| Objective:To understand the post-traumatic growth level and its influencing factors at the time of discharge and the 1st,3rd and 6th months after discharge of patients with enterostomy and to explore its change trajectory,so as to provide theoretical basis and reference for clinical health care personnel to adopt targeted interventions and improve the post-traumatic growth level of patients with enterostomy.Methods:This study was a prospective observational study.Patients who underwent enterostomy for the first time from January to July 2021 in the gastrointestinal surgery departments of two tertiary care hospitals in Nanchong were selected,and the general information questionnaire,Simplified Chinese version of the post-traumatic growth assessment scale,the resident health information literacy self-assessment questionnaire and the social support scale were used to survey patients 1 day before discharge(T1),1 month after discharge(T2),3 months(T3)and 6 months(T4)when they returned to the hospital for review Surveys were conducted.The first data collection was performed in the patient’s inpatient ward,and the next three time points were performed at the patient’s outpatient follow-up,and if the patient did not come to the outpatient follow-up on time,the data were collected from the patient by telephone and online.Statistical methods included descriptive statistical analysis,independent sample t-test,repeated measures ANOVA,one-way ANOVA,Pearson correlation analysis,and multilevel modeling.Results:1.Follow-up completion:A total of 144 study subjects were included in this study,and finally 132 patients completed four questionnaires,with a follow-up rate of 91.7%;12 cases were lost,with a loss rate of 8.3%.2.The post-traumatic growth scores of enterostomal patients at four time points wereT1(56.51±8.13),T2(48.18±13.70),T3(55.43±12.34)and T4(56.08±15.09);the percentage of enterostomal patients with low post-trau matic growth levels at four time points were 68.8%,75.0%,60.7%and56.8%,respectively;repeated measures ANOVA showed that the differences i n post-traumatic growth score changes at different time points were stat istically significant(P<0.01).3.The health information literacy scores of enterostomal patients at the four time points were T1(13.85±3.20),T2(15.72±3.20),T3(17.78±3.02)and T4(18.85±2.86),respectively;the percentage of enterostomal patients with passing health information literacy scores at the four time points were 15.9%,31.4%,61.5%and 71.2%,respectively;The repeated measures ANOVA showed that the health information literacy scores of patients with enterostomies and their scores on the five dimensions showed a c ontinuous increase,and the difference was statistically significant(P<0.05).4.The social support scores of patients with enterostomies at four time points were T1(45.25±4.28),T2(41.85±6.54),T3(43.87±6.01)and T4(45.06±6.14);the percentage of patients with enterostomies at high social s upport level at four time points were 63.2%,37.1%,50.4%and 58.3%,res pectively.Repeated-measures ANOVA showed that the differences in cha nges in social support scores at different time points were statistically s ignificant(P<0.01).5.Univariate analysis revealed that post-traumatic growth scores at four time points T1,T2,T3,and T4 in patients with enterostomy were stat istically different(P<0.05)by education,personality type,per capita monthly household income,and medical payment method.Further two-by-two co mparison revealed that the differences in post-traumatic growth scores w ere statistically significant(P<0.05)between patients with elementary sch ool education and below compared with those with junior high school education and above;the differences in post-traumatic growth scores wer e statistically significant(P<0.05)between patients with extroverted perso nality type and introverted and intermediate patients;the differences in p ost-traumatic growth scores between patients with per capita monthly ho usehold income<3000 and the difference was statistically significant(P<0.05)between patients with per capita monthly family income>4500 an d those with per capita monthly family income>4500;the post-traumatic growth score of patients whose medical expenses were paid by urban and rural residents’ medical insurance was lower than those whose medi cal expenses were paid by urban workers’ medical insurance(P<0.01).Ma rital status was an influential factor for post-traumatic growth at time p oints T2,T3 and T4 in patients with enterostomies,and the post-traumati c growth scores of those without spouses were lower than those with s pouses(P<0.05);residence was an influential factor for post-traumatic gro wth at time points T1,T2 and T3 in patients with enterostomies,and the differences between the post-traumatic growth scores of patients living in rural areas and towns and those living in counties and prefectures or above were statistically significant(P<0.05).6.Health information literacy and social support scores at T1,T2,T3 and T4 were positively correlated with post-traumatic growth scores,and patients with higher health information literacy and social support scores had higher post-traumatic growth scores,and the difference was statistically significant(P<0.05).7.Trends in post-traumatic growth in patients with enterostomies:The initial level of post-traumatic growth of enterostomal patients was different(P<0.01),and the slope of time and the slope of the quadratic term of time were-10.235 and 2.166,respectively,indicating that the level of post-traumatic growth of enterostomal patients showed a trend of first decreasing and then increasing with time.The intercept was negatively correlated with the slope of time(r=-19.091)and positively correlated with the slope of the quadratic term of time(r=6.444),indicating that individuals with higher initial post-traumatic growth scores had slower post-traumatic growth changes in the T1-T2 time period and faster changes in the T2-T4 time period.8.Factors influencing the trend of post-traumatic growth in patients with enterostomies:non-time-varying covariates(demographic variables and disease-related information)do not affect the trend of post-traumatic growth in patients with enterostomies(P>0.05);the rate of change of health information literacy affects the trend of post-traumatic growth in patients with enterostomies(β=-0.044and 0.500,P<0.05),the faster the patient’s health information literacy increases,the faster the growth rate of post-traumatic growth,and the slower the growth rate of health information 1 iteracy,the slower the growth rate of post-traumatic growth;social support does not affect the trend of post-traumatic growth(β=-0.508 and 0.020,both P>0.05).Conclusions:1.The overall level of post-traumatic growth was low at all four time points in patients with enterostomies,and showed a secondary growt h trend of decreasing and then increasing within 6 months after surgery,but the growth rate was slow.2.The level of health information literacy in patients with enterosto mies was poor at four time points and showed a continuous upward tre nd in the level of health information literacy during the six months after surgery.3.The level of social support was better in the four time points of patients with enterostomies,and the trend of social support level within 6 months after surgery showed the same trend of decreasing and then increasing with post-traumatic growth.4.Education,marital status,personality traits,place of residence,percapita monthly household income,medical payment method,health inf ormation literacy and social support are the main influencing factors of post-traumatic growth in patients with enterostomy.5.The rate of increase in health information literacy has a greater impact on the trend of post-traumatic growth in patients with enterostomies.6.Medical and nursing staff should focus on the level of post-traumatic growth in patients with an enterostomy,especially in the first mon th after surgery.Individualized nursing interventions can be focused on patients with low education,no spouse,relatively introverted personality,living in rural areas and low economic income,health information literacy and social support,so as to improve the overall level of post-traumatic growth of patients. |
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