New training could help health workers support millions across Europe with body image fears

New training developed by the University of the West of England (UWE Bristol) could help the next generation of health workers support millions of patients across Europe burdened by 'visible differences' and body image fears.

Academics from UWE Bristol identified a dearth of expertise among medics when it came to handling patients worried about their appearance. They say healthcare professionals are often unable to intervene when they should, leading to worsening social and psychological problems for patients including those with an altered appearance caused by health conditions, medical treatments and injuries.

Working with universities across Europe, UWE Bristol's appearance experts have created a two-week training course which could help health professionals from dentists to plastic surgeons improve their support for these vulnerable patients in future.

The academics from the internationally-renowned Centre for Appearance Research, based at UWE Bristol, believe the need for extra training is paramount because the growing popularity of social media is leaving an increasing number of people with low self-esteem over their looks.

As part of the study, 700 healthcare professionals from five European countries responded to a survey asking whether they had insufficient knowledge to effectively help patients with appearance concerns. Of the respondents, 70 per cent said they would benefit from further training.

Dr Heidi Williamson, who is working on the two-year project alongside Dr Martin Persson, Professor Nichola Rumsey and Professor Diana Harcourt, said: "We weren't surprised there was a gap in knowledge. We've been working in this field for 20 years and have become aware that healthcare professionals can lack knowledge in this area. If they are not recognising there is a problem and not intervening appropriately, negative social and psychological consequences could develop or worsen if not addressed appropriately.

"Healthcare professionals need to know who is distressed and how to provide support. Health care professionals can hold attitudes about the patient's appearance change and make assumptions about their support needs which are not helpful. We know that the cause of a visible difference, its severity and its location are not always accurate predictors of psychosocial outcome. You can't look at someone and guess what support they need. For example, you could have someone with a small, aesthetically-pleasing cleft scar who is very conscious of it or have someone with a very obvious visible difference who is coping very well.

"There are differences in the way individuals respond to appearance changes and that's what we need to make healthcare professionals aware of. They need to raise the issue, talk about it and find out the patient's perspective and support needs."

About one in 43 people have a condition or injury affecting their appearance, with between 30 and 50 per cent of those harbouring concerns about their appearance. It is estimated 148 million Europeans have a condition resulting in a visible difference of appearance.

The survey was answered by healthcare professionals from a range of different disciplines, including nurses, dentists, doctors, midwives and occupational therapists, from England, Turkey, Lithuania, Sweden and Italy.

Dr Williamson said: "The survey raised more appearance issues than we expected – there were health professionals who told us about heart disease patients who had been very conscious of their internal cardiac defibrillators protruding through their skin and the impact of swollen limbs on their body image. We were informed that rheumatology patients were concerned about the shapes of their fingers and limbs, and dialysis patients were self-conscious about the visible bulge from the cannula in their arms. We also heard from health care professionals who reported the impact of physical disability, stroke and multiple sclerosis on body image.

"The age and experience of the healthcare professional didn't seem to have a bearing on how confident they were in managing appearance issues. Someone who has spent 30 years as a health professional may be no more confident with people with a visible difference than someone who has only spent a year in the field."

The internationally-transferable training, which will be finalised in August, is expected to run in universities as an accredited course from 2017 but will also be available as an online resource.

Dr Persson, who led the project for UWE Bristol, said: "We expect this expertise will improve health care provision for people affected by disfigurement and more general body image dissatisfaction, which in the longer term has the potential to improve associated physical and mental health-related outcomes. It will also challenge poorly informed attitudes that can lead to discrimination, by raising awareness of these issues to health professionals and contributing to a social dialogue about stigmatisation and the social exclusion of individuals/families with disfiguring conditions and appearance-related concerns."