Lived Experiences In Burn Scar Management: A Qualitative Exploration of Perceived Intervention Effectiveness and Factors Influencing Adherence

Date of Award

5-2026

Degree Name

Doctor of Philosophy

Department

Interdisciplinary Health Sciences

First Advisor

Diane Dirette, Ph.D.

Second Advisor

Mary Lagerwey, Ph.D.

Third Advisor

Gregory Chown, OTD

Abstract

Burn injuries often result in scarring, which plays a role in physical functioning, such as the ability to move an affected joint or perform an everyday task, as well as psychosocial functioning, such as altered social functioning and impaired body image. Various approaches to scar management are used to reduce the consequences of scarring, including interventions such as pressure garments, laser therapy, scar massage, and silicone. Despite available interventions and some demonstrated efficacy in the literature, the development of scarring and subsequent associated consequences persist, leading some survivors to seek alternative interventions such as acupuncture or Reiki. A key component to understanding the success of and barriers to these scar management interventions is exploring the patients’ subjective experiences. Using an interpretive phenomenological approach, this qualitative study sought to explore burn survivors’ lived experiences of scar management interventions, including barriers and facilitators to engagement and perceived intervention effectiveness.

Data collected included a demographic survey, the patient scale of the Patient and Observer Scar Scales (POSAS), and in-depth, semi-structured interviews with ten burn survivors who had a history of burn scarring and engagement in scar management interventions. Data were analyzed using Braun & Clarke’s (2006) six-step approach to thematic analysis, which resulted in five superordinate themes: Long-Term Disruption and Identity Reconstruction, Integrating Scar Management into Everyday Life, Experiences of Scar Interventions, Systems, Access, and the Work of Getting Care, and Evaluating Scar Intervention Benefits, Limitations, and Adaptations, with additional subthemes identified for each superordinate theme.

Findings indicated that scar management was experienced within a broader context of life-altering and prolonged recovery, in which participants worked to integrate scar management interventions into their everyday lives and existing responsibilities. Motivation to engage in interventions varied by age at injury and life context, and at times varied throughout the course of recovery. Scar interventions were most often characterized as physically uncomfortable, with the appearance-altering burden of pressure garments being further highlighted. Additional barriers included financial concerns, limited resources, gaps in knowledge and preparedness, and accessibility issues, including access to specialized interventions and burn-competent providers and therapists.

Despite these apparent barriers, many participants continue to view interventions as non-negotiable and perceive effects including improved scar characteristics, improved range of motion, higher self-confidence, and overall improved function and quality of life. Key facilitators to intervention engagement included peer support, which provided validation, practical “tips and tricks”, and shared experiential knowledge, as well as family support. Establishing routines, flexible wear schedules, and the use of more acceptable alternatives, such as athletic compressive clothing, further supported engagement.

The findings from this study underscore the need for more preparation for burn recovery, greater integration of mental health and peer support into care, and more flexible interventions that can be adapted to changing motivation, roles, and life contexts. The findings further reveal gaps in burn-specific expertise, access, and insurance navigation, suggesting opportunities for improved provider education, expanded case management, and system-level approaches. These results emphasize the need for burn scar management programs that are not only clinically informed but also grounded in survivors’ realities, emphasizing feasibility, well-being, and participation in everyday life.

Access Setting

Dissertation-Abstract Only

Restricted to Campus until

5-1-2036

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