Short Communication
Nutrition and Health
Nutrition education programs for burn 1–7© The Author(s) 2023
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survivors: A scoping review sagepub.com/journals-permissions
DOI: 10.1177/02601060231203282
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Jonathan Bayuo1 , Joyce Pwara2, Jephtah Davids3,
Anita Eseenam Agbeko4, Pius Agbenorku5,6
and Paa Ekow Hoyte-Williams6
Abstract
Background: Despite the importance of nutrition education for burn survivors, only limited work has been done to
ascertain what is known about these education programs. Aim: To scope the existing literature to ascertain what is
known about the nature and outcomes associated with nutrition education programs for burn survivors, their families
and caregivers. Methods: Arksey and O’Malley scoping review approach were utilized with searches across peer-
reviewed databases and gray literature sources. Results: Six studies were retained. Five studies focused on burn survivors
and one focused on healthcare professionals. One study reported improved knowledge regarding postburn nutritional
support following the implementation of the nutrition counseling program. Three studies reported on the inclusion of
a nutrition education component in comprehensive postdischarge rehabilitation programs albeit no nutrition-specific out-
comes were reported. Conclusion: The review affirms the limited literature, highlighting a need for more work to
implement and evaluate outcomes of nutrition education programs for burn survivors.
Keywords
Burns, education, nutrition
Introduction literature. For instance, in a systematic review that included
six studies, the authors reported that the nutrition education
The occurrence of burns can lead to several physiological intervention had a positive effect in reducing biochemical
derangements which put an intense strain on an individual’s and anthropometric risk factors for chronic diseases in indi-
nutritional status. The resulting hypermetabolic state fol- genous Australians (Schembri et al., 2016). Another study
lowing the burn is often sustained and may persist for a pro- also observed that a nutrition education program for 3–
longed period. In fact, severe burns can accelerate a burn 6-year-olds was helpful in improving parental nutrition
patient’s metabolic state (Saffle et al., 2012). Without nutri- knowledge and positively shaping the family’s eating
tional support commensurate to their needs, persons reco- habits (Kostecka, 2022). A recent randomized controlled
vering from burns are predisposed to infections, poor trial has also reported that a tailor-made nutrition education
wound healing, prolonged inpatient stay, readmissions
and their associated increasing healthcare costs (Dijkink
et al., 2020), altered anthropometric measurements (such 1Department of Nursing and Midwifery, Presbyterian
as weight), and altered laboratory indices (such as low University, Agogo, Ghana
serum protein levels and nitrogen balance) (Saffle et al., 2 School of Nursing and Midwifery, University of Ghana, Legon, Ghana
3
2012). Working toward attaining optimum nutrition in Department of Nutrition, University of Ghana, Legon, Ghana
4
burn patients, therefore, remains paramount. Directorate of Surgery, Komfo Anokye Teaching Hospital, Kumasi,
Ghana
Attaining optimum nutrition in burn patients is an 5 School of Medicine and Dentistry, Kwame Nkrumah University of
ongoing process that does not end following discharge. Science and Technology, Kumasi, Ghana
Evidence suggests that support for caregivers often trans- 6Division of Plastic and Reconstructive Surgery, Directorate of Surgery,
lates to better support for the burn survivor (Ravindran Komfo Anokye Teaching Hospital, Kumasi, Ghana
et al., 2013). Despite these, burn survivors and their care-
Corresponding author:
givers are often ill-prepared to support the process, particu- Jonathan Bayuo, Department of Nursing & Midwifery, Presbyterian
larly after discharge. The impact of nutrition education in University, Ghana, Asante Akyem Campus, P.O. Box 42, Agogo, Ghana.
other disease states has been reported widely in the existing Email: jbayuo88@gmail.com
2 Nutrition and Health 0(0)
program was helpful at preventing malnutrition in adult searched the following gray literature sources: Trove,
cancer patients undergoing radiotherapy (Zhang et al., Agency for Healthcare Research and Quality, MedNar and
2022). Additionally, some studies have also observed a OpenGrey.
