Elsevier

Burns

Volume 37, Issue 8, December 2011, Pages 1317-1325
Burns

Impact of pediatric burn camps on participants’ self esteem and body image: An empirical study

https://doi.org/10.1016/j.burns.2011.01.009Get rights and content

Abstract

Objective

This study focuses on possible effects of specialized summer camps on young burn survivors’ self esteem and body image.

Method

Quantitative as well as qualitative measures was used. To study possible effects, a pretest–posttest comparison group design with a follow-up was employed. Self-report questionnaires were used to measure self esteem and body image in a burn camp group (n = 83, 8–18 years) and in a comparison group of children with burns who did not attend a burn camp during the course of the study (n = 90, 8–18 years). Additionally, burn camp participants and parents completed an evaluation form about benefits derived from burn camp.

Results

A small positive short-term effect of burn camp participation was found on the ‘satisfaction with appearance’ component of body image. Overall, participants and parents showed high appreciation of the burn camps and reported several benefits, particularly concerning meeting other young burn survivors.

Conclusions

Albeit statistically modest, this is the first quantitative study to document on a significant short-term impact of burn camp on young burn survivors’ body image. Implications of this result for future research and burn camp organization were discussed, including the strengths of residential camps for young burn survivors.

Introduction

Originating in the US in the 1980s, specialized summer camps for children with burns have been organized for many years. Nowadays, numerous camps for pediatric burn survivors exist throughout the world [1]. Although locations and themes vary, the overall aims seem similar: to provide children with the opportunity to meet other children with burns in a warm and safe environment, to experience success, and to enhance self esteem through challenging activities [2]. Although most burn camps do not provide structured psychological interventions, they do offer companionship and a challenging program on top of pleasure and fun, and there are believed to be or may be psychosocial benefits from attending camp.

Several research initiatives to document potential psychological and social effects for participants have been performed. The outcomes from previous qualitative and quantitative studies are not uniform [1]. Qualitative reports, based on focus groups on burn camps, or evaluation forms from participants, parents, and staff completed shortly after camp, clearly indicate psychological benefits of attending camp. Positive experiences were for instance reported in self confidence or self esteem related topics, social skills, e.g. developing new relationships or working in a team, and burn scars or appearance related topics, e.g. more confidence to show scars, putting their scars in perspective, integrating scars in overall self image, and enhanced coping with a burn [2], [3], [4], [5], [6], [7]. As most quantitative studies that often investigated short-term effects on self esteem in relatively small samples could not confirm these positive statements [5], [8], [9], there is an ongoing research challenge to document potential benefits of pediatric burn camps [5].

Gaskell [5] proposed possible explanations for quantitative studies’ failure to find significant effects from pediatric burn camps. First, she argued that some children do benefit from burn camp, but others do not, because they may be doing well already before camp. Second, the questionnaires used may have been too general to grasp the particular changes that participants, parents, and staff members observe. Third, one might question whether a weeklong experience can, in the short, have such a substantial impact on a highly internalized complex construct as self esteem. A longer-term follow-up could possibly reveal, if present, a more gradual process. Last, a randomized controlled design may be a more appropriate design to study effects, but such a design would raise ethical issues since a control group would have to wait a year for burn camp participation.

The current study adopted some of the aforementioned suggestions and explored the effect of burn camp on self esteem and body image. Self esteem was selected as an outcome to enable comparison with previous research and to study potential longer-term effects. Although global self esteem in children with burns is generally reported to be comparable to norm populations or sometimes even more positive [10], [11], suggestions are also made that particular sub domains of self esteem might be impaired [12].

Additionally, we selected “satisfaction with appearance” as a quantitative outcome measure of body image. Body image has been described as the “inside view” people have of their appearance, i.e. a multidimensional concept referring to a package of perceptions, feelings, responses and evaluations about the body [13]. The few available studies describe an overall satisfying body image for children with burns [14], [15], but also for instance a relationship between more severe scarring and a more negative body image [15]. Several qualitative studies addressed the positive impact of burn camps on appearance related topics [3], [4], [7], however, no quantitative data have been reported concerning this topic.

Qualitative as well as quantitative measures were employed in the current study, since previous research clearly showed merit of using both methods together. Further, our research design included measurements before, shortly after, and well after burn camp to detect potential short-term and long-term changes. Multiple statistical methods were employed to accurately study possible effects of burn camp. Last, without randomization, an intervention group and a comparison group were composed following the naturalistic line of invitation procedure for Dutch pediatric burn camps. By means of this comprehensive research approach and the inclusion of another outcome measure besides self esteem, i.e. satisfaction with appearance that may be more susceptible to change, we attempted to grasp potential effects of burn camp participation.

Section snippets

Characteristics Dutch burn camps

In the Netherlands, three camps are held each year in springtime: a burn camp for children (ages 8–11), teenagers (ages 11–14), and adolescents (ages 14–18). The camps vary in length from 5 to 6 days. The Dutch burn camps are financially supported by the Foundation Child and Burn, making contribution for participants very low. All camp staffs consist of one or two coordinators, two cooking staff members, and approximately 10 volunteers. Most volunteers work in burn centres (e.g. medical

Participants

Table 1 shows demographic, burn, and burn camp characteristics of all study participants. Children in the burn camp group had more body zones with scars, more of them had visible scars, and more of them had attended a burn camp before, compared to children in the comparison group. There were no differences with regard to gender, age, number of years postburn, and etiology of the burns.

Short-term effects

Paired samples t-tests showed that SWAP-C-D Dissatisfaction With Appearance significantly decreased in the burn

Discussion

This is one of the few quantitative studies to report on a positive impact of burn camps regarding psychological outcome in young burn survivors, and the first study that documents a significant short-time change in satisfaction with appearance. This finding may be useful for future development of burn camp programs. As reported in other studies (e.g. [3]), participants and parents were very positive about the burn camp experience and personal benefits for the children, and no effect of burn

Conflict of interest statement

None declared.

Acknowledgements

This work was supported by the Dutch Foundation Child & Burn. We would like to thank all children and caregivers for their participation and Mr. Zuiker, Ms. Van Unen, Ms. Plantinga, Mr. Eshuis, Mr. Holtus, Mr. De Nooijer, Ms. Van de Steenoven, Ms. Stoker, Ms. Boerma, and Ms. Van Duinen for their assistance in the research project.

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