to their mental health.

A two-arm cluster randomized controlled trial evaluated the impact of Body Confident Athletes (BCA) on girls' ( = 568, 11-17 years) body image, sports enjoyment, and affect. Sports organizations were randomly allocated (1:1) into either an intervention (BCA; = 29) or waitlist control condition ( = 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. 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%). 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. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

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.