Using online blogs to explore positive outcomes after burn injuries

This study uses blog analysis, a new and novel technique, to explore the positive outcomes experienced by burn survivors. This study examined 10 burn survivor blogs to offer a unique, longitudinal insight into burn survivor recovery. Using thematic analysis, three themes emerged: shift in self-perception, enhanced relationships and a change in life outlook. Many of these themes contained stories and experiences unique to a traumatic burn injury, suggesting that standardised trauma scales are not effectively measuring the impact of a burn in this population. Reflections on blog analysis are discussed, along with a recommendation that health researchers utilise the vast amount of data available from online blogs.


Introduction
A burn is a common, invasive trauma with long-term physical, emotional and psychological consequences. According to the most recent available statistics, 175,000 people in the United Kingdom attend Accident and Emergency departments with a burn each year, with 13,000 of these being admitted to hospital (British Burn Association, 2001). In the United States, nearly half a million people each year require emergency medical attention for a burn (Centre for Disease Control and Prevention, 2011). There is a pressing need to understand the psychosocial consequences of survival and rehabilitation following a burn, as advances in wound care are ensuring more people survive these traumatic experiences (Acton et al., 2007).
Currently, research into the psychosocial consequences of burns has predominantly focused on the adverse negative impact (Corry et al., 2009;Klinge et al., 2009). While some studies report burn survivors having more favourable outcomes than their non-burned peers on measures such as body image, mood and general quality of life (Pope et al., 2007), this is not the same as reporting positive outcomes as a consequence of the burn. Little attention has specifically been given to positive psychosocial consequences, despite them being evident in the qualitative accounts of recovery given by survivors of burns and other traumatic injuries (Dekel et al., 2012;Lau and Van Niekerk, 2011;Linley and Joseph, 2004;Pressman and Cohen, 2005). An understanding and identification of positive outcomes would give a more holistic representation of the experiences of people affected by burns (Lau and Van Niekerk, 2011;Moi and Gjengedal, 2008), could potentially instil hope in others during rehabilitation and beyond, and has been linked to a reduction in burn patient distress (Linley and Joseph, 2004).
To date, two quantitative studies have examined positive outcomes following a burn injury. Rosenbach and Renneberg's (2008) sample of 148 burn patients reported positive changes including a greater appreciation of life, an enhancement of relationships and a sense of personal strength, while a recent study by Baillie et al. (2014) identified the role of coping and perceived social support as predictors of posttraumatic growth (defined as having levels of functioning and well-being greater than those that were evident before the traumatic event took place). The notion of post-traumatic growth is particularly important within burns since stories of other patients' positive outcomes could be inspiring for those who are struggling, and it offers a framework for clinicians looking to support their patients after serious burn injuries (Baillie et al., 2014). However, a major limitation of these studies is their reliance on the posttraumatic growth inventory (PTGI) to measure positive outcomes. This 5-factor measure of growth (relating to others, new possibilities, personal strength, spiritual change and appreciation in life) has been criticised for creating a positive response bias (Coyne and Tennen, 2010) and may not provide a comprehensive account of life after a traumatic event, particularly during an ongoing experience such as a burn injury and adapting to a change in appearance. Importantly, the PTGI does not enable researchers to capture all the positive aspects that may be evident in any given trauma. For example, women living with HIV/AIDS have been shown to improve their health behaviours (Siegel and Schrimshaw, 2000), something which is not captured by the PTGI. Indeed, the PTGI authors themselves advise each type of trauma to be looked at independently in terms of the positive outcomes which may be present (Tedeschi and Calhoun, 2006).
Although some qualitative studies have looked at positive adjustment to a visible difference in general (Egan et al., 2011), few have specifically explored positive outcomes among burn patients, where both a traumatic experience and a visible difference are likely to be present. Zhai et al. (2010) employed phenomenological analysis to assess positive outcomes among 10 patients being treated at a burn centre in China. They found four of the five factors described by the PTGI were present, but little support for spiritual growth, which they suggest was due to sociocultural differences in how positive outcomes emerge following trauma. Quantitative studies have also failed to find spirituality as an outcome following a burn (Rosenbach and Renneberg, 2008). However, Lau and Van Niekerk (2011) identify spiritual growth within six young survivors' narratives of their experiences of burn injury in South Africa.
This study aims to build on current research by qualitatively exploring the positive outcomes that may be present following a burn injury since previous literature offers limited knowledge into the specific positive aspects that may arise in this growing population. Acknowledging that they can exist, and exploring specifically what they are, is an important step in guiding burn care practice and may help to challenge assumptions about the ubiquity of negative impacts following burn injuries.

