Efficacy of the Mental Health App “Intellect” to Improve Body Image and Self-compassion in Young Adults: A Randomized Controlled Trial With a 4-Week Follow-up

Background Body image concerns are prevalent among young adults, who may be vulnerable to developing body image concerns because of particular risk factors associated with this life period. With technological advancements, digital mobile health (mHealth) apps are cost-effective and scalable interventions. Thus, mHealth apps can be explored as a form of prevention effort to alleviate body image concerns in young adults. Objective In this randomized controlled trial, we examined the effectiveness of a self-guided mHealth app in improving body image and self-compassion in a sample of university students. Methods Participants (N=310) were randomized to a 9-day self-guided body image and self-compassion mHealth app (n=149) and to an active waitlist control group (n=161), where they completed a similarly structured 9-day program on cooperation. Both programs consisted of content learning and activities such as quizzes, with the number and length of activities matched for both programs. Measures were obtained at baseline, upon completion of the programs (after the intervention), and at 4-week follow-up. Results The intervention group for female participants reported significant reduction in body dissatisfaction (P<.001) and improvements in body appreciation (P<.001) and self-compassion (P=.001) compared with the active waitlist control group after the intervention. Similarly, for male participants after the intervention, a significant reduction was found in the intervention group in body dissatisfaction (P<.001) after the intervention as well as improvements in body appreciation (P=.02) and self-compassion (P=.047). The effects were maintained at 4-week follow-up for female participants on body dissatisfaction (P<.001), body appreciation (P<.001), and self-compassion (P=.02) but not for male participants. On body image risk factors, significant reductions were found for female participants after the intervention for thin-ideal internalization (P<.001), peer pressure (P=.002), and media pressure (P<.001) after the intervention, while the effects were only maintained for thin-ideal internalization (P=.008) and media pressure (P=.01) at 4-week follow-up, compared with the active waitlist control group. As for male participants, no intervention effects were found both after the intervention and at follow-up for all body image risk factors of muscularity internalization, peer pressure, and media pressure. Both apps were acceptable and participants engaged equally across the intervention and active waitlist control groups, as indicated on a measure of app engagement (P=.76). Conclusions This study provides preliminary evidence for a self-guided mHealth app in improving body image concerns and self-compassion in young adult university students. Future studies should include longer follow-ups, and examine its effects with the wider populations of young adults. Trial Registration ClinicalTrials.gov NCT04977973; https://clinicaltrials.gov/ct2/show/NCT04977973

yes: all primary outcomes were signi cantly better in intervention group vs control partly: SOME primary outcomes were signi cantly better in intervention group vs control no statistically signi cant difference between control and intervention potentially harmful: control was signi cantly better than intervention in one or more outcomes inconclusive: more research is needed Other: Approx. Percentage of Users (starters) still using the app as recommended after 3 months no ms number (yet) / not (yet) submitted to / published in JMIR Other: TITLE AND ABSTRACT 1a) TITLE: Identification as a randomized trial in the title yes Other: subitem not at all important 1 2 3 4 5 essential Manuscript tracking number * If this is a JMIR submission, please provide the manuscript tracking number under "other" (The ms tracking number can be found in the submission acknowledgement email, or when you login as author in JMIR. If the paper is already published in JMIR, then the ms tracking number is the four-digit number at the end of the DOI, to be found at the bottom of each published article in JMIR) ms#41800 1a) Does your paper address CONSORT item 1a? * I.e does the title contain the phrase "Randomized Controlled Trial"? (if not, explain the reason under "other") 1a-i) Identify the mode of delivery in the title Identify the mode of delivery. Preferably use "web-based" and/or "mobile" and/or "electronic game" in the title. Avoid ambiguous terms like "online", "virtual", "interactive". Use "Internet-based" only if Intervention includes non-web-based Internet components (e.g. email), use "computer-based" or "electronic" only if o ine products are used. Use "virtual" only in the context of "virtual reality" (3-D worlds). Use "online" only in the context of "online support groups". Complement or substitute product names with broader terms for the class of products (such as "mobile" or "smart phone" instead of "iphone"), especially if the application runs on different platforms. Does your paper address subitem 1a-i? * Copy and paste relevant sections from manuscript title (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Yes "A 9-Day "Mobile Health App" For Improving Body Image and Self-compassion in Young Adults: Randomized Controlled Trial With a 4-Week Follow-up"

1a-ii) Non-web-based components or important co-interventions in title
Mention non-web-based components or important co-interventions in title, if any (e.g., "with telephone support").
C l e a r s e l e c t i o n Does your paper address subitem 1a-ii?
Copy and paste relevant sections from manuscript title (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Item is not applicable as our study is evaluating a mobile app program, all components are mobile app based 1a-iii) Primary condition or target group in the title subitem not at all important 1 2 3 4 5 essential Does your paper address subitem 1a-iii? * Copy and paste relevant sections from manuscript title (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Yes "A 9-Day Mobile Health App For Improving Body Image and Self-compassion in Young Adults: Randomized Controlled Trial With a 4-Week Follow-up"

