Self-Management Support After Burns: Protocol for a Multicenter, Stepped-Wedge Hybrid Type II Effectiveness-Implementation Study.

BACKGROUND

After a burn injury, the survivors have to manage and integrate the physical, psychological, and social consequences of their injury into their daily lives, such as functional limitations, aesthetic complaints, and fatigue. How successful survivors of burn injuries are at this depends on their self-management skills. Health care professionals play an important role in supporting the self-management of survivors of burn injuries. Currently, there are no burn-specific self-management support interventions. Therefore, we developed a self-management support intervention for survivors of burn injuries, called BreeZe (Brandwonden en Zelfmanagement).

OBJECTIVE

This study aimed to describe a study protocol to implement and evaluate the BreeZe intervention.

METHODS

This multicenter study in the Netherlands is an implementation-effectiveness hybrid type 2 study, with a nonrandomized stepped-wedge design. Starting April 2024, 3 phases have been sequentially rolled out across the 3 specialized Dutch burn centers over a period of 20 weeks-the preimplementation phase (usual care), implementation phase, and postimplementation phase. To identify barriers and facilitators of implementation, the Consolidated Framework for Implementation Research (CFIR) will be used. For evaluation, the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) evaluation framework is used. The coprimary outcomes are (1) self-management skills and (2) the implementation outcomes are reach, adoption, implementation, and maintenance. Secondary effectiveness outcomes are self-regulation, participation, dependency, patient-centeredness for survivors of burn injuries, self-management support skills for health care professionals, and cost-effectiveness. Data collection for survivors of burn injuries occurs at 2 weeks, 6 months, and 12 months post discharge, using questionnaires. Data collection for health care professionals occurs before training and 3, 6, and 12 months post implementation, using questionnaires, video observations, and interviews. Data analysis will include both quantitative and qualitative methods for comprehensive evaluation.

RESULTS

Participant recruitment ended on June 30, 2025. Follow-up data collection ends in July 2026.

CONCLUSIONS

This study will evaluate both the effectiveness and implementation of the BreeZe self-management support intervention for survivors of burn injuries using a hybrid effectiveness-implementation design. By applying the CFIR and RE-AIM frameworks within a stepped-wedge design embedded in routine burn aftercare, this study aims to generate robust and practice-relevant evidence on how self-management support can be effectively implemented in burn care. The findings are expected to inform both clinical practice and future implementation efforts in burn aftercare settings.