Methodological rationale and design
This study adopts an innovative methodology to obtain a unique, original and international perspective into the lives of burn survivors via the analysis of online blogs. Blogs are personal diary-type posts published online by an individual on a regular basis. Blog analysis is considered rich, qualitative data giving an archival account of an individual's life (Beer and Burrows, 2007). These longitudinal data are particularly useful in trauma recovery research, due to the day-to-day positive and negative changes evident in this population (Charmaz, 1991). Previous qualitative studies of burn survivors' experiences (Lau and Van Niekerk, 2011;Moi and Gjengedal, 2008) are usually limited to a single interview on one occasion, and the authors of these studies have highlighted the need for longitudinal data in this area. Additionally, using unobtrusive, naturally written discourse allows salient thoughts and opinions to come to the fore, free from any researcher biases present in both interview-and questionnaire-based studies. Alongside these strengths, there are a number of limitations to using blogs as a source of research data. These are discussed in detail later in this article, but at this point it is important to acknowledge that blogs are views and accounts of events as perceived by the bloggers themselves -they do not necessarily reflect all possible views on an issue and those who choose to share their experiences by blogging may differ from people who choose not to do so.
Blog analysis has been advocated by many social science researchers (Hookway, 2008;Wilkinson and Thelwall, 2011), but there is a general consensus that they are currently underutilised (Domingo et al., 2014). Blog analysis has been used successfully within the health arena to explore the experiences of 'health travellers' to Turkey (Ozan-Rafferty et al., 2014), feminist approaches to sport (Antunovic and Hardin, 2015) and how blogs that define themselves as challenging beauty ideals are in fact creating and further supporting them (Lynch, 2011). However, we are not aware of any research using blogs in relation to an appearance-altering condition such as a burn. Therefore, since our research explores the viability of this method in appearance-related research, we initially conducted a broad scoping exercise of the type, quality and quantity of data available through online blogs. Keywords ('burn injury blog', 'burn survivor blog' and 'burn scar blog') were entered into popular search engines such as Google and Bing. This proved fruitful in ensuring relevant blogs existed. One interesting finding from this scoping exercise was the identification of several burn survivor blogs conducted via a video link (known as 'vlogs'), so these were incorporated as an additional data source.
Once we had established that relevant data were available, a more structured systematic search was undertaken. 'Blogger' and 'LiveJournal' were searched through Google as they are two of the most popular blogging sites in the world (Nielsen, 2012). Additionally, YouTube, the largest video sharing website in the world (O'Neill, 2012), was used to find vlogs. This structured approach was deemed necessary due to the overwhelming experience of searching for blogs online (Hookway, 2008). Search terms used were 'burn survivor', 'burn injury', 'burn scar' and 'burn victim'. We recognise that the term 'victim' can be contentious and is often espoused by the burns community, but the terms used in this search were chosen on the basis that they were all used in blogs identified in our initial scoping exercise. From our systematic search results, blogs were included for analysis if they were personal and a burn was mentioned in the blog biography or 'About Me' section. Despite the constraints imposed for the blog search, the vast majority of search results were inappropriate for inclusion in the study, for example, the blogs were written by injury lawyers or burn survivor family members. Results were ordered in terms of the extent they mentioned the search terms and considered for inclusion until the mention of a burn became minimal in the blogs being returned from the search and therefore unlikely to meet the above inclusion criteria. Snowball sampling was also used as many burn survivor blogs contained links to similar blogs.