1b-i) Key features/functionalities/components of the intervention and comparator in the METHODS section of the ABSTRACT
Mention key features/functionalities/components of the intervention and comparator in the abstract. If possible, also mention theories and principles used for designing the site. Keep in mind the needs of systematic reviewers and indexers by including important synonyms. (Note: Only report in the abstract what the main paper is reporting. If this information is missing from the main body of text, consider adding it) C l e a r s e l e c t i o n Does your paper address subitem 1b-i? * Copy and paste relevant sections from the manuscript abstract (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Yes. "Methods: Participants (N=310) were randomized to a 9-day self-guided body image and self-compassion mHealth app (n=149) and to an active waitlist control group (n=161), where they completed a similarly structured 9-day program on cooperation. Both programs consisted of content learning and activities such as quizzes, with the number and length of activities matched for both programs. Measures were obtained at baseline, upon completion of the programs (after the intervention), and at 4-week follow-up." Your response is too large. Try shortening some answers.
subitem not at all important 1 2 3 4 5 essential subitem not at all important 1 2 3 4 5 essential 1b-ii) Level of human involvement in the METHODS section of the ABSTRACT Clarify the level of human involvement in the abstract, e.g., use phrases like "fully automated" vs. "therapist/nurse/care provider/physician-assisted" (mention number and expertise of providers involved, if any). (Note: Only report in the abstract what the main paper is reporting. If this information is missing from the main body of text, consider adding it) C l e a r s e l e c t i o n Does your paper address subitem 1b-ii?
Copy and paste relevant sections from the manuscript abstract (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Yes "Methods: Participants (N=310) were randomized to a 9-day self-guided body image and self-compassion mHealth app (n=149) and to an active waitlist control group (n=161), where they completed a similarly structured 9-day program on cooperation." 1b-iii) Open vs. closed, web-based (self-assessment) vs. face-to-face assessments in the METHODS section of the ABSTRACT Mention how participants were recruited (online vs. o ine), e.g., from an open access website or from a clinic or a closed online user group (closed usergroup trial), and clarify if this was a purely web-based trial, or there were face-to-face components (as part of the intervention or for assessment). Clearly say if outcomes were self-assessed through questionnaires (as common in web-based trials subitem not at all important 1 2 3 4 5 essential Does your paper address subitem 1b-iii? Copy and paste relevant sections from the manuscript abstract (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Unable to include in the current abstract due to word count limitations 1b-iv) RESULTS section in abstract must contain use data subitem not at all important 1 2 3 4 5 essential Does your paper address subitem 2a-i? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Yes. "Emerging adulthood often marks the onset of body image concerns [36]. Presently, most intervention programs are designed for female participants and are conducted in Western populations. The Body Project was only recently modified to cater to male participants and mixed-sex groups [42][43][44]. However, these programs are conducted face-toface and not on mobile platforms. Evidence is emerging that mobile apps can provide convenient, effective, and cost-friendly mental health interventions [45]. Therefore, this study evaluated the effectiveness of a self-guided mHealth body image app for both female and male participants. The app adopted both cognitive dissonance and self-compassion approaches, covering the following three topics: media literacy, appearance comparisons, and self-compassion. These topics were selected because of the robust empirical evidence that has been found for their role as risk and protective factors of body image concerns. The content was adapted from existing evidence-based interventions for body image, eating disorders, and self-compassion [46][47][48][49][50]. We predicted that the intervention would lead to significant improvements on measures of body image and self-compassion after the intervention and 4-week follow-up, compared with an active waitlist control group." 2a-ii) Scientific background, rationale: What is known about the (type of) system Does your paper address subitem 2a-ii? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Yes "Background Body image problems are highly prevalent among adolescents and young adults and have been frequently implicated in the development and maintenance of problematic eating behaviors [1,2] and body dysmorphic disorder [3,4]. Young adults may be particularly vulnerable to developing body image problems because of particular risk factors associated with this life period [5,6]. As young people transition through this developmental period, their bodies change in height, weight, and proportion while being exposed to social pressures associated with physical appearances [7]. Sociocultural factors play an important role in the development of body image concerns. According to the tripartite influence model, media, peers, and parents are the main sources of social influence on an individual's body image [8]. These influences largely take place through appearance-ideal internalization and appearance comparisons [9]. Research has shown that women tend to desire the thin-ideal, whereas men desire muscularity and weight [10]. Appearance-ideal internalization was found to mediate the relationship between sociocultural influences and body dissatisfaction [11,12], with greater internalization exacerbating body dissatisfaction [9]. This suggests that reducing the internalization of appearance ideals likely decreases body dissatisfaction.
Individuals tend to engage in upward appearance comparison, whereby they compare their appearance to others whom they perceive to be more attractive [13]. Consequently, they experience lower body esteem and higher body dissatisfaction, which perpetuate further appearance comparison [9,14].
Exposure to media contributes to appearance-ideal internalization and appearance comparison. Media and social networking platforms are filled with ideal-looking images of the self and others which are often skewed representations of reality [15,16]. Through social learning, individuals tend to normalize such content and internalize them as reality [15,17]. Moreover, individuals with vulnerability factors such as preexisting body image concerns, low self-esteem, depression, perfectionism, or overvalued appearance ideals are more likely to engage in appearance comparison to seek assurance and validation [18]. Altogether, appearance comparison on media platforms contributes to the development and maintenance of body dissatisfaction [9], highlighting the importance of addressing media literacy in reducing body image concerns.
Among peers, appearance-focused comparison and appearance-related conversations and activities may also increase body dissatisfaction as they increase individuals' awareness of their bodies, strengthen the internalization of appearance ideals, and negatively alter personal attitudes and beliefs in relation to beauty standards [19].
Apart from sociocultural influences, ruminative cognitive styles have been associated with greater body dissatisfaction [20]. Rumination is a response style to distress wherein individuals focus on repetitive thoughts and feelings about the distress [21]. As such, distress arising from negative body image may elicit rumination about one's appearance, which in turn contributes to body dissatisfaction [22].
