3.1.1 Lack of family communication.

Teachers acknowledged that adolescents need environments where they can talk and feel heard, although the adolescents confessed that physical appearance was not important in the family environment and that they did not discuss this topic with their parents. Some parents believed that talking too much to their children about BI and associated problems could be counterproductive. Additionally, both parents and teachers perceived that adolescents did not listen to them, with their valuing their friends’ opinions more.

‘Sometimes, students just need a space to chat openly, without any judgment, and spill the beans about what’s going on. They just want to feel heard’ T2

‘She thinks that if we tell her “you’re thin,” we’re telling her because I’m her mother and we want her to eat (...) In adolescence it’s more important what friends say or what someone who doesn’t know them at all says than their parents’ P7

The adolescents confirmed that they sought refuge in their friends due to a feeling of lack of communication and trust in the family environment, expressing that they would trust their parents more if they improved their communication skills.

‘You have to talk more with your parents. It depends on how, there are times when parents don’t give confidence (...) they are too strict and the children close up (...) You have to know how to give them confidence: I am your father, I am your mother... you have to have respect, but I want to have some confidence with you, I want to know how you feel, I want to know what you think, what has happened to you today, who you like....’ A8

3.1.2 Unfavourable family environment.

Teachers associated students with low SE or BD with unfavourable family environments. According to the teachers, parents with insecurities, fears, hypercritical attitudes, or high demands instilled insecurity, fear, and low SE in their children. They also reported examples of adolescents receiving negative comments from their parents regarding their BI, and encouraging unhealthy exercise and eating habits.

‘I find that when it comes to people with low self-esteem, with a somewhat negative perception of themselves, this can often be attributed to a disorganised and inconsistent family environment’ T6

‘If you have a father or a mother who is very insecure or afraid of everything, transmits this fear and insecurity. The child tends to be the same, not always, but in the majority of cases (...) Sometimes they tell me... my dad or my mom tells me I’m fat, that I shouldn’t eat’ T7

3.1.3 Lack of training.

Teachers acknowledged difficulties in managing complex situations in the classroom, leading them to request training to learn about strategies, management resources, and activities to promote healthy SE and BI. Additionally, they believed that the initiatives carried out in the classroom (See S3 File) should be reinforced at home, deeming it crucial to train parents to achieve collaborative work. Parents confirmed the need for training.

‘Parent education plays a significant role. As a teacher, what I’ve found is that parents are acting as pedagogues with their children to a lesser extent, that is, they subsist, they have a lot of doubts, and don’t know how to handle it (...) because we encounter many situations where we don’t know how to react, situations which are complex (...) If there is good training, and this is lacking, I think the rest is also easier to manage’ T2

‘All of us parents try to give as much as we can, the best advice we can. Now, maybe you don’t know enough or don’t have enough experience to explain things they need to know’ P5

Given the lack of training, both teachers and parents believed that it was most appropriate to seek help from educational psychologists, psychologists from the educational institution, and primary care professionals. For parents, consulting a doctor represented a quick solution to the problem.

‘If I can’t help her anymore, I would take her to a doctor quickly because the solution is a doctor and fixed quickly´ P3

3.1.4 SM influence.

Teachers perceived that adolescents are dissatisfied with themselves because of the physical and psychological changes they experience. According to the teachers, society promotes beauty standards through SM, which is saturated with inappropriate values and messages. Additionally, they believed that adolescents were unaware of the influence this has on their physical and mental well-being.

‘Always this background of social media, music... all of this that affects adolescents (...) negatively affects them a lot, and they don’t realise it’ T3

‘If I have a YouTuber as a role model, and a YouTuber can make a living, a very good one, by making four videos, why should I make an effort?’ T2

In contrast, adolescents were aware that SM led them to compare themselves with others based on certain beauty standards, thereby increasing their BI concerns and BD. They believed that it was challenging to prevent the risks of SM, although parents insisted on raising awareness among adolescents about how filters are used in photography to ‘enhance’ the body representations seen online.

‘On Instagram, everything looks perfect (...) people’s stories, their photos, you can say look at this one, and someone who feels bad about themselves sees it and thinks they want to be like that. This affects us more and more, what people will say and their opinions’ A2

‘Explain clearly what filters are and conduct many talks about internet-related topics, explaining the harm that a word can do to a person, which can destroy their life’ P7

3.1.5 Influence of gender stereotypes.

Adolescents and teachers believed that boys possessed better BI and greater self-confidence and placed less importance on physical appearance. However, girls believed that physical appearance was also a concern for boys, even if not explicitly expressed. Teachers acknowledged an increasing number of cases where boys felt uncomfortable about their physical appearance, which negatively impacted their involvement in collective activities.