Bloggers
Ten blogs were identified for inclusion in this study. Three of the bloggers were male, and three were 'vloggers' (all of which were female). Five of the bloggers were from the United States, three from the United Kingdom and one from Australia. One blogger's location was unknown. As is often the case in research using blogs, very little information was available about other demographic details such as age, or details such as the area or severity of the burn, or time since injury.

Ethical considerations
Ethical approval for this study was received from the third author's institutional Ethics Committee. The main ethical considerations are those surrounding informed consent, privacy and anonymity. Informed consent is not a requirement as the research is focused on the blog itself, as opposed to the blogger (Eynon et al., 2009;Wilkinson and Thelwall, 2011) and only blogs considered 'purely public' (Eastham, 2011) were used (i.e. publicly accessible, open access blogs). The blogging websites used to source the blogs give bloggers the option to keep their entries private or only accessible via registration to the site; blogs with any of these security settings were not included. Finally, with regard to anonymity and privacy, all usernames reported in the results below have been changed. In addition, direct quotes have been kept to a minimum or, where necessary to convey a theme, longer quotes have been paraphrased to ensure the blog is not traceable via online search engines, as suggested by Ess (2007).

Data analysis
Blogs were initially transferred to a word document. Vlogs were transcribed verbatim. Data reduction took place during this stage, akin to previous studies using unsolicited data (O'Brien and Clark, 2012). Examples of discarded data include blog posts which were about hobbies and interests unrelated to the burn injury or recovery and data on the negative impact of the burn injury. While the selected blogs did include both negative and positive accounts, which support previous reports that even those who would be considered well adjusted still have bad days and distress associated with their situation (see Baillie et al., 2014;Egan et al., 2011;Hefferon et al., 2009;Rosenbach and Renneberg, 2008), this article focuses solely on the positive accounts because the majority of previous research in burns has focused on negative issues and the published literature is therefore potentially giving an incomplete representation of the experiences of people affected by burns. Eiserman (2001) suggests it is unethical not to consider positive outcomes associated with visible differences.
The data were analysed using thematic analysis, so that the researcher could systematically extract the most pertinent positive outcomes. In order for the analysis to be structured, replicable and transparent, the guidelines set out by Braun and Clarke (2006) were followed. To begin, the first author immersed herself in the data through repeated reading and initial noting of thoughts and ideas. From this, a number of codes were developed of important topics within the text, which were then clustered to form meaningful themes. Themes were scrutinised to check for coherence and representativeness against the original text before a final thematic map was constructed. The analysis was checked by the third author and where differences arose, the authors came to a joint decision to ensure that the themes described were an accurate reflection of the data set. Finally, examples from the data set which clearly illustrate each theme were extracted as evidence.
In terms of epistemology, which is deemed flexible within thematic analysis and therefore must be explicitly stated (Holloway and Todres, 2003), a contextualist position was taken. This standpoint posits that although our experiences are a product of our interpretation, they are very much real to the person it is happening to (Willig, 2013). Taking this perspective allows the researcher to explore the experiences described in the blogs and the meanings attached to them, as well as looking at the role played by the broader social environment in the shaping of this.

Results
Three themes emerged: shift in self-perception, enhanced relationships and a change in life outlook. Each theme is discussed below with supporting quotes from the blogs. Pseudonyms are used throughout, as well as minor modifications to quotes to preserve anonymity, as outlined above.