Positive Body Image and Self-compassion Positive body image is characterized as being accepting, appreciating, and respecting of our bodies through attending to the body's needs, protecting ourselves against unrealistic body Your response is too large. Try shortening some answers.
ideals, having broader conceptualizations of beauty, and filtering information in a bodyprotective manner [23,24]. In qualitative studies, participants with positive body image actively rejected unrealistic media images to protect their body image [25,26]. Growing literature highlights that self-compassion contributes to a positive body image [27]. Selfcompassion has been found to buffer the impact of media pressure on thin-ideal internalization in women [24], and to reduce body image distress and body dissatisfaction, reduce rumination, and increase body appreciation [24,25,46]. Homan and Tylka [30] highlighted that women who were high in self-compassion maintained high levels of body appreciation in the face of body-related comparisons. Thus, enhancing individuals' selfcompassion may reduce the effects of negative body image and promote positive body image.
Intervention programs targeting body image risk and protective factors have been developed in the last 2 decades. Psychoeducational and cognitive behavioral programs have been effective in improving body image concerns, reducing disordered eating behaviors and attitudes, thin-ideal internalization, and dieting in adolescents and young adults [31,32]. Dissonance-based interventions are also increasingly adopted to address health and social behaviors [33]. For example, the Body Project adopted dissonance-based approaches in a group setting by having participants voluntarily critique and take a counterattitudinal stance against the thin-ideal in verbal, written, and behavioral activities [34]. It was theorized that the discrepancy generated between participants' personal beliefs (eg, thinner is better) and the counterattitudinal arguments made against pursuing thinness would elicit discomfort, and the discomfort would be alleviated by adjusting their personal beliefs to be more in line with the anti-thin-ideal statements [34]. Efficacy trials of the Body Project showed reduced eating disorder risk factors (eg, thin-ideal internalization and body dissatisfaction) and fewer eating disorder symptoms in female adolescents and young adults with body image concerns compared with assessment-only control conditions or alternative interventions, with numerous effects sustained up to 3-year follow-ups [35,36]. The Body Project M designed for male participants found that cognitive dissonance approach improved outcomes related to male participants' dissatisfaction with body fat and muscularity, body appreciation, muscularity-enhancing behaviors, appearance comparison, and internalization after the intervention, with all outcomes except dissatisfaction with muscularity and internalization being sustained at 3-month follow-up [33]. Encouraging findings were also found for the Body Project: More Than Muscles, wherein significant reductions were observed for several eating disorder risk factors and muscularity and body fat dissatisfaction in male participants, with some outcomes maintained at the 4-week followup [34]. A further extension of the Body Project, the Body Project 4 All, evaluated the effectiveness of a mixed-sex program which found gains to be sustained over a 6-month follow-up [35]. Meta-analyses confirmed the effectiveness of dissonance-based programs [36,37]. Altogether, these studies suggest that dissonance-based interventions are promising in improving body image concerns in male and female participants.
The direct challenging of the thin-ideal within dissonance-based interventions differs somewhat from a self-compassion approach, which aims to promote greater awareness of adverse outcomes created by the thin-ideal. In response to this awareness, self-compassion interventions engender a mindset that promotes self-kindness and connection with others in the face of body image concerns. In other words, self-compassion approaches seek to alter the way in which individuals cope with the distress associated with negative body image [28,29] rather than changing body image itself.
Self-compassion interventions are gaining empirical support in alleviating body image concerns. Self-compassion meditation and single-session self-compassion writing tasks can reduce women's body dissatisfaction and body shame and improve self-compassion and body appreciation [28,37]. A recent RCT by Toole et al [38] found self-compassion and dissonance-based interventions for young women with body image distress to be comparable with and more effective than waitlist control and suggested that integrating Your response is too large. Try shortening some answers.
2b) In INTRODUCTION: Specific objectives or hypotheses METHODS 3a) Description of trial design (such as parallel, factorial) including allocation ratio both self-compassion and dissonance-based approaches in interventions for body image may increase the acceptability of the interventions and reap more beneficial outcomes.
Self-guided, mobile-based body image programs have been developed and evaluated in light of technological advancements [39][40][41]. The 7-day mobile app study by Kosinski [40] led to a decrease in participants' body dissatisfaction, drive for thinness, and increase in selfesteem. Cerea et al [39] adopted a cognitive behavioral training approach with short, daily, cognitive training exercises for 16 days and found that it reduced body dissatisfaction in female university students. Finally, BodiMojo, a 6-week program, which involves sending daily intervention messages on body image and self-compassion-related content, increased appearance esteem and self-compassion in adolescents [41]. In a sample of high school and college students, BodiMojo improved participants' body image and self-compassion [41]." Does your paper address CONSORT subitem 2b? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Yes. "Therefore, this study evaluated the effectiveness of a self-guided mHealth body image app for both female and male participants." and "We predicted that the intervention would lead to significant improvements on measures of body image and self-compassion after the intervention and 4-week follow-up, compared with an active waitlist control group." 3b) Important changes to methods after trial commencement (such as eligibility criteria), with reasons subitem not at all important 1 2 3 4 5 essential Does your paper address CONSORT subitem 3a? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Yes. "Thereafter, participants were randomized to 1 of 2 conditions, intervention or active waitlist control, using simple randomization procedures. In this study, blinding of participants was marginally feasible as the content of the intervention programs that the participants engaged in were different in nature. However, participants were not outwardly informed of the real function of each intervention condition or of the real nature of the study being to evaluate the effectiveness of the body image program. The title of the study made known to participants was kept general (The effectiveness of a self-guided mobile phone application in improving the way we see ourselves and our bodies) to reduce the demand characteristics of the participants." Does your paper address CONSORT subitem 3b? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study No important changes to methods after trial commencement

