Impact of pediatric burn camps on participants’ self esteem and body image: An empirical study
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.
References (22)
- et al.
Disfiguring burn scars and adolescent self-esteem
Burns
(1999) Body image: past, present, and future
Body Image
(2004)- et al.
Body image, mood and quality of life in young burn survivors
Burns
(2007) - et al.
Assessing body image in patients with systemic sclerosis (scleroderma): validation of the adapted satisfaction with appearance scale
Body Image
(2007) - et al.
Summer camps for children with burn injuries: a literature review
J Burn Care Res
(2010) - et al.
Impact of a pediatric residential burn camp experience on burn survivors’ perceptions of self and attitudes regarding the camp community
J Burn Care Res
(2007) - et al.
A Pan-European evaluation of residential burns camps for children and young people
Burns
(2009) - et al.
Shedding the layers: exploring the impact of the burn camp experience on adolescent campers’ body image
J Burn Care Rehabil
(2004) The challenge of evaluating rehabilitative activity holidays for burn-injured children: qualitative and quantitative outcome data from a burns camp over a five-year period
Dev Neurorehab
(2007)- et al.
The expectations and experiences of children attending burn camps: a qualitative study
J Burn Care Res
(2008)
Creating a social work link to the burn community: a research team goes to burn camp
Soc Work Health Care
Cited by (23)
Burn camps for burns survivors—Realising the benefits for early adjustment: A systematic review
2020, BurnsCitation Excerpt :Eight studies used standard validated scales to measure psychosocial outcomes, among which the Rosenberg Self-Esteem Scale was most common [13–15,20,21]. Other scales included the Satisfaction with Appearance Scale to assess body image [21], the Community Alienation Scale [15] and the Youth Experience Survey [16] and other scales. The qualitative studies largely focused on assessing experiences, benefits and/or feedback about burn camp [12,17–19].
Holistic burn care: Survival and beyond
2017, BurnsPatient opinion of scarring is multidimensional: An investigation of the POSAS with confirmatory factor analysis
2017, BurnsCitation Excerpt :Scarring has been associated with long term physical limitations including altered sensory function [7], chronic pain [8,9], chronic itch [10–14], and limitations to functional movement [15,16]. The psychosocial sequelae can include social stigmatism [3], social anxiety [17], discrimination [3,18], depression [19,20], post-traumatic stress [3,17] and poor body image [21–23]. Understanding the relationship between scar severity and quality of life outcome is integral to directing future treatment practices.
Childhood burn survivors' and their siblings' perceptions of their body image
2015, Journal of Pediatric Nursing