Shift in self-perception
Many bloggers stated that feelings of personal strength emerged since the burn injury, recognising that they must have had considerable strength to survive their trauma, or that the burn injury forced them to discover strength they never knew they had. Either way, they acknowledged themselves as strong, selfassured individuals: Many studies into positive outcomes following trauma identify personal strength as being important (Tedeschi and Calhoun, 1996). However, the blogs identified a range of experiences that they had endured in order to bring about feelings of personal strength, suggesting that these feelings may be a particularly salient positive outcome for burn survivors. For example, bloggers cited the event itself, the endurance of chronic pain, undergoing surgery, adapting to a change in appearance and dealing with negative social reactions as all being catalysts to feelings of strength, as opposed to the one traumatic experience, as might be found in some types of trauma.
In addition, bloggers consistently referred to themselves as 'survivors', rather than victims, exemplifying their feelings of achievement and strength to survive their traumatic burn experience: I am a burn survivor, not burn victim. That is the correct way to describe someone who has been burned … So I am no longer a victim of the fire or of my burn, I am a survivor. And I like that better.
Makes me feel more powerful to be a survivor rather than a victim. (Sara) Beyond personal strength, bloggers identified a range of other positive traits that they had become aware of and developed since the burn. In particular, the burn injury allowed them the opportunity to challenge the 'status quo', learn something new or improve themselves in some way. For example, two bloggers expressed becoming more creative; one in order to create fashionable outfits that minimised the attention placed on her scars, and the other developing a creative mind, as she used her fantasies as a form of escapism from her chronic pain. Others simply listed the diverse and wide-ranging positive attributes they felt they had developed since the burn, for example, 'bravery, courage, strength, tenacity, fearlessness, patience, diligence, honesty, integrity, compassion, humility and overall badassness' (Sara).
The blogs illustrated a sense of pride as a consequence of this shift in self-perception. Many bloggers talked proudly of their accomplishments, however small, whether this be taking a trip to the circus (Amy), eating corn on the cob for the first time post-burn (Sara) or being a good mother (Jacqui). Celebrating these achievements was important in fostering pride, as Mark said, 'anyone who has endured tragedy knows that there are no small steps in recovery'.

Enhanced relationships
Interpersonal relationships. An enhancement in interpersonal relationships was a prevalent theme discussed throughout the blogs. Many of the bloggers spoke of how their burn injury had enabled them to see what a 'real, true friend is' (Sara). Likewise, the traumatic experiences and subsequent support that they needed, such as help with carrying out day-to-day tasks and adapting to a change in appearance, meant that the bloggers felt surrounded by people they felt truly cared for them: They also discussed developing stronger connections with those they knew pre-burn, but even more importantly for many burn survivors, the relationships they had formed with fellow burn survivors were considered particularly special, and were often described as being closer than any other relationships they had had in the past: Bloggers spoke of the 'immediate bonding' (Sara) and 'special bonding' (Lucy) that takes place when two burn survivors meet. This interpersonal growth is so profound that it led Lucy to state, 'I love being burned, it's the best thing that's ever happened to me, I've met the most amazing people in the entire world from being burned'. Clearly, they felt these uniquely strong relationships with others in the burns community would not have been possible without the experience of a burn.
Interpersonal skills. A number of bloggers felt they had improved many interpersonal skills since the burn, namely, empathy, compassion, gratitude and appreciation of others. Some quotes highlighted empathy as being one of the most important things they had learnt from the burn injury (Amy). An illustration of this compassion came from Mark, who recounted a plane trip where he overheard an elderly lady tell the passenger beside her that she was looking forward to talking to someone as it was her first trip since her husband's death. Mark, on hearing the gentleman beside her say he would be spending the trip sleeping rather than talking to her, opted to swap seats (quite selflessly -he too prefers to sleep during a flight) to listen to the lady's story. Many other blogs reported that the burn injury had made them less judgemental, as they had a greater understanding for others. Similarly, others had dedicated their lives to helping others since their burn. For example, Lucy wanted to train to be a psychologist (in order to help other burn survivors) and Jacqui had raised money for trauma charities. This concept is often also known as altruism born of suffering (Tedeschi et al., 1998), which is evident in the aftermath of many different traumas.