3b-i) Bug fixes, Downtimes, Content Changes
Bug xes, Downtimes, Content Changes: ehealth systems are often dynamic systems. A description of changes to methods therefore also includes important changes made on the intervention or comparator during the trial (e.g., major bug xes or changes in the functionality or content) (5-iii) and other "unexpected events" that may have in uenced study design such as staff changes, system failures/downtimes, etc.

4a) Eligibility criteria for participants
subitem not at all important 1 2 3 4 5 essential Does your paper address subitem 3b-i?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study No important changes made on the intervention or comparator during the trial Does your paper address CONSORT subitem 4a? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Yes. "The sample consisted of 310 female (age: mean 21.12, SD 2.07 years) and male (age: mean 22.68, SD 2.10 years) adults aged between 18 to 30 years, recruited from the department of psychology's research participant pool and the research recruitment platform of the National University of Singapore"

4a-i) Computer / Internet literacy
Computer / Internet literacy is often an implicit "de facto" eligibility criterion -this should be explicitly clari ed. subitem not at all important 1 2 3 4 5 essential Does your paper address subitem 4a-i?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Participants in our study are required to register for the study via an web-based link in order to take part in the study.
4a-ii) Open vs. closed, web-based vs. face-to-face assessments: Open vs. closed, web-based vs. face-to-face assessments: Mention how participants were recruited (online vs. o ine), e.g., from an open access website or from a clinic, and clarify if this was a purely web-based trial, or there were face-to-face components (as part of the intervention or for assessment), i.e., to what degree got the study team to know the participant. In online-only trials, clarify if participants were quasi-anonymous and whether having multiple identities was possible or whether technical or logistical measures (e.g., cookies, email con rmation, phone calls) were used to detect/prevent these.
C l e a r s e l e c t i o n Does your paper address subitem 4a-ii? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Yes. "The sample consisted of 310 female (age: mean 21.12, SD 2.07 years) and male (age: mean 22.68, SD 2.10 years) adults aged between 18 to 30 years, recruited from the department of psychology's research participant pool and the research recruitment platform of the National University of Singapore." and "Data collection took place in Singapore in an entirely web-based setting." Your response is too large. Try shortening some answers.
subitem not at all important 1 2 3 4 5 essential 4b) Settings and locations where the data were collected 4a-iii) Information giving during recruitment Information given during recruitment. Specify how participants were briefed for recruitment and in the informed consent procedures (e.g., publish the informed consent documentation as appendix, see also item X26), as this information may have an effect on user self-selection, user expectation and may also bias results.
C l e a r s e l e c t i o n Does your paper address subitem 4a-iii?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Yes. "Procedure and Participant Flow Participants first read the Participation Information Sheet on Qualtrics. After providing informed consent, participants completed measures on body image, body image risk factors, and self-compassion to obtain baseline ratings. Thereafter, participants were randomized to 1 of 2 conditions, intervention or active waitlist control, using simple randomization procedures. In this study, blinding of participants was marginally feasible as the content of the intervention programs that the participants engaged in were different in nature. However, participants were not outwardly informed of the real function of each intervention condition or of the real nature of the study being to evaluate the effectiveness of the body image program. The title of the study made known to participants was kept general (The effectiveness of a self-guided mobile phone application in improving the way we see ourselves and our bodies) to reduce the demand characteristics of the participants.
Next, the participants downloaded the mobile app and were guided on how to navigate the app. Participants in the intervention group underwent 9 days of body image training, while participants in the active waitlist control group underwent 9 days of the cooperation learning program. The anticipated time participants spent on each program was comparable (<5 minutes per day)." Your response is too large. Try shortening some answers.
subitem not at all important 1 2 3 4 5 essential Does your paper address CONSORT subitem 4b? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Yes. "Data collection took place in Singapore in an entirely web-based setting." 4b-i) Report if outcomes were (self-)assessed through online questionnaires Clearly report if outcomes were (self-)assessed through online questionnaires (as common in web-based trials) or otherwise.
C l e a r s e l e c t i o n Does your paper address subitem 4b-i? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Yes. "After providing informed consent, participants completed measures on body image, body image risk factors, and self-compassion to obtain baseline ratings." and "Participants filled out the same questionnaires upon program completion (postintervention measure) and after 4 weeks (follow-up measure). The feedback questionnaire was administered only after the intervention." Your response is too large. Try shortening some answers.
subitem not at all important Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Not applicable to our study. There are no institutional affiliations relevant in our study.

5-i) Mention names, credential, affiliations of the developers, sponsors, and owners
Mention names, credential, a liations of the developers, sponsors, and owners [6] (if authors/evaluators are owners or developer of the software, this needs to be declared in a "Con ict of interest" section or mentioned elsewhere in the manuscript). subitem not at all important 1 2 3 4 5 essential Does your paper address subitem 5-i?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Yes. "The study was partly funded by Intellect Pte Ltd. The study design, data management, interpretation, analysis, and reporting and the decision to publish the study are entirely independent of Intellect Pte Ltd." and "OS had a research collaboration with Intellect Pte Ltd at the time of the data collection and has since joined Intellect Pte Ltd as their clinical director."

5-ii) Describe the history/development process
Describe the history/development process of the application and previous formative evaluations (e.g., focus groups, usability testing), as these will have an impact on adoption/use rates and help with interpreting results.
C l e a r s e l e c t i o n Your response is too large. Try shortening some answers.
Does your paper address subitem 5-ii?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Yes. "The app adopted both cognitive dissonance and self-compassion approaches, covering the following three topics: media literacy, appearance comparisons, and selfcompassion. These topics were selected because of the robust empirical evidence that has been found for their role as risk and protective factors of body image concerns. The content was adapted from existing evidence-based interventions for body image, eating disorders, and self-compassion"; "Body Image Program This 9-day program adopted cognitive dissonance and self-compassion approaches designed around the following three topics: media literacy, appearance comparison, and self-compassion. At the start of each 3-day period, the participants underwent a 5-minute content learning and dissonance-based or self-compassion activity related to the topic (Textbox 1). The dissonance-based activity involved participants challenging sociocultural influences regarding media messages, appearance ideals, and appearance comparison. Participants typed their answers to questions which guided them in challenging sociocultural ideals. Self-compassion interventions involved psychoeducation and experiential activities. Participants were also given a cognitive or behavioral task which encouraged noticing and challenging sociocultural influences in their daily lives, or practicing self-compassion. Daily body image and self-compassion-focused messages were sent through the app to participants thrice a day, messages modeled after the BodiMojo mobile app (Table 1) [41]. These intervention messages included psychoeducation, affirmations, behavioral tips, short activities, and quizzes to reinforce participants' learning ( Figure 1)." "Cooperation Learning Program Participants in the active waitlist control group engaged in a self-guided learning program on cooperation. The active waitlist control group was chosen instead of a waitlist control as it serves as an attention control to create similar experiences for participants in both groups to control for nonspecific factors that may influence the study outcomes [54]. This 9-day learning program develops participants' skills to improve group morale and relationships. It consists of content learning once a day and activities such as quizzes, and the number and length of activities was matched to the body image app." Your response is too large. Try shortening some answers.
subitem not at all important

5-iii) Revisions and updating
Revisions and updating. Clearly mention the date and/or version number of the application/intervention (and comparator, if applicable) evaluated, or describe whether the intervention underwent major changes during the evaluation process, or whether the development and/or content was "frozen" during the trial. Describe dynamic components such as news feeds or changing content which may have an impact on the replicability of the intervention (for unexpected events see item 3b).
C l e a r s e l e c t i o n Does your paper address subitem 5-iii?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Not appplicable for our study-there is only one version of the program to date.

5-iv) Quality assurance methods
Provide information on quality assurance methods to ensure accuracy and quality of information provided [1], if applicable. subitem not at all important 1 2 3 4 5 essential Does your paper address subitem 5-iv?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Yes. "Most outcome variables met the assumption tests for ANCOVA. The homogeneity of variance assumption was violated for a small number of outcome measures. However, because of the robustness of ANCOVA when sample sizes in each group are relatively equal [65], analysis using ANCOVA proceeded. The assumption of independence between independent variable and covariate was met for all outcome measures (P>.20), except BIQ for male participants. The assumption of homogeneity of regression slopes were violated in 2 variables for female participants (postintervention BIQ; postintervention SATAQ-4R Internalisation: Thin/Low Body Fat). For these variables, 1-way ANOVA was conducted using differences in scores between baseline and after the intervention and baseline and followup, respectively." and "The coauthor (OS) also provided supervision of the overall study" 5-v) Ensure replicability by publishing the source code, and/or providing screenshots/screen-capture video, and/or providing flowcharts of the algorithms used Ensure replicability by publishing the source code, and/or providing screenshots/screencapture video, and/or providing owcharts of the algorithms used. Replicability (i.e., other researchers should in principle be able to replicate the study) is a hallmark of scienti c reporting.
C l e a r s e l e c t i o n

Does your paper address subitem 5-v?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Yes. Screenshots and flowcharts have been uploaded through the submission system.

