Disfiguring burns and the experienced reactions in Iran: Consequences and strategies—A qualitative study K. Rahzani, F. Taleghani *, A. Nikbakht Nasrabadi Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran 1. Introduction Burns are a prevalent health issue throughout the world, particularly in developing countries [1]. It is estimated that around 1.1 million burns in America and 1 million in Europe receive medical attention annually [2,3]. In Iran burns are still widespread with a high incidence of mortality. In this country around 724,000 burns occur annually out of whom 335,000 recover by self-treatment, 348,000 receive outpatient services from medical centers, 382,000 would be hospitalized and the remaining 2920 expire [4]. During the 20th century, the survival of burnt patients has significantly improved due to developments in burn care [2,5]. The comparison of epidemiological studies from 1994 to 2004 in Iran confirms the truth of this claim, too [1,6–9]. Burns have numerous consequences such as scars, disfigurement and other dysfunctions from contractures [10] therefore, burn survivors have a challenging and prolonged recovery process [11]. Even after most advanced surgical reconstructions, patients are often resigned to live with an unnatural appearance. Living with scars, especially in a socio cultural context which values physical appeal very much, can be very problematic [12]. The cost to society of the long-term morbidity from loss of physical function or associated psychological and cosmetic impairment is incalculable [13]. Among all disfigurements, facial scars have attracted significant attention for their importance; the face is the center of attractiveness and beauty [14], strongly associated with a person’s identity, main channel for environmental perception and presenting one’s self and communication [15]. Physical attractiveness has a stereotyped nature. That is attractive people appear to be more intelligent, better adjusted, more dominant and more socially competent [16]. People usually make more positive impressions about them, and thus treat them more respectfully [12]. On the other hand, less attractive people have problems interacting with others. They burns 35 (2009) 875–881 article info Article history: Accepted 10 November 2008 Keywords: Burn disfigurement Qualitative study Social problems Iran abstract As the exact stereotyped content of physical attractiveness depends on cultural values, a study was conducted to obtain information concerning psycho-social problems experienced by people with burn disfigurement after being discharged from the hospital, in order to devise psycho-social support programs based on this evidence. In this qualitative study, individual in-depth interviews were performed with 21 parti- cipants. These interviews were analyzed by the content analysis method, upon which five main themes appeared such as: behaviors and beliefs of society, sufferings, assessment of reactions, solutions, and exhaustion. Our findings maintain that people’s negative thoughts and behaviors provide the grounds for difficulties in disfigured individuals, hence taking troublesome measures to confront them. There exists a need to devise a proper protective plan to train the community, family and the affected individuals themselves, aimed at promotion of levels of awareness, attitude and performance. # 2008 Elsevier Ltd and ISBI. All rights reserved. * Corresponding author. Tel.: +98 3117922926. E-mail address: Taleghani@nm.mui.ac.ir (F. Taleghani). available at www.sciencedirect.com journal homepage: www.elsevier.com/locate/burns 0305-4179/$36.00 # 2008 Elsevier Ltd and ISBI. All rights reserved. doi:10.1016/j.burns.2008.11.003