Change in life outlook
A common theme across all blogs was a positive change in life perspective. Bloggers stated that their burn injury gave rise to an altered world view, also termed 'enlightenment about life' (Amy) and 'new understanding to the world' (Lucy): I really learned about life when I had my accident and the struggles and experiences I have gone through since. We know more about what life is truly about, how hard it can be and how precious it really is because we have been through our accidents where most people haven't a clue. (Sara) Bloggers described three ways in which this change in outlook had impacted them. First, they believed their priorities had changed for the better, with Amy realising she had been prioritising her work over her loved ones too much and Sara recognising that she had lost sight of her dreams pre-burn. A change in priorities in terms of making more time for loved ones was often described throughout the blogs.
Second, bloggers frequently mentioned living life to the full, with a recurring intention to seize every opportunity: I'm going through a bit of a 'yes' phase. I think it's because I feel so lucky to be able to do things again. Even if I don't really fancy something or I would normally be too lazy to go, I'm saying yes.
Other bloggers talk about 'grasping life with both hands' (Sara) and conquering activities and entering championships which are often considered for the elite, fit and healthy individual (Jon). Throughout the blogs there was a determination and passion to be living life to the full.
The last positive outcome with regard to having a changed outlook on life was gratitude and appreciation. For example, Mark wrote a poem asking for more skills rather than less pain and suffering (showing that he appreciates the bad as well as the good in life). Likewise, Jacqui dedicates her burn anniversary to a 'celebration of life day', thus reframing the burn event as a positive one. Lucy stated her appreciation and gratitude for life, while also advising others on how to live life to the full: Similarly, after a series of surgical procedures to improve hearing in his burnt ear, Jon is still partially deaf but shrugs this off ('ach well, you just adapt and remain grateful you have what you got and don't moan'). This appreciation appears to exemplify this new found positive attitude for life.

Discussion
Despite evidence that positive outcomes are common among trauma patients (Linley and Joseph, 2004), little research attention has been given to this aspect of burn survivor rehabilitation. Those that have studied positive outcomes have used restricted standardised scales (Rosenbach and Renneberg, 2008) or traditional interviews (Lau and Van Niekerk, 2011;Moi and Gjengedal, 2008), or considered a burn injury as the same as any other disfiguring condition (Egan et al., 2011), despite calls to view each trauma as event-specific (Tedeschi and Calhoun, 1996). We sought to address these issues using an original source of data (blogs) to conduct an innovative qualitative study to understand the positive outcomes that may result from a burn.