‘Girls, more than boys, tend to obsess more about their appearance and chase an ideal (...) Boys might not talk about it, but they feel it inside too’ A4

‘Sometimes it seemed like this was more of a girls’ issue, but now we find it more in boys as well’ T2

‘Some boys, if they are chubby or have a belly, they are also ashamed of engaging in certain activities in public in front of others (...) They wear looser clothes, such as sweatshirts, even when it’s hot, or they don’t even want to take off their coats in the winter’ T7

Some teachers contended that girls were more affected by derogatory comments regarding their physical appearance. Girls deemed it necessary to engage in activities that promoted increased participation and awareness among boys. Furthermore, they proposed implementing separate gender-specific activities and a collective discussion to juxtapose viewpoints.

‘Some girls are having a hard time because of the comments boys are making (...) saying they’re fat, that they don’t have breasts, that their butt is big (…) Girls suffer more than boys, and boys can be quite cruel’ T3

‘If we conduct a workshop sometimes only for girls and only children? (...) Sometimes divided, we see the female perspective and the male perspective, and then we come together, and everyone learns more’ A8

3.1.6 Social rejection.

According to teachers, group acceptance would contribute to high SE. The majority of adolescents dressed similarly to feel part of the group, as they believed that both clothing style and personality traits influenced their social acceptance or rejection. Additionally, there was evidence of a minority of adolescents who did not identify with the group and tended to isolate themselves. Teachers hope that adolescents learn to respect and accept differences. To achieve this, the heterogeneity among students should be discussed across various subjects, involving the entire teaching staff.

‘I believe that if the group accepts you as you are, this raises your self-esteem because you see your own defects, but you notice that others don’t take them into account (...) I believe at this age, it’s the main factor’ T2

‘I want him to learn to accept and value those who are not like him. That’s my goal’ T7

3.2.1 Family involvement.

Parents and teachers acknowledged that the family plays a crucial role in the development of SE. For parents, having high SE and a healthy BI is important for life, and they believe that these aspects should be addressed within the school environment. Teachers believe that adolescents’ social environment influences their SE and BI, both relying on the values instilled by the family since childhood. They believed that parents should encourage effective communication with positive reinforcement, trust, and sincerity.

‘The family, in principle, is the first place. A solid family environment should be a certain degree of solidity and coherence with the parents or those who take charge. A certain coherence is also necessary in their attitudes, which can transmit values’ T6

‘I think it has to be in both places. I also don’t think that teachers can wash their hands of all this and say, “No, you do this at home.” I believe that at school, you can work on many things, and that’s good, because the parents are not there’ P2

‘Firstly, there should be complicity with the family to be able to talk, to explain things, not to hide from anything, not to establish taboos, right? They should be able to come home, express themselves, and vent their emotions, and from here, well, there should be good support’ T3

Parents confirmed and emphasised the importance of emotional bonds within the family and behaviours that reinforce positive attitudes towards adolescents, although they believed it was necessary to establish clear behavioural guidelines to instil a sense of security.

‘I really like to ask and ask. I know that sometimes they won’t tell me everything, but a mother with a child or a father has to have a lot of trust with their children’ P3

‘It is to provide positive reinforcement and make them see what they are worth, even if at school they are not made to see it or they do not fully see it, encouraging them to look for things they can excel in’ P2

‘I have always given them very clear guidelines on what to do in many situations (...) I believe all of this contributes to self-esteem, making them feel secure’ P4

3.2.2 Modelling as a strategy.

Parents and adolescents believed that gaining closer insights into the experiences of other teenagers or individuals with low SE or BD could assist them in reflecting on and reconsidering their own negative thoughts.

‘How do you achieve this self-esteem? What has happened to you to have this self-esteem? Because if I have self-esteem now, it does not mean that I had it five years ago, or that I have not been bullied or that I’ve always been the centre of attention. Each person has a way of behaving, and this behaviour depends on what has happened to them’ A8

‘I would conduct talks with adolescents who have self-esteem, who have gone through tough times, who have been hospitalised due to self-esteem issues... there are conditions like depression and other illnesses because of this. Real-life stories, people who can come and speak’ P7

For teachers, exposing adolescents to real-life cases could bring them closer to the sociocultural reality, enhancing their understanding of these issues.

‘Explain to others how you developed such high self-esteem and how you accept yourself, and then look for defects in yourself so that you can explain to others how you are aware of these defects and yet maintain your high self-esteem. That they have references that teach them that the image is not the primary thing in this life (...) People who have suffered, people who have gone through a process of self-knowledge and have felt, in quotes, mistreated by society for not being equal, the stereotypes that society imposes.(...) if they can see real examples, they will understand it much more than when conveyed just in words’ T3

3.3.1 Characteristics of activities.

Adolescents and teachers believed that individual activities could be more beneficial than group activities for improving SE, especially for adolescents concerned about their BI or those facing social rejection.

