Addressing Burn-Injury Stigma through Health Education and Communication Campaign in Pakistan: Study Protocol

Ozlem Eylem-van Bergeijk^1*Ali Hussain²Maria Panagioti¹Ameer B Khoso¹Zainab F Zadeh³Muhammad Rehan^4,5Tayyeba Kiran³Alexander Hodkinson¹Duolao Wang⁶Amy Blakemore¹Helen Brooks¹Tariq Iqbal^4,5Irfan Ullah⁷Muhammad Mustehsan Bashir⁸Samia Tasleem⁹Aamna Sanober¹⁰Nabila Soomro¹¹Rakhshi Memon¹²Nusrat Husain¹Nasim Chaudhry³

• ¹The University of Manchester, Manchester, United Kingdom
• ²University of Sharjah, Sharjah, United Arab Emirates
• ³Pakistan Institute of Living and Learning, Karachi, Punjab, Pakistan
• ⁴Other, Islamabad, Pakistan
• ⁵Department of Burn and Reconstructive Surgery, Burn Care Centre, Pakistan Institute of Medical Sciences, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan, Islamabad, Pakistan
• ⁶Liverpool School of Tropical Medicine, Liverpool, United Kingdom
• ⁷Department of Burns and Plastic Surgery Centre, Hayatabad Peshawar, Pakistan, Peshawar, Pakistan
• ⁸Other, Lahore, Pakistan
• ⁹Burns Center, Dr Ruth.K.M.Pfau Civil Hospital Karachi, Dow University of Health Sciences, Karachi, Pakistan, Karachi, Pakistan
• ¹⁰Department of Plastic Surgery, Faculty of Surgery & Allied Sciences, Liaquat University of Medical & Health Sciences, Jamshoro, Pakistan
• ¹¹Sindh Institute of Physical Medicine and Rehabilitation, Karachi, Pakistan, Karachi, Pakistan
• ¹²Department of Science and Technology Studies, Faculty of Mathematical and Physical Sciences, University College London, London, England, United Kingdom

Background: Burn injuries remain a neglected public health issue in low-and middle-income countries (LMICs). Up to 90% of burn injuries occur in LMICs, where there is a lack of appropriate burn prevention, acute care and rehabilitation services. When co-created with target populations, health education and communication campaigns could play a pivotal role in promoting risk assessment and improving knowledge, attitudes and practices regarding first aid for burns in low-resource settings.The present study protocol describes the design of a health education and communication campaign incorporating Photovoice, a co-creation approach, to improve knowledge, attitudes and practices regarding burn injuries in Pakistan. Methods and analysis: This cohort study will follow 600 participants (n = 600; n = 500 burn survivors; n = 100 caregivers) with three measurement points at 6-to 12-month intervals. The primary outcomes are knowledge, attitudes and practices regarding burn injuries. The secondary outcomes are meaning in life; gratitude, resentment and appreciation; hope; optimism; temporal satisfaction with life; coping strategies; social interaction anxiety; self-stigma and resilience, measured using the Meaning in Life Questionnaire, the Gratitude, Resentment and Appreciation Scale, the Adult Workers Hope Scale, the Patient Optimism Scale, the Temporal Satisfaction with Life Scale, the COPE Inventory, the Social Interaction Anxiety Scale, the Self-Stigma Scale and the Brief Resiliency Scale, respectively. The participants are grouped as follows: the exposure group (i.e. burn survivors [n = 200] and caregivers [n = 100] exposed to campaign messages), the non-exposure group (i.e. burn survivors [n = 250] not exposed to campaign messages) and the Photovoice group (i.e. burn survivors [n = 50] who participate in Photovoice and are exposed to the campaign messages). This design evaluates the impact of the health communication campaign and determines whether Photovoice has any additional effects on the primary and secondary outcomes. Ethics and dissemination: Ethical approval was obtained from the Pakistan National Bioethics (Approval ID: NBC-985) and Manchester University Research Ethics Committees (Approval ID: 2023-18027-31199). The results of this study will be distributed through public dissemination events, social media channels and peer-reviewed journals.