5-vi) Digital preservation
Digital preservation: Provide the URL of the application, but as the intervention is likely to change or disappear over the course of the years; also make sure the intervention is archived (Internet Archive, webcitation.org, and/or publishing the source code or screenshots/videos alongside the article). As pages behind login screens cannot be archived, consider creating demo pages which are accessible without login.
C l e a r s e l e c t i o n Does your paper address subitem 5-vi?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Yes. Screenshots of the app program are provided. The app program is currently not readily available as a URL.

5-vii) Access
Access: Describe how participants accessed the application, in what setting/context, if they had to pay (or were paid) or not, whether they had to be a member of speci c group. If known, describe how participants obtained "access to the platform and Internet" [1]. To ensure access for editors/reviewers/readers, consider to provide a "backdoor" login account or demo mode for reviewers/readers to explore the application (also important for archiving purposes, see vi). subitem not at all important 1 2 3 4 5 essential Does your paper address subitem 5-vii? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Yes. "Participants first read the Participation Information Sheet on Qualtrics. After providing informed consent, participants completed measures on body image, body image risk factors, and self-compassion to obtain baseline ratings. Thereafter, participants were randomized to 1 of 2 conditions, intervention or active waitlist control, using simple randomization procedures.", "Next, the participants downloaded the mobile app and were guided on how to navigate the app. Participants in the intervention group underwent 9 days of body image training, while participants in the active waitlist control group underwent 9 days of the cooperation learning program", " Does your paper address subitem 5-viii? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Yes. "The app adopted both cognitive dissonance and self-compassion approaches, covering the following three topics: media literacy, appearance comparisons, and selfcompassion. These topics were selected because of the robust empirical evidence that has been found for their role as risk and protective factors of body image concerns. The content was adapted from existing evidence-based interventions for body image, eating disorders, and self-compassion"; "Body Image Program This 9-day program adopted cognitive dissonance and self-compassion approaches designed around the following three topics: media literacy, appearance comparison, and self-compassion. At the start of each 3-day period, the participants underwent a 5-minute content learning and dissonance-based or self-compassion activity related to the topic (Textbox 1). The dissonance-based activity involved participants challenging sociocultural influences regarding media messages, appearance ideals, and appearance comparison. Participants typed their answers to questions which guided them in challenging sociocultural ideals. Self-compassion interventions involved psychoeducation and experiential activities. Participants were also given a cognitive or behavioral task which encouraged noticing and challenging sociocultural influences in their daily lives, or practicing self-compassion. Daily body image and self-compassion-focused messages were sent through the app to participants thrice a day, messages modeled after the BodiMojo mobile app (Table 1) [41]. These intervention messages included psychoeducation, affirmations, behavioral tips, short activities, and quizzes to reinforce participants' learning ( Figure 1)." "Cooperation Learning Program Participants in the active waitlist control group engaged in a self-guided learning program on cooperation. The active waitlist control group was chosen instead of a waitlist control as it serves as an attention control to create similar experiences for participants in both groups to control for nonspecific factors that may influence the study outcomes [54]. This 9-day learning program develops participants' skills to improve group morale and relationships. It consists of content learning once a day and activities such as quizzes, and the number and length of activities was matched to the body image app." Your response is too large. Try shortening some answers.
subitem not at all important 1 2 3 4 5 essential 5-ix) Describe use parameters Describe use parameters (e.g., intended "doses" and optimal timing for use). Clarify what instructions or recommendations were given to the user, e.g., regarding timing, frequency, heaviness of use, if any, or was the intervention used ad libitum.
C l e a r s e l e c t i o n Does your paper address subitem 5-ix?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Yes. "The anticipated time participants spent on each program was comparable (<5 minutes per day)." "Body Image Program ....At the start of each 3-day period, the participants underwent a 5-minute content learning and dissonance-based or self-compassion activity related to the topic (Textbox 1). The dissonance-based activity involved participants challenging sociocultural influences regarding media messages, appearance ideals, and appearance comparison. Participants typed their answers to questions which guided them in challenging sociocultural ideals. Self-compassion interventions involved psychoeducation and experiential activities. Participants were also given a cognitive or behavioral task which encouraged noticing and challenging sociocultural influences in their daily lives, or practicing self-compassion. Daily body image and self-compassion-focused messages were sent through the app to participants thrice a day, messages modeled after the BodiMojo mobile app (Table 1) [41]. These intervention messages included psychoeducation, affirmations, behavioral tips, short activities, and quizzes to reinforce participants' learning ( Figure 1)." "Cooperation Learning Program ....This 9-day learning program develops participants' skills to improve group morale and relationships. It consists of content learning once a day and activities such as quizzes, and the number and length of activities was matched to the body image app." Your response is too large. Try shortening some answers.

5-x) Clarify the level of human involvement
Clarify the level of human involvement (care providers or health professionals, also technical assistance) in the e-intervention or as co-intervention (detail number and expertise of professionals involved, if any, as well as "type of assistance offered, the timing and frequency of the support, how it is initiated, and the medium by which the assistance is delivered". It may be necessary to distinguish between the level of human involvement required for the trial, and the level of human involvement required for a routine application outside of a RCT setting (discuss under item 21 -generalizability).
C l e a r s e l e c t i o n

Does your paper address subitem 5-x?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Yes. "Data collection took place in Singapore in an entirely web-based setting."

