A mixed methods evaluation of medical tattooing for people who have experienced a burn injury.

Introduction: There are no existing studies examining the psychological merits of using facial medical tattooing (MT) following burn injury. This study evaluated an MT service supported by The Katie Piper Foundation. It examined accessibility, satisfaction and whether there were improvements in quality of life (QoL). Methods: Thirty-five service-users were invited to participate in a cross-sectional online survey. Twenty-five (71%) responded (24 women; age range = 21–64 years), and of these five (4 women; age range = 26–59 years) also participated in telephone interviews, which were analysed using descriptive thematic analysis. Findings: The service was largely considered easy to access (22/25) and convenient (25/25). Most service-users (22/25) were satisfied with the results of MT. Some areas of dissatisfaction were described, by a minority of service-users, including: the procedure being painful (1/25); the tattoo being below expectation or fading over time (3/25). The majority reported that MT had improved confidence (22/25); mood (19/25); and ability to socialise (19/25). The procedure improved some service-users’ ability to carry out essential activities (14/25) and enjoyable activities (16/25). The qualitative responses provided during interview, indicated that all respondents found the procedure useful to their adjustment, although a minority (3/5) found it painful and also commented on fading (1/5). All described MT as contributing to a sense of increased normality. Conclusions: MT had the largest impact on emotional wellbeing and interpersonal domains of QoL. MT services should now improve awareness of the procedure, lobby for further support to provide wider access to the procedure, and routinely use measures assessing psychosocial outcomes. Lay summary As part of their support ’for’ individuals who have experienced burn injuries, The Katie Piper Foundation has offered to support medical tattooing (MT), a procedure which can enhance and restore the appearance of individuals’ eyebrows, eyes and lips following a burn injury. There are no known studies examining the psychological impact of MT for individuals with burn injuries. This evaluation asked its service-users (35 people) about their levels of satisfaction with the referral and assessment procedures, the procedure itself and its results, and whether medical tattooing had led to perceived improvements in quality of life. Twenty-five people agreed to complete a survey and five people agreed to be interviewed by telephone. Almost all respondents considered the service easy to access and convenient. Staff were perceived to be warm and friendly. Most respondents were satisfied with the results. Some areas of dissatisfaction were described, by a minority of respondents, including: the procedure being painful; the tattoo being contrary to expectation or fading over time. Large proportions of respondents reported that MT had improved their confidence, mood and ability to socialise. A small number of respondents reported functional benefits (e.g. ability to carry out essential daily tasks). All respondents reported finding the procedure helpful to their adjustment and that it had helped restore a sense of normality. The results of this evaluation suggest that medical tattooing has the potential to have a positive impact on emotional wellbeing of people who have experienced a burn injury. Providers of MT services could now consider ways to improve access to the the procedure and look to measure psychosocial outcomes in routine practice.