positive association between caregiver nutritional knowl- The following search terms were utilized: (burns or burn
edge and improved feeding practices (Demir et al., 2020; injury or burns trauma or major burns) AND (survivors)
Tessema et al., 2020). Despite the evidence regarding the AND (nutrition or diet or dietary or food or nourishment
impact of nutrition education interventions in other or food intake or eating) AND (educational programs or
patient groups such as persons with chronic diseases, imple- programs or interventions) AND (caregivers or family
mentation of such innovative programs has received members or relatives or informal caregivers or healthcare
minimal attention among burn survivors and their care- staff). Any study reporting a nutrition education program
givers which can adversely impact the recovery process for burn patients/survivors and/or their caregivers (formal
(Bayuo and Wong, 2021). This is particularly critical con- and informal) was considered eligible irrespective of the
sidering the protracted nature of the postburn recovery study type. Considering the scoping nature of the study,
process which has been noted to mimic living with a any unpublished thesis reporting on nutritional education
chronic ailment (Bayuo et al., 2020). Besides, burn units for burn patients or survivors was also considered eligible
in most countries often lack structured nutrition teaching for inclusion. Studies that reported only on the nutritional
guides or educational programs that can prepare burn survi- needs of the burn patients were excluded. Preprints were
vors and their caregivers for the period after discharge. The also not considered for inclusion in this study.
general lack of active follow-up services following dis- The identified studies were pooled into the Rayyan
charge from the burn unit implies that burn survivors and Intelligent Systematic Review Platform for deduplication
their caregivers are often on their own with little to no pro- purposes (Ouzzani et al., 2016). Title, abstract, and full-text
fessional support as they navigate the postdischarge period screening were carried out by three authors. Any disagree-
(Jagnoor et al., 2018). In fact, there is limited information ments between the authors were resolved through discus-
available on nutrition education programs for burn survi- sion with the remaining authors. The references of the full
vors and their families and it remains unclear how such pro- texts were exported to Endnote X8.2. The retained studies
grams can be organized and implemented. Put together, the were retrieved and screened to ensure that they met the
phenomenon of nutrition education continues to receive inclusion criteria for consideration. See Figure 1 for the
limited attention in the burn survivor population despite PRISMA flow chart regarding the study selection process.
the importance of nutrition in the postburn recovery Following the study selection process, we retrieved
process. It is to answer this knowledge gap that the information regarding the authors, study setting, and parti-
current review sought to ascertain what is known regarding cipants (see Table 1). Additionally, we extracted data
nutrition education programs for burn survivors and inform regarding the nature of the programs and outcomes if
further work in this area. Most especially, to scope and reported. Following these, we used the review aim as a
examine existing literature regarding the nature and out- heuristic guide to develop codes based on which a narrative
comes associated with existing nutrition education pro- synthesis was undertaken.
grams for burn survivors.
Results
Methods
Study characteristics
Arksey and O’Malley scoping review approach was utilized
for this study and reported according to the PRISMA exten- Six studies were identified and included (Chang and
sion guidelines (Arksey and O’Malley, 2005; Tricco et al., Wang, 2010; Hairston et al., 1999; Hashemi et al., 2014;
2018). This approach was used as it helped to map key con- Heydarikhayat et al., 2018; Lukman et al., 2020; Rezaei
cepts, ascertain what is known about nutritional education et al., 2020). Two of the included studies were conducted in
programs, and to identify gaps in existing literature. This the United States and reported on nutrition education programs
review proceeded through the following steps: (1) identify- targeting pediatric burn patients (Chang and Wang, 2010;
ing the research question, (2) identifying the relevant Hairston et al., 1999). The third study was undertaken in
studies, (3) study selection, (4) charting the data, (5) collat- Indonesia and it focused on nutrition education for adult burn
ing, summarizing, and reporting the data. patients (Lukman et al., 2020). The remaining three studies
We undertook extensive searches in both peer-reviewed were undertaken in Iran and they focused on adult burn survi-
and gray literature sources from inception to December vors (Hashemi et al., 2014; Heydarikhayat et al., 2018; Rezaei
2022. Three members of the research team undertook exten- et al., 2020). The publication years ranged from 1998 to 2020.
sive searches in the following databases (1) CINAHL, (2)
EMBASE, (3) PubMed, (4) Web of Science. Additionally,
the reference lists of identified papers were hand-searched Nature of the programs
manually for potential papers by the research team. In add- The program reported by Hairston et al. was composed of
ition to the peer-reviewed databases, the research team also 10 sessions, each session about 30 min to 1 h in length.
