Primary prevention of eating disorders: characteristics of effective programmes and how to bring them to broader dissemination.
OBJECTIVE
Based upon the observation of advances in the primary prevention of eating disorders (ED), it is summarized that school-based programmes, focusing on risk factors for females with interactive elements, dissonance induction and booster sessions yield significant effects even under strong methodological conditions. However, beyond the presented research findings it remains often unclear, if and how programmes can be brought to a broader dissemination within a community, region or country.


METHODS
Introducing the programme PriMa (German school-based programme for the primary prevention of anorexia nervosa (AN) for girls up to the age of 12), we describe the process of programme evaluation (including 1.006 girls from 42 schools in Thuringia, Germany, who participated in a controlled study using a pre-post-design and a 3 months follow-up), programme implementation and development of follow-up programmes, including an intervention for boys and flanking secondary preventive actions (such as a telephone hotline).


RESULTS
Using standardized measures, the girls in the intervention group of PriMa reported significant improvements in body self esteem, figure dissatisfaction, knowledge and eating attitudes. The teachers, who conducted the programme, felt well qualified and were evaluated significantly positive by their students. Based upon the PriMa evaluation, we established a comprehensive health promotion programme at 60 Thuringian schools within the last 3 years, which could function as a model of a fruitful cooperation between a governmental institution (Thuringian Ministry of Culture) and a research institution (University Hospital Jena).


CONCLUSIONS
Existing programmes have the potential for effective prevention of ED. To confirm these effects under 'real world conditions' within a given community will still be a great challenge that often requires methodological and organizational concessions and compromises.
Berger
Uwe
U
Institute of Psychosocial Medicine and Psychotherapy, University Hospital, Friedrich-Schiller-University Jena, Germany. uwe.berger@uni-jena.de
Sowa
Melanie
M
Bormann
Bianca
B
Brix
Christina
C
Strauss
Bernhard
B
D000856:Anorexia Nervosa / Q000517:prevention & control* / Q000523:psychology; D001294:Attitude to Health; D001828:Body Image; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D015397:Program Evaluation / Q000379:methods / Q000706:statistics & numerical data*; D012307:Risk Factors; D012572:School Health Services / Q000706:statistics & numerical data*; D012649:Self Concept; D011795:Surveys and Questionnaires