Positive outcomes present in burn survivors
The study identified three themes around positive outcomes following a burn injury: outlook in life, enhancement of relationships and perception of self. These overlap with four scales of the PTGI (Tedeschi and Calhoun, 1996): relating to others, new possibilities, personal strength and appreciation of life, but not the PTGI factor 'enhancement of faith and spirituality'. This may be because blogs are generally written by young adults (Miura and Yamashita, 2007) and spiritual growth is more often identified in older populations (Prati and Pietrantoni, 2009). Nevertheless, a lack of spiritual growth has been reported throughout a number of health-related studies (Morris et al., 2012) and may also be less appropriate for health-related trauma such as a burn. Where faith and spirituality were evident in this study, it seemed that the bloggers were already spiritual before their injury rather than this being something that had changed following the burn.
Compassion for others was a prominent theme throughout the blogs. This study, along with others into health-related traumas (Morris et al., 2012), suggests this is a prominent positive outcome requiring more attention than it is currently given in the field of growth following adversity. A stronger focus on looking after oneself has been identified both in the current research and other health-related studies (Siegel and Schrimshaw, 2000), and creativity was identified as a skill that survivors did not previously realise they had. These examples effectively demonstrate the need to study positive outcomes in a trauma-specific way, as suggested by Tedeschi and Calhoun (1996).
An interesting finding in this study questions the assumption made by many researchers of what constitutes a positive outcome. While the post-traumatic growth literature and widely used measures see empathy as a positive outcome, the narratives in this study suggest an alternative view may need to be taken. For example, one blogger described increased empathy as a 'curse'; she now feels great sadness and worry every time she hears an ambulance, something that impacts on her own health and well-being. Such accounts of trauma outcomes that are only captured through qualitative data exemplify the need for researchers to avoid imposing pre-conceptions onto their data when measuring subjective experiences.
The current findings support, to some extent, recent quantitative research into post-traumatic growth among adult burn survivors. Baillie et al. (2014) reported that the severity of the burn, the part of the body affected and time since the injury occurred all positively influenced post-traumatic growth, as did active coping and perceived social support, whereas dispositional optimism was not related to growth. The theme of 'enhanced relationships' in this study echoes the importance of perceived social support within post-traumatic growth, while the theme 'change in life outlook' suggests that growth may not be dependent upon having an optimistic or positive outlook preinjury. The lack of data about the burn injuries experienced by the bloggers in our study preclude us drawing any conclusions about the role of the injury itself on determining positive outcomes. Our study has also identified aspects of positive outcomes and growth not previously reported within the burns literature. Specifically, a sense of gratitude among the burn survivors for things they could still do, and an appreciation and respect for their bodies have not been widely reported within previous burns research yet do resonate with the growing field of positive body image (defined by Wood-Barcalow et al. (2010) as 'an overarching love and respect for the body that allows individuals to (a) appreciate the unique beauty of their body and the functions that it performs for them; (b) accept and even admire their body, including those aspects that are inconsistent with idealized images; (c) feel beautiful, comfortable, confident, and happy with their body, which is often reflected as an outer radiance, or a "glow"; (d) emphasize their body's assets rather than dwell on their imperfections; (e) have a mindful connection with their body's needs; and (f) interpret incoming information in a body-protective manner whereby most positive information is internalized and most negative information is rejected or reframed' (p. 112)). Future research could usefully explore the prevalence and nature of positive body image among people affected by burn injuries.
The themes identified in this study (outlook in life, enhancement of relationships and perception of self) point towards the possible benefits of psychosocial interventions to promote positive outcomes and post-traumatic growth among burn survivors. For example, Baillie et al. (2014) have previously discussed the potential of using narratives and enhancing social support networks to promote positive outcomes within burn care services, social interaction skills training has offered benefits to people affected by a variety of visible differences including burns (Robinson et al., 1996), and cognitive behavioural therapy (CBT) is widely used to support those negatively affected by burn injuries and is central to new online interventions such as Face IT (Bessell et al., 2012).

Study limitations
There are a number of limitations in this study that should be acknowledged. First, this study involved active burn survivor bloggers, so the results cannot be generalised across the wider burn survivor population. A recent study by Stockton et al. (2014) has found that trauma sufferers who expressively wrote about their experiences showed an increase in posttraumatic growth compared to a control writing group who were asked not to make reference to feelings or opinions, or their traumatic experience. Therefore, the data from this population cannot be generalised to non-blogging burn survivors. Second, it needs to be acknowledged that blogs are written for many reasons (Miura and Yamashita, 2007); therefore, they are not free from self-presentational bias. However, Hookway (2008) puts forward a strong case that blogs can be considered as trustworthy as interview data; both are social constructions on the issue being discussed. Additionally, it is noteworthy that bloggers wrote about the freedom and self-empowerment that writing a blog had given them and that they felt it was a safe platform to discuss how they were truly feeling. We considered the blogs to be naturally occurring because they were not written for the purpose of the research (i.e. the blogger had freely chosen to write a blog on the subject), but acknowledge that (like any qualitative study) as researchers we have had an influence on the study, for example, through the selection of blogs, the process of analysis and selection of quotes included in this article.