Bayuo et al. 3
Figure 1. PRISMA Flowchart for Study Selection.
Chang and Wang also reported on a nutrition education peer-reviewed publications in this area, we acknowledge
program targeting healthcare professionals (Chang and that burn units across the globe may have established pro-
Wang, 2010). Lukman et al. (2020) focused on delivering tocols regarding nutrition education which may be included
lectures and discussions led by physicians to improve the in discharge preparation charts and may not be available in
knowledge of adult burn survivors regarding the first aid peer and nonpeer-reviewed data sources. This assertion not-
management of burns and nutritional support. Iran reported withstanding, the finding still draws attention to a critical
that nutrition education as a component of a comprehensive need to develop and evaluate the impact of these nutrition
postdischarge rehabilitation program (Hashemi et al., 2014; education programs among the burn survivor population,
Heydarikhayat et al., 2018; Rezaei et al., 2020). their caregivers, and healthcare professionals. Even when
they are included in comprehensive rehabilitation pro-
grams, there is a need to ascertain their outcomes alongside
Outcomes of the programs other postburn rehabilitation outcomes.
Lukman et al. reported improved knowledge regarding the Undoubtedly, burn care has improved in recent times
first aid management of burns and nutritional support for with decreasing mortality rates. Although the importance
burn patients following the implementation of their educa- of nutrition in burn care has been highlighted, the current
tional and counseling program (Lukman et al., 2020). The review noted the limited progress made toward evaluating
remaining studies did not report any outcomes associated the outcomes associated with nutrition education programs.
with the nutrition education program. More worrying is the fact nutrition education outcomes are
not considered a component of the core outcome sets for
burn survivors. Education is essential to improving the
Discussion knowledge base of patients and their caregivers. This is
Six studies that reported on nutrition education programs particularly essential for burn survivors considering the pro-
for burn survivors were identified with one study reporting tracted nature of the postburn recovery process. The limited
outcomes. Though this may suggest a limited number of follow-up strategies following discharge make the need for
4
Table 1. Data extraction.
Author/years/ Outcomes related to
setting Study aim Participants Nature of the program nutrition Key findings
Chang and To understand how to assess Healthcare professionals Lecture on medical nutrition therapy for Postdischarge nutritional Participants able to develop a care
Wang (2010) and implant nutritional care pediatric burn survivors following support care planning for plan includes risk screen, nutrition
United States plan for the pediatric burn discharge pediatric burn survivors. diagnoses, nutrition prescription,
of America patient after discharge nutrition monitoring and
home from hospital evaluation.
Hairston et al., To develop a multicultural Pediatric burn patients A multicultural audience and focused on Nutritional intake, weight, The authors noted that the program
(1999) hospital-based nutrition and their parents/ children with >50% Total Body height, and knee-height was still in its initial stages and has
United States education program that will caregivers Surface Area Burn (TBSA) measurements were not demonstrated success regarding
of America enhance the nutrition undergoing rehabilitation either in the stated in the results. increased acceptability of foods by
uptake of pediatric burn hospital or at home. The nutrition the foreign patients and improved
patients education program was composed of dietary intake in several patients.
10 sessions, each session about
30 min to 1 h in length.
Hashimi et al., To determine the effects of Adult burn survivors and Nutrition education incorporated into a No nutrition-specific No finding regarding the participants’
(2014) Orem self-care program on their caregivers (56 comprehensive postdischarge outcome was reported nutritional status was reported.
Iran quality of life of burn participants in the rehabilitation/self-care program. Five After 1 month and 2 months of the
patients intervention group and weeks of theoretical and practical use of self-care model, the quality
54 in the control training in of life of the cases improved from
group) self-care for 75 to 90 min (one 73.33% to 83.78%
session per week) using lecture, and 98.12%, respectively
demonstration, and group discussion; (p<0.001).
Phone calls and in-person
consultation every 15 days for 2
months during which the participants
were encouraged to ask questions
bothering them and receive support/
advice for 2 months following
discharge.
