Burn injury is a traumatic injury particularly for a young person where experiences of pain, uncertainty, fear and trauma occur throughout the continuum of care. Burn injuries can leave patients with long-term physical scarring, psychosocial and psychological difficulties. These difficulties include facing the challenges of accepting an altered appearance and acceptance by others. This can be difficult given society’s preoccupation with physical appearance. Hence, stigmatisation is one of the commonly reported experiences of burn survivors.
For young people with burn scarring, these difficulties can continue over many years and can increase during specific developmental phases. Adolescence; is a significant time for young people as identity development and acceptance are important psychosocial tasks. The literature shows variance in psychosocial outcomes with some young people with burn scarring reporting positive adjustment and others experiencing psychosocial problems. Furthermore, there is a lack of understanding of young people’s experiences of burn scarring, how they view themselves and perceive others to view them in relation to their burn experience, and what effective interventions are available.
One intervention to help manage psychosocial recovery is cosmetic camouflage. Limited research exists investigating the efficacy of camouflage as a psychosocial intervention. Hence, the aims of this mixed methods study was to explore the psychosocial functioning of young people with burn scarring, as well as perceptions of self in the context of their burn scarring, their experiences with significant others and their social interactions more generally. It also investigated the efficacy of cosmetic camouflage (Microskin™) to improve psychosocial functioning. Whilst there are many facets to psychosocial functioning, this study focused on health-related quality of life (HRQoL), self-concept, behaviour, and family functioning.
This mixed methods sequential explanatory study consisted of a prospective multi-centre randomised control trial (RCT) using a wait-list design, followed by a qualitative component.
The RCT was conducted across six Australian and New Zealand paediatric hospitals and consisted of a battery of psychometric measures including the Pediatric Quality of Life Inventory (PedsQL), the Piers-Harris Self Concept Scale (P-H SCS), the Strengths and Difficulties questionnaire (SDQ) and the Family Assessment Device (FAD). The Microskin™ questionnaire (MSQ) that asked questions about the camouflage was also included. Sixty three participants (49 females, mean age 12.7±2.1 years) were enrolled.
Baseline data was compared with published norms of a matched sample of healthy controls and a cancer sample for Perceived Physical Appearance (PPA). For the RCT the intervention group completed baseline data, and were provided with Microskin™. Microskin™ can be colour corrected to the individuals’ skin tone and lasts on the skin for several days. Participants used Microskin™ over a six month period. The psychometric measures were repeated at 8, 16 and 24 weeks of use. The wait-list group completed baseline data with a re-test after an 8 week wait period. They were then offered Microskin™ with follow-up data collected at 8, 16 and 24 weeks of use. The qualitative phase consisted of semi-structured interviews conducted with 13 adolescents from the Brisbane study site. Interviews were chosen to gather rich data from the adolescents on the influence of a burn experience on perceptions and expectations of self and of others. A qualitative description methodology was employed, interviews were transcribed verbatim and analysed thematically.
Burn survivors and their caregivers reported significantly higher emotional and behavioural problems and lower HRQoL, but no significant differences in self-concept, compared to healthy counterparts. They also reported significantly poorer PPA than a matched paediatric cancer sample.
The intervention group demonstrated significant HRQoL improvements in socialization, school and PPA and a clear reduction in peer problems, following Microskin™. However self-concept remained stable from baseline throughout intervention. The qualitative results provided further understanding of the normative self-concept finding, with the analysis highlighting the continual tension adolescents experience due to shifting perceptions of self through their interactions and relationships within and across public and private spheres. This was implicated in how the young people described and understood their experiences in relation to family, peers and social interactions, and filtered the future through the burn experience.
The findings show that young people with burn scarring appear to have lower HRQoL particularly related to scarring and appearance and more behavioural problems than healthy controls. These differences seem to be connected to their social experiences and the influence of significant others’ on their perceptions of self which impacts overall psychosocial functioning. Cosmetic camouflage also appears to improve HRQoL and behaviour, specifically aspects related to social experiences. These findings highlight that young people with burn scarring require extensive psychosocial support including positive relationships with family and peers. These relationships influence perceptions of self and assist young people in building positive coping strategies to manage unpleasant social experiences that impact psychosocial functioning. These issues must be explored sensitively by the burn team and comprehensive support plans developed that include psychosocial and surgical interventions.