5-xi) Report any prompts/reminders used
Report any prompts/reminders used: Clarify if there were prompts (letters, emails, phone calls, SMS) to use the application, what triggered them, frequency etc. It may be necessary to distinguish between the level of prompts/reminders required for the trial, and the level of prompts/reminders for a routine application outside of a RCT setting (discuss under item 21 -generalizability). subitem not at all important 1 2 3 4 5 essential 6a) Completely defined pre-specified primary and secondary outcome measures, including how and when they were assessed Does your paper address subitem 5-xi? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Yes. "Daily body image and self-compassion-focused messages were sent through the app to participants thrice a day, messages modeled after the BodiMojo mobile app (Table 1) [41]. These intervention messages included psychoeducation, affirmations, behavioral tips, short activities, and quizzes to reinforce participants' learning ( Figure 1)."

5-xii) Describe any co-interventions (incl. training/support)
Describe any co-interventions (incl. training/support): Clearly state any interventions that are provided in addition to the targeted eHealth intervention, as ehealth intervention may not be designed as stand-alone intervention. This includes training sessions and support [1]. It may be necessary to distinguish between the level of training required for the trial, and the level of training for a routine application outside of a RCT setting (discuss under item 21 -generalizability. C l e a r s e l e c t i o n Does your paper address subitem 5-xii? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Not applicable. No other co-interventions were required for our study.
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Does your paper address CONSORT subitem 6a? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Yes. "Outcome Measures Overview Body Image Ideals Questionnaire (BIQ [56]) is a 22-item scale that assesses body image satisfaction-dissatisfaction by measuring the degree of congruence or discrepancy in one's perceived and idealized physical attributes. On a scale ranging from 0 (exactly as I am) to 3 (very unlike me), participants rated the degree to which they resembled their physical ideal on 11 physical attributes. Next, participants rated the importance that they assigned to attaining their ideal on each physical attribute. The cross-products of the discrepancy and importance ratings for each physical attribute were obtained and a composite BIQ score was computed. Higher scores indicated greater disparity between one's perceived and ideal physical attributes, suggesting higher levels of body dissatisfaction. The BIQ showed good internal consistency, with a Cronbach α of .81 for male participants and .76 for female participants.
The Body Appreciation Scale-2 (24) is a 10-item scale that assesses individuals' positive attitudes toward their bodies. The items are scored on a scale from 1 (never) to 5 (always). Scores on all items are averaged with higher scores indicating greater body appreciation. The Body Appreciation Scale-2 has excellent internal consistency, with a Cronbach α of .96 for male participants and .97 for female participants.
The Sociocultural Attitudes Toward Appearance Questionnaire-4 Revised [57] measures internalization ideals and appearance-related sociocultural pressures. The 7 subscales consist of 31 items for female participants and 28 items for male participants on a scale ranging from 1 (definitely disagree) to 5 (definitely agree). Higher scores on each subscale indicate higher levels of internalization and sociocultural pressure. In this study, the subscales of Internalisation: Thin/Low Body Fat (for female participants), Internalisation: Muscularity (for male participants), and Pressures: Peers and Media were used. The internal consistencies of the subscales are good, with Cronbach α of ≥.82 in a sample of university female participants and Cronbach α of ≥.75 in a sample of university male participants.
Self-Compassion Scale-Short Form [58] is a 12-item scale that measures self-compassion on 6 subscales. Each item is scored from 1 (almost never) to 5 (almost always). A total selfcompassion score is the mean of all 6 subscales, with higher scores indicating higher levels of self-compassion. The internal consistency of the scale is excellent, with a Cronbach α of .86. The online questionnaires are self-report items that has been used by other web-based studies. CHERRIES items were not applied for our study.

6a-ii) Describe whether and how "use" (including intensity of use/dosage) was defined/measured/monitored
Describe whether and how "use" (including intensity of use/dosage) was de ned/measured/monitored (logins, log le analysis, etc.). Use/adoption metrics are important process outcomes that should be reported in any ehealth trial.
C l e a r s e l e c t i o n Does your paper address subitem 6a-ii?
Copy and paste relevant sections from manuscript text Our paper did not address the item explicitly. However, back-end checks were conducted with The Intellect Company to ensure that participants completed all activities in the program before questionnaires were administered after intervention and before reimbursement.
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subitem not at all important 1 2 3 4 5 essential 6b) Any changes to trial outcomes after the trial commenced, with reasons 7a) How sample size was determined NPT: When applicable, details of whether and how the clustering by care provides or centers was addressed 6a-iii) Describe whether, how, and when qualitative feedback from participants was obtained Does your paper address CONSORT subitem 7b? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Not applicable. No interim analyses and stopping guidelines are required for our study.
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8b) Type of randomisation; details of any restriction (such as blocking and block size) 9) Mechanism used to implement the random allocation sequence (such as sequentially numbered containers), describing any steps taken to conceal the sequence until interventions were assigned 10) Who generated the random allocation sequence, who enrolled participants, and who assigned participants to interventions Does your paper address CONSORT subitem 8a? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Not applicable. Care providers were not required in our trial groups.
Does your paper address CONSORT subitem 8b? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Yes. "Thereafter, participants were randomized to 1 of 2 conditions, intervention or active waitlist control, using simple randomization procedures." Does your paper address CONSORT subitem 9? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study 11a) If done, who was blinded after assignment to interventions (for example, participants, care providers, those assessing outcomes) and how NPT: Whether or not administering co-interventions were blinded to group assignment subitem not at all important 1 2 3 4 5 essential Does your paper address CONSORT subitem 10? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study This was not explicitly written in the manuscript, but simple randomisation procedures were performed on the web-based sign up system--Qualtrics platform.