Heydarikhayat To evaluate the effects of a Adult burn survivors (44 Nutrition education implemented as a No nutrition-specific No findings reported regarding
et al., (2018) posthospital discharge in the control group component of postdischarge outcome was reported nutrition. Authors noted
Iran follow-up on health status and 42 in the rehabilitation program. Few days after improved quality of life, anxiety,
of burn patient intervention group) hospital discharge, home visit and scarring.
based on patients’ need was planned;
the
patients in the intervention group
were contacted by phone to plan a
schedule for the
home visits. Patients were educated
about exercising the involved joints,
preworkout skin care, joint
contractures, prompt notification in
case of any problems, scar
(continued)
5
Table 1. (continued)
Author/years/ Outcomes related to
setting Study aim Participants Nature of the program nutrition Key findings
management, and nutrition.
Telenursing was carried out by
texting via social media, SMS, or
phone calls. The frequency of
the phone calls was once per week,
but it
increased in case of major problems
or
upon request up to 1.5 months
postdischarge.
Lukman et al., To increase the community’s Adult burn injured This event consisted of a lecture session Basic knowledge regarding There was a significant increase in
(2020) knowledge and awareness patients and the first-aid treatment, the knowledge of the respondents
Indonesia of the importance of discussion session provided by the and nutrition for burn before and after counseling the
nutrition in burn patients. Division of Plastic Surgery, patients nutrition of burn patients
Department of Surgery of the (p<0.05). Thus, counseling is
hospital. The counseling was proven to increase knowledge in
performed by a senior plastic surgeon the general population that it
and medical doctors. Topics in the should be performed routinely in
lecture sessions were basic various areas.
knowledge of burns, first aid for burn
patients, nutrition in burn patients,
and complications that may occur in
burn patients.
Rezaei et al., To compare the effect of Ninety adult burn Nutrition education delivered as part of No nutrition-specific No finding related to nutrition was
(2020) telenursing and face-to-face survivors in three a comprehensive telenursing outcome was reported. reported. The authors noted
Iran training on the quality of life groups aftercare program; Each intervention significant differences regarding
of patients with a burn group received 1-on-1 telephone quality of life across the groups.
injury. training and face-to-face training in
eight sessions (two sessions of 15 to
20 min/week). The control group
received regular care. The content of
the provided materials was based on
the latest articles and books including
wound care; scar management, such
as wearing pressure garments; range
of motion training; complications of
immobility and contracture;
nutritional education; itching control;
and the psychological consequences
of burn.
6 Nutrition and Health 0(0)
nutrition education more paramount to enable the burn methodology, data curation, and writing up; Pius Agbenorku:
survivors and their caregivers to be able to plan their methodology, data curation and critical review of final draft; Paa
dietary pattern to support their recovery journey. Such Ekow Hoyte Williams: methodology, data curation, and critical
nutrition education may be brief and often included in review of final draft.
the discharge planning teaching. The significance of
nutrition to the postburn recovery however makes it Availability of data and materials
important to ensure that there is enough emphasis All data for this review are included in the manuscript.
and reinforcement of education episodes to potentially
improve outcomes. Declaration of conflicting interests
Across the included studies, only one study reported an The authors declared no potential conflicts of interest with respect
outcome relating to knowledge about nutrition following to the research, authorship, and/or publication of this article.
burns. This finding emphasizes the need to evaluate nutri-
tion education programs, particularly considering the crit- Ethical approval
ical role that nutrition plays in the postburn recovery This is a scoping review and ethics approval is not required.
process. Other outcomes relating to nutrition education
such as self-efficacy, attitudes, changes in eating habits, Funding
food selection, balanced meal preparation, anthropometric
The study is part of an ongoing study funded by Nestle Foundation
measures, and laboratory indices may need to be evaluated for the study of problems of nutrition in the world, Lausanne,
as well to ascertain the effects of nutrition education pro- Switzerland awarded to Dr Jonathan Bayuo.
grams. Additionally, more age-specific outcomes such as
those related to children, adults, and older adults need to ORCID iD
be included. Information about these outcomes can poten-
Jonathan Bayuo https://orcid.org/0000-0001-8437-2730
tially help to drive further work to support the postburn
recovery process.
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