Development Of The Chinese Version Of Stoma Acceptance Questionnaire And Its Application

BACKGROUNDEnterostomy is one of the main surgical methods for low rectal cancer.At present,many domestie and foreign experts are committed to the anus preservation surgery for low rectal cancer,but 5%～30%of rectal cancer patients still need permanent intestinal ostomy surgery.Although stoma surgery saves the patient’s life,it destroys the integrity of the body.Patients with stoma will face a lot of physiological,Psychological and social problems.Problems associated with stoma include changes in bowel habits,body appearance,and sex life.Some studies have shown that colostomy acceptance is related to social relationship quality,social support,alexithymia,self-esteem and coping style,stigma,hope level,cognitive and emotional regulation style,quality of life and other factors.The quality of life of patients with stoma is closely related to acceptance.Improving the acceptance of stoma is beneficial to improve the quality of life.In addition,studies have shown that the acceptance of stoma directly affects the adaptation of postoperative life.At present,there are few tools to evaluate the acceptance of stoma,and the general questionnaire is used to evaluate the acceptance of stoma.Rarely is a questionnaire specifically designed for patients with colostomy.In 2017,Dr.Bagnasco et al.developed the stoma acceptance questionnaire for patients with colostomy,which was used to measure the level of stoma acceptance of patients with colostomy,promote patients’ acceptance and adaptation to stoma,and improve their self-care ability and quality of life.At present,there is no report on the sinicization and application of the questionnaire in China.OBJECTIVEWe introduced the English stoma acceptance questionnaire to form the Chinese stoma acceptance questionnaire and evaluate its reliability and validity.We applied this questionnaire to investigate the status quo and influencing factors of stoma acceptability of patients with colostomy.METHODS1.Through translation,back translation,cultural adjustment and preliminary survey,a Chinese version of the stoma acceptance questionnaire was developed.Convenient sampling method was adopted to select 215 cases of colostomy patients from three general hospitals in Guangzhou from March to August 2018,and the questionnaire was applied.Item analysis,internal consistency reliability,retest reliability,content validity,structure validity,exploratory factor analysis were used to test the reliability and validity of the Chinese version of the questionnaire.2.From June to November 2018,convenience sampling method was adopted to carry out field questionnaire survey on the outpatient review of stoma in three general hospitals of Guangzhou and the colostomy patients hospitalized for surgery.We investigated 235 cases of colostomy patients in total from hospitals of Guangzhou and different regions of the country through online investigation.We analyzed the relationship between stoma acceptance and quality of life,cognitive emotion in patients with colostomy and explored the influencing factors.RESULTS1.The reliability and validity of the Chinese stoma acceptance questionnaire was good with 12 items.The Cronbach’s α coefficient of the total scale was 0.826,the Cronbach’s α coefficient of each dimension was 0.651～0.795,the intraclass correlation coefficient was 0.912,and the content validity index(S-CVI/Ave)of the average scale level was 0.988.Criterion correlation validity r=0.610.Three factors were extracted by exploratory factor analysis,and 64.48%of the total variance was explained.2.In this study,the median score of ostomy acceptance of patients with colostomy was 34,and the interquartile interval was 7,which was generally in the medium level.Univariate analysis showed that age,family residence,education,marital status,income level,postoperative time,type of ostomy,mode of payment,monthly cost of ostomy supplies,self-care status of ostomy,participation in ostomy lecture or fraternity status had statistically significant influence on the score of stoma acceptance(P<0.05),Correlation analysis showed that stoma acceptance was closely related to quality of life.Stoma acceptance was positively correlated with positive cognitive emotion regulation strategies,including acceptance,re-focus on planning,positive re-evaluation and rational analysis.It was negatively associated with negative cognitive emotions including rumination and other-blame.Multivariate linear regression analysis showed that age,income level,medical mode of payment,monthly cost of ostomy supplies,self-care level,attending lectures or fraternity status,quality of life,Positive re-evaluation and rational analysis were the main factors affecting the acceptance of patients with intestinal ostomy.CONCLUSIONThe Chinese version of stoma acceptance questionnaire has good reliability and validity,which is suitable for Chinese patients with colostomy.In this study,the stoma acceptance of patients with colostomy was at a medium level.Medical staff should pay attention to the acceptance and adaptation of patients with colostomy,and provide individualized health services and psychological support,and help patients to improve the ability of self-care for stoma and the quality of life.They should guide patients to adopt positive cognitive emotional regulation.This can promote patients to better accept stoma and actively respond to stoma,which is conducive to maintaining patients’ physical and mental health.