11a-i) Specify who was blinded, and who wasn't
Specify who was blinded, and who wasn't. Usually, in web-based trials it is not possible to blind the participants [1, 3] (this should be clearly acknowledged), but it may be possible to blind outcome assessors, those doing data analysis or those administering cointerventions (if any).
C l e a r s e l e c t i o n Does your paper address subitem 11a-i? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study This was not explicitly indicated on the manuscript, but the authors were not blinded. It was addressed that "blinding of participants was marginally feasible as the content of the intervention programs that the participants engaged in were different in nature. However, participants were not outwardly informed of the real function of each intervention condition or of the real nature of the study being to evaluate the effectiveness of the body image program. The title of the study made known to participants was kept general (The effectiveness of a self-guided mobile phone application in improving the way we see ourselves and our bodies) to reduce the demand characteristics of the participants." Your response is too large. Try shortening some answers.
subitem not at all important 1 2 3 4 5 essential 11b) If relevant, description of the similarity of interventions (this item is usually not relevant for ehealth trials as it refers to similarity of a placebo or sham intervention to a active medication/intervention) 11a-ii) Discuss e.g., whether participants knew which intervention was the "intervention of interest" and which one was the "comparator" Informed consent procedures (4a-ii) can create biases and certain expectations -discuss e.g., whether participants knew which intervention was the "intervention of interest" and which one was the "comparator".
C l e a r s e l e c t i o n Does your paper address subitem 11a-ii?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Yes. "In this study, blinding of participants was marginally feasible as the content of the intervention programs that the participants engaged in were different in nature. However, participants were not outwardly informed of the real function of each intervention condition or of the real nature of the study being to evaluate the effectiveness of the body image program. The title of the study made known to participants was kept general (The effectiveness of a self-guided mobile phone application in improving the way we see ourselves and our bodies) to reduce the demand characteristics of the participants." Your response is too large. Try shortening some answers.
12a) Statistical methods used to compare groups for primary and secondary outcomes NPT: When applicable, details of whether and how the clustering by care providers or centers was addressed subitem not at all important 1 2 3 4 5 essential Does your paper address CONSORT subitem 11b? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Yes. "It consists of content learning once a day and activities such as quizzes, and the number and length of activities was matched to the body image app." and "Participants in the intervention group underwent 9 days of body image training, while participants in the active waitlist control group underwent 9 days of the cooperation learning program. The anticipated time participants spent on each program was comparable (<5 minutes per day)." Does your paper address CONSORT subitem 12a? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Yes. Paragraphs on "Analytical approach" describes the statistical methods adopted.

12a-i) Imputation techniques to deal with attrition / missing values
Imputation techniques to deal with attrition / missing values: Not all participants will use the intervention/comparator as intended and attrition is typically high in ehealth trials. Specify how participants who did not use the application or dropped out from the trial were treated in the statistical analysis (a complete case analysis is strongly discouraged, and simple imputation techniques such as LOCF may also be problematic [4]). Does your paper address subitem 12a-i? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Yes. "Intent-to-treat analyses were conducted to address loss of participant data because of participant withdrawal or technical difficulties, by carrying forward the participants' last reported score. " Does your paper address CONSORT subitem 12b? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Not applicable. No additional analyses were conducted in our study. Does your paper address subitem X26-i?

X26-i) Comment on ethics committee approval
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Yes. "Ethics approval for this study was obtained from the National University of Singapore's (NUS) Institutional Review Board (NUS-IRB-2021-85), and it was preregistered with ClinicalTrials.gov (registration number: NCT04977973)."

x26-ii) Outline informed consent procedures
Outline informed consent procedures e.g., if consent was obtained o ine or online (how? Checkbox, etc.?), and what information was provided (see 4a-ii). See [6] for some items to be included in informed consent documents.
C l e a r s e l e c t i o n Does your paper address subitem X26-ii?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Yes. "Participants first read the Participation Information Sheet on Qualtrics. After providing informed consent, participants completed measures on body image, body image risk factors, and self-compassion to obtain baseline ratings."

X26-iii) Safety and security procedures
Safety and security procedures, incl. privacy considerations, and any steps taken to reduce the likelihood or detection of harm (e.g., education and training, availability of a hotline) C l e a r s e l e c t i o n Your response is too large. Try shortening some answers.

RESULTS
13a) For each group, the numbers of participants who were randomly assigned, received intended treatment, and were analysed for the primary outcome NPT: The number of care providers or centers performing the intervention in each group and the number of patients treated by each care provider in each center 13b) For each group, losses and exclusions after randomisation, together with reasons Does your paper address subitem X26-iii?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study This was not explicitly written in our manuscript as there are no foreseeable discomforts and risks for participants.
Does your paper address CONSORT subitem 13a? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Yes. These information are clearly indicated on the Consort diagram and tables to the submission.
Does your paper address CONSORT subitem 13b? (NOTE: Preferably, this is shown in a CONSORT flow diagram) * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Yes. These information are clearly indicated on the Consort diagram and tables to the submission. Your response is too large. Try shortening some answers.  14a-i) Indicate if critical "secular events" fell into the study period Indicate if critical "secular events" fell into the study period, e.g., signi cant changes in Internet resources available or "changes in computer hardware or Internet delivery resources" C l e a r s e l e c t i o n Does your paper address subitem 14a-i?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Not applicable to our study-no critical secular events fell using study period.
Does your paper address CONSORT subitem 14b? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Not applicable. Trial did not end or stop early.
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subitem not at all important 1 2 3 4 5 essential 16) For each group, number of participants (denominator) included in each analysis and whether the analysis was by original assigned groups Does your paper address CONSORT subitem 15? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Yes.

15-i) Report demographics associated with digital divide issues
In ehealth trials it is particularly important to report demographics associated with digital divide issues, such as age, education, gender, social-economic status, computer/Internet/ehealth literacy of the participants, if known. 16-i) Report multiple "denominators" and provide definitions Report multiple "denominators" and provide de nitions: Report N's (and effect sizes) "across a range of study participation [and use] thresholds" [1], e.g., N exposed, N consented, N used more than x times, N used more than y weeks, N participants "used" the intervention/comparator at speci c pre-de ned time points of interest (in absolute and relative numbers per group). Always clearly de ne "use" of the intervention.
C l e a r s e l e c t i o n Does your paper address subitem 16-i? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Our app program runs for 9-days with clear instructions of use for all participants. Segment on "Body Image Program" and "Cooperation Learning Program" define each of the program usage clearly.

16-ii) Primary analysis should be intent-to-treat
Primary analysis should be intent-to-treat, secondary analyses could include comparing only "users", with the appropriate caveats that this is no longer a randomized sample (see 18-i). 17a) For each primary and secondary outcome, results for each group, and the estimated effect size and its precision (such as 95% confidence interval) subitem not at all important 1 2 3 4 5 essential Does your paper address subitem 16-ii?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Yes. "Intent-to-treat analyses were conducted for participants who were lost to follow-up by carrying forward their last reported scores. Missing scores for AES were substituted with the mean score. Independent t tests did not reveal any attrition-related biases across demographic and outcome variables (P>.10)." Does your paper address CONSORT subitem 17a? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Yes. Effect sizes of the main analyses outcomes are included in tables 6 and 7.