‘Depending on the activity, but group activities often make people who have some issues feel terrible (...) group activities, not at all´ T6

‘In a group, they wouldn’t open up as much, and they wouldn’t be as honest. If you go individually, I suppose you would help them more. I guess you’re afraid of expressing yourself in front of everyone´ A2

According to teachers and parents, the primary education stage (6 − 12 years of age) is the most suitable period for conducting activities, as they believe that SE is established during early adolescence.

‘Self-esteem is not at 16. Self-esteem is shaped at 9 (...) If you do it outside the centre, they won’t come´ P7

‘I think that primary school is a good time because that’s when they are perhaps more receptive (...) is where it has a greater impact, and in secondary school, you have to keep working, but in a more subtle and gradual way´ T5

Additionally, they considered the educational institution to be the best place for these activities, given the significant amount of time spent there. These explanations were supported by the majority of adolescents, although some expressed the opinion that discussions within the educational setting might be ineffective, suggesting alternative environments, including SM.

‘Sometimes what is said at school is like wow! It has been said at school! It’s something important, you know? When you’re young, the information really gets to you, and school is like going to university when you are 6 or 8 or 12 years old´ A8

‘In high school no one would pay much attention. They give talks and people end up doing what they want, they don’t listen (...) I believe it’s better through social media´ A1

‘Doing some kind of talk for those who are more interested, but not at the institute!´ A7

Some parents supported the use of social, sports, and extracurricular settings. Parents believed that successful activities should be proposed by the adolescents themselves, so they should be provided with the necessary resources and social support to carry them out. They also believed that including family members from various generations in leisure and recreational activities could be enriching and bring diverse perspectives.

‘What I would do is promote cultural entities and associations like the scouts, where everyone can participate (...) where everyone works equally, and I don’t know... as I would put it, socialize´ P5

‘Local associations, those places they go to because they want to (…) and in sports as well, and in extracurricular activities (…) If they need collaboration from the city council, it’s provided, but organizing things for them, I think, would be a mistake (…) They have to organize it themselves. It has to be their initiative, I think´ P2

‘I believe that activities should always involve more than one generation, but at the same time, they should be creative and fun (…) You enrich yourself when you have other perspectives´ P1

3.3.2 Proposed themes.

The majority of adolescents believed that future activities aimed at improving SE and BI should focus on normalising the understanding that there are all kinds of bodies, all of which are equally valid and can be healthy, without stigmatising or discriminating against individuals based on their appearance. They considered that addressing the effects of SM from early adolescence could prevent issues associated with BD and requested information on healthy eating and ED to increase social awareness. The adolescents deemed accepting oneself and self-love crucial for liberation from suffering.

‘There’s always talk about models being tall, having a 90-60-90 figure, and they have to be perfect (…) People give a very wrong idea about this, and on social media, you always see a certain type of person: the hot girl with a very big butt, and the hot guy is the one who is muscular and does abs (...) When you’re young, especially if you don’t talk about this with anyone and no one can help you, it’s normal that it affects you quite a bit´ A8

‘You really have to accept yourself as you are, because if not, you’ll suffer your whole life saying ‘I want to be like this,’ and in the end, you have to end up accepting yourself as you are (...) Don’t compare yourself to other people, if you can change something, then go ahead and try to feel good about yourself, because self-esteem and self-love are very important´ A6

‘Most of us who end up with eating disorders come from people’s comments (…) People give their opinions, and in reality, they don’t know anything and don’t realize how a comment can affect another person (...) The whole concept of miracle diets, all of this needs to be explained. Because I’ve also been a person who didn’t have the concepts of healthy eating´ A5

3.3.3 Types of activities.

Adolescents admitted to receiving informative talks in the educational environment on gender perspectives, gender-based violence, sexually transmitted diseases, and substance dependencies. However, they called for information on how to improve SE and activities with continuity over time. Therefore, they proposed workshops in educational institutions with recreational dynamics to work on SE and promote reflection.

‘Usually, they come to give us many talks about sexual diseases or drugs, but never about self-esteem´ A4

‘Surely there are workshops that can be fun and at the same time make you reflect. There are probably many specialists who know about these things and can conducting a workshop, for example, at school´ A8

However, parents and teachers considered it more appropriate for adolescents to have a subject on values and emotional education to encourage reflection and enhance social and emotional skills. Some teachers believed that these topics should not be addressed in a single subject but rather integrated throughout the school curriculum.

‘Emotional education is about working on the emotions of the students, firstly identifying which emotions exist, and secondly, figuring out how these emotions can be managed´ T2

‘For me, it’s a subject (...) about coexistence, values... everything, at school´ P7

‘From all subjects, it can be conveyed. Sometimes it feels like it’s only the tutor who has to do it or the teacher of culture and ethical values or religion who has to do it. But it’s not true, in the end, we all are providing a model of image´ T2