Future directions
This study has provided an evidence base from which to build further research regarding positive outcomes among burn survivors. Like research in other areas of health-related trauma, our study highlights the need to look more broadly than standardised measures in order to fully understand the potential positive outcomes and resilience among burn survivors. Further research is now needed with a more representative sample of burn survivors, to establish the extent to which the themes identified in this study are common among this population. This knowledge would be useful for the possible development of interventions to foster these outcomes among burn survivors, a necessary step if we are to move to a more positive focused rehabilitation model. For example, promoting easy access to other burn survivors' accounts of positive outcomes might be beneficial and inspiring for some, while also useful in training for health professionals working with this patient group who might otherwise focus solely on the 'psychopathology of burn survivors' (Pope et al., 2007: 747). While an extensive body of research has explored the benefits of expressive writing (see, for example, the review by Frattaroli, 2006), the therapeutic benefits of blogging as an expressive writing intervention and the impact of focusing on benefit finding (Stanton et al., 2002) warrant further consideration among burn survivors. Positive outcomes among family members of burns patients is also an area worthy of examination, with a view to giving greater understanding of the experiences and support needs of those close to the person who sustained the injury.

Reflections on blog analysis
Blog analysis has seldom been used in the field of health-related recovery. Side-stepping the hurdle of patient recruitment, blogs are readily accessible, chronologically ordered accounts of day-to-day life. Hookway (2008) offers a comprehensive account of how to conduct blog analysis; however, several reflections are provided here. To keep data collection consistent and to save time, it was decided that the blog needed to mention a burn in the profile description/blogger background information in order to be included in this study, as has been done elsewhere (Hookway, 2008). Such strict parameters are required, given the vast number of blogs now available through online search engines. Blogs have been described as 'musing on the everyday' (Hookway, 2008: 102) and therefore, unlike solicited data, much of a selected blog can contain irrelevant information, therefore the data-reduction stage can be a time-consuming process. Nevertheless, the quality and richness of the data makes this process a worthwhile endeavour, particularly considering the ethical, recruitment and transcription processes that are bypassed in doing this type of research.
A strength of blog research is the potential to include culturally diverse data. Although we only considered blogs written in English, future research could specifically explore blogs in other languages and examine cultural diversity among bloggers.
Future research could also usefully explore what coping strategies are successful at bringing about positive change after a burn, whether and how positive outcomes change over time and whether the construct of a personal narrative is effective in promoting a successful recovery. All of these areas are important avenues for future research, and the consideration of blogs as a data source is encouraged. Indeed, the use of blogs as data entails such a volume of information regarding rehabilitation and recovery that it should hold intuitive appeal for many health researchers, in many different fields.
Finally, online research is a rapidly evolving field. This study was conducted prior to the publication of updated recommendations by the Association of Internet Researchers (AoIR, 2012). We therefore made decisions about consent for use of the blog data based on current thinking at the time but would recommend that researchers considering this type of research in the future (whether that be in the field of burns or any other area) should consider carefully the issues raised and thoughtfully discussed by Lomborg (2013).

Conclusion
This study has provided an alternative account of burn survivor rehabilitation. Previous to this study, using restrictive positive outcome scales or relying on retrospective accounts of burn survivor rehabilitation has not provided a comprehensive account of the positive consequences for people affected by a burn injury. Using a novel technique, this study has explored the positive outcomes that may arise from a burn injury, as told by naturally occurring burn survivor narratives. The results identify a wealth of positive outcomes following a traumatic burn injury, some of which hold specific relevance to this population, thus emphasising the need to look beyond the use of standard trauma-general scales when analysing recovery. This study has demonstrated that blog analysis has potential for greater use within research in the field of health and trauma. The type of data collected from blogs are not easily accessible using more traditional research methods such as interviews or questionnaires and therefore the use of blogs as data is strongly encouraged.