Co-Created Screen Use Program Lifted Adolescent Body Image in Rural Catalonia
A community-built intervention centered on screen use produced measurable gains in positive body image, self-esteem, and self-concept among adolescents in rural Catalonia. The signal came from a single-group pre-post study in Bellpuig, where adolescents aged 12 to 16 years at Lo Pla d’Urgell institute took part in a participatory program designed with families, teachers, healthcare professionals, and local stakeholders.
The clinical relevance is straightforward. Adolescence is when identity becomes vulnerable to external pressure, and digital platforms intensify that pressure by turning appearance into a continuous comparison exercise. In that setting, screen habits are not just a behavioral issue; they can become a psychological exposure that shapes how young people interpret their own worth, their social standing, and their bodies.
Why Digital Comparison Hits Adolescents Hard
The intervention was built around a simple but clinically important premise: body image does not develop in isolation. It is molded by school life, family dynamics, peer groups, and the digital environment, all of which can either reinforce or soften self-evaluative stress. Social media increases the frequency of comparison with edited, filtered, and curated images, and that repeated exposure can erode confidence long before it produces an obvious psychiatric diagnosis.
A rural setting adds another layer. Geographic closeness often means tighter social visibility, stronger community norms, and fewer mental health resources within immediate reach. In that context, a school-only prevention model can miss the wider ecology that sustains screen habits and self-perception. The participatory design used here tried to close that gap by bringing adolescents and their surrounding community into the intervention itself.
Participatory Design Replaced the Usual Top-Down Model
Investigators used a quasi-experimental single-group design with measurements before and after the program. Adolescents completed validated self-report instruments assessing screen-related and psychosocial outcomes, and change over time was analyzed with nonparametric tests. Effect sizes were estimated with rank-biserial correlations and 95% confidence intervals.
The key innovation was not the measurement strategy alone. The program itself was co-created through an ecological and participatory process that included adolescents, families, teachers, healthcare professionals, and community stakeholders. Educational and participatory activities focused on digital balance while also reinforcing self-esteem, self-concept, and positive body image. That structure matters because adolescent behavior change rarely sticks when the surrounding environment sends the opposite message.
One sentence captures the core result: the intervention moved psychological outcomes in the right direction without relying on a purely individualistic approach.
Moderate Gains in Self-Perception and Body Image
After the intervention, adolescents showed a moderate improvement in positive body image, self-esteem, and self-concept. No meaningful sex-based difference emerged in the intervention effect, although boys started with higher baseline values for self-esteem and body image. Those baseline differences fit the broader literature, where girls often report greater body dissatisfaction and greater sensitivity to appearance-based comparison.
The mechanism is plausible. Reducing unstructured or excessive screen exposure may lower the volume of appearance-based social comparison, while participatory education can replace passive digital consumption with more reflective habits. At the same time, including adults and peers in the program likely reinforced the message outside the classroom, which is essential when the target outcome is not only knowledge but also identity formation.
The study does not claim to have reversed all harms linked to screen use. It does show that a program anchored in the community can alter a set of psychological outcomes that often resist brief, isolated educational efforts.
Rural Communities Need More Than School-Based Prevention
The public health implication reaches beyond one municipality in Catalonia. Rural adolescents may face limited access to mental health support, fewer structured prevention resources, and social environments where norms circulate quickly and persistently. When digital life is layered onto that setting, the risk is not only more screen time but more intense internalization of appearance pressure.
A co-created intervention offers a different model of prevention. It treats adolescents as participants in design rather than passive recipients of instruction, and it treats families, schools, and local health professionals as part of the therapeutic environment. That approach may be especially relevant where formal services are thin and where community trust determines whether a program is accepted at all.
What the Findings Can and Cannot Prove
Because the study used a single-group pre-post design, it cannot separate the intervention effect from every external influence that may have occurred during the same period. There was no comparison arm, so causality remains limited by design. Even so, the direction of change across multiple psychosocial domains points toward a coherent benefit rather than a random fluctuation.
The evidence also remains short-term. Long-term durability was not established, and the abstract does not describe whether the gains persisted once the program ended. Adaptation to other rural settings, other school environments, and different cultural contexts also remains untested. Those are not minor questions, because interventions that work in a close-knit Catalan municipality may need reshaping elsewhere to preserve engagement and relevance.
Still, the bedside and community message is practical: when screen use is addressed through a shared ecological framework, adolescent self-perception can improve. For clinicians, educators, and policymakers, the study supports a move away from narrowly individual counseling models and toward programs that reflect the social conditions in which digital behavior actually develops.
The unresolved issue is durability, not direction. Whether these gains can be sustained, scaled, and reproduced in other populations will determine how far this model can travel beyond Bellpuig.