Self-Efficacy Of Patients With Enterostomy: A Cross-sectional Survey And Analysis Of Impact Factors

Objective:The important role of self-efficacy in patients with chronic disease were well documented in the earlier studies, however, the predictors of self-efficacy in patients with enterostomy have not been studied extensively. The purpose of this cross-sectional study was to explore the influence of demographic and medical variables, health condition, emotional status, adjustment and social support on self-efficacy among patients with enterostomy.Methods:This research contains two major steps:instruments revision and cross-sectional survey.Step one:By extensive literature review, we selected and introduced the City of Hope-Quality of Life-Ostomy Questionnaire (COH-QOL-OQ) and Ostomy Adjustment Inventory-23(OAI-23) into China. Based on the process of translation, back-translation, culture adaption, we completed the exploratory factor analysis (EFA) and confirmative factor analysis (CFA) process to ensure the excellent reliability and validity of the Chinese version scales.Step two:Through methods of theory study, literature review, experts consultation to determine impact factors and measuring instruments, the research instruments included the Chinese version-City of Hope-Quality of Life-Ostomy Questionnaire (C-COH), Chinese version-Ostomy Adjustment Inventory (C-OAI), Stoma Self-efficacy Scale, Social Support Revalued Scale (SSRS), Hospital Anxiety and Depression Scale (HADS) and self-designed Sociodemographic and Disease-related Questionnaire. Using methods of univariate analysis, correlation analysis and stepwise multiple regression to determine the influencing factors of self-efficacy among patients with enterostomy.Results:1. Revision and psychometric test of Chinese version-City of Hope-Quality of Life- Ostomy Questionnaire (C-COH):C-COH is composed of4subscale (physical well-being, psychological well-being, social well-being and spiritual well-being) and32items. The scale reliabilities estimated from the CFA results for the four subscales were0.860,0.885,0.864and0.686, respectively. All of the computed I-CVI values were greater than0.70, and most were greater than0.80, indicating adequate content validity. Item reliabilities estimated from test-retest were all greater than0.8, indicating that all the items of the C-COH have good stabilities.2. Revision and psychometric test of Chinese version-Ostomy Adjustment Inventory (C-OAI):Factor analysis supported the C-OAI being composed of three subscales,20items. Good internal consistency (Chronbach’s a of the OAI was0.886and the Chronbach’s a of the three subscales are ranging from0.704to0.855). All of the computed I-CVI values were greater than0.70, and most were greater than0.80, indicating adequate content validity. Item reliabilities estimated from test-retest were all greater than0.7, indicating that all the items of the C-OAI have good stabilities. Our findings suggest that the C-OAI can be readily used by health care providers as a useful tool for assessing the level of adjustment of the patients with ostomy in China.3. Results of descriptive analysis and univariate analysis of self-efficacy for patients with enterostomy:Patients with enterostomy in this research experienced medium/low self-efficacy level. The mean total score of self-efficacy was (68.85±18.64); self-care self-efficacy (35.06±9.54) and social self-efficacy (21.28±7.65), the mean score of the other single six items are (1.40±0.86),(1.36±0.79),(2.67±1.04),(2.56±0.95),(2.03±1.05),(2.42±1.05), respectively. In this sample, a total of177enterostomy patients with low-level self-efficacy, accounting for43.28%;208enterostomy patients with medium level self-efficacy, accounting for50.86%, only24patients with high level self-efficacy, accounting for5.87%. Self-efficacy of most enterostomy patients is at medium/low level. Univariate analysis found that gender, body mass index (BMI), work status, marital status, education levels, coping styles, self-care degree, complications, comorbidities, coping style, communicating with doctors were related to self-efficacy (p<0.05).4. Results of multiple stepwise regression analysis for enterostomy patients:For the enterostomy patients, multiple regression analysis showed that the variables of psychological well-being, depression, utilization of social support, gender, constant worry, acceptance and subjective social support entered the model gradually. Conclusions:The study provides evidence that the Chinese version of the C-OAI and C-COH can be considered as valid and reliable instruments for assessing adjustment and life quality of patients with ostomy in China.Psychological well-being, depression, utilization of social support, gender, constant worry, acceptance and subjective social support are predictors of self-efficacy for patients with enterostomy. Our findings can help health providers identify patients who may be at risk for poor future self-efficacy. What’s more, our research results may provide the excellent basis for the building of self-management programs and further intervention studies for patients with enterostomy.