17a-i) Presentation of process outcomes such as metrics of use and intensity of use
In addition to primary/secondary (clinical) outcomes, the presentation of process outcomes such as metrics of use and intensity of use (dose, exposure) and their operational de nitions is critical. This does not only refer to metrics of attrition (13-b) (often a binary variable), but also to more continuous exposure metrics such as "average session length". These must be accompanied by a technical description how a metric like a "session" is de ned (e.g., timeout after idle time) [1] (report under item 6a).
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17b) For binary outcomes, presentation of both absolute and relative effect sizes is recommended 18) Results of any other analyses performed, including subgroup analyses and adjusted analyses, distinguishing pre-specified from exploratory Does your paper address subitem 17a-i?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Not applicable. Process outcomes were not used in this study.
Does your paper address CONSORT subitem 17b? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Not applicable. Outcomes are not binary in this study.
Does your paper address CONSORT subitem 18? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Not applicable-no other analyses are performed.
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subitem not at all important

18-i) Subgroup analysis of comparing only users
A subgroup analysis of comparing only users is not uncommon in ehealth trials, but if done, it must be stressed that this is a self-selected sample and no longer an unbiased sample from a randomized trial (see 16-iii).
C l e a r s e l e c t i o n Does your paper address subitem 18-i?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Not applicable. Subgroup analysis of comparing only users not conducted.
Does your paper address CONSORT subitem 19? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study There are no foreseeable discomforts and risks for participants in our study.
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subitem not at all important Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study The participant information sheet that participants read and consented as part of the study (segment on "Procedure and Participant Flow" in the paper) addressed privacy and confidentiality concerns, as well as who to contact should they require assistance. Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Not applicable. Qualitative feedback was not obtained in our study.

22-i)
Restate study questions and summarize the answers suggested by the data, starting with primary outcomes and process outcomes (use) Restate study questions and summarize the answers suggested by the data, starting with primary outcomes and process outcomes (use).
C l e a r s e l e c t i o n Does your paper address subitem 22-i? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Yes. "Discussion" segment of the paper described these information.
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subitem not at all important Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Yes. "As literature in this area remains relatively new, further research is required to improve our understanding of gender role norms in self-compassion, to effectively tailor selfcompassion approaches for female and male participants.", "To capture male participants' body image concerns more accurately, male-specific measures such as Male Body Attitudes Scale [90] can be used in future studies.", "Finally, in light of increasing studies which found self-compassion to mediate the effects of body image interventions, future studies can examine self-compassion as a mechanism of change. It would also be beneficial to obtain qualitative feedback from participants on elements of the body image program, such as their perception of the tone or number of intervention messages, to evaluate the effectiveness of the program."

20-i) Typical limitations in ehealth trials
Typical limitations in ehealth trials: Participants in ehealth trials are rarely blinded. Ehealth trials often look at a multiplicity of outcomes, increasing risk for a Type I error. Discuss biases due to non-use of the intervention/usability issues, biases through informed consent procedures, unexpected events.
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21) Generalisability (external validity, applicability) of the trial findings
NPT: External validity of the trial ndings according to the intervention, comparators, patients, and care providers or centers involved in the trial subitem not at all important 1 2 3 4 5 essential Does your paper address subitem 20-i? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Yes. "This study has some limitations. First, student participants may limit the generalizability of findings, as university students and the public may differ in factors such as level of education [89]. Hence, the university sample may not be representative of the general young adult population. Secondly, self-report measures are prone to social desirability bias, expectancies, and demand characteristics, which all may have contributed to the observed effects. Third, incentivizing participants with course credits or money may have motivated their participation and retention.
The sample size for male participants in our study was small despite additional recruitment efforts and thus was likely underpowered. Moreover, in view of sex differences in body image, more research is required to better understand ways to increase the effectiveness of mobile-based body image programs for male participants in a mixed-sex format and address muscularity concerns. "

21-i) Generalizability to other populations
Generalizability to other populations: In particular, discuss generalizability to a general Internet population, outside of a RCT setting, and general patient population, including applicability of the study results for other organizations Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Yes. "Future research should seek to further enhance the program's effectiveness with the wider young adult population." 21-ii) Discuss if there were elements in the RCT that would be different in a routine application setting Discuss if there were elements in the RCT that would be different in a routine application setting (e.g., prompts/reminders, more human involvement, training sessions or other cointerventions) and what impact the omission of these elements could have on use, adoption, or outcomes if the intervention is applied outside of a RCT setting.
C l e a r s e l e c t i o n Does your paper address subitem 21-ii?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study No applicable for our study.
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24)
Where the full trial protocol can be accessed, if available 25) Sources of funding and other support (such as supply of drugs), role of funders X27) Conflicts of Interest (not a CONSORT item) Does your paper address CONSORT subitem 23? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Trial Registration: ClinicalTrials.gov NCT04977973 Does your paper address CONSORT subitem 24? * Cite a Multimedia Appendix, other reference, or copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Not applicable. The authors of this study can be contacted for further queries pertaining to this study.
Does your paper address CONSORT subitem 25? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Yes. "The study was partly funded by Intellect Pte Ltd. The study design, data management, interpretation, analysis, and reporting and the decision to publish the study are entirely independent of Intellect Pte Ltd." Your response is too large. Try shortening some answers.
subitem not at all important 1 2 3 4 5 essential About the CONSORT EHEALTH checklist yes, major changes yes, minor changes no X27-i) State the relation of the study team towards the system being evaluated In addition to the usual declaration of interests ( nancial or otherwise), also state the relation of the study team towards the system being evaluated, i.e., state if the authors/evaluators are distinct from or identical with the developers/sponsors of the intervention.
C l e a r s e l e c t i o n Does your paper address subitem X27-i?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or brie y explain why the item is not applicable/relevant for your study Yes. "Conflicts of Interest The study was partly funded by Intellect Pte Ltd. The study design, data management, interpretation, analysis, and reporting and the decision to publish the study are entirely independent of Intellect Pte Ltd. OS had a research collaboration with Intellect Pte Ltd at the time of the data collection and has since joined Intellect Pte Ltd as their clinical director." As a result of using this checklist, did you make changes in your manuscript? * What were the most important changes you made as a result of using this checklist? STOP -Save this form as PDF before you click submit To generate a record that you lled in this form, we recommend to generate a PDF of this page (on a Mac, simply select "print" and then select "print as PDF") before you submit it.
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