Population and sample. The study population encompassed patients with stomas (N = 1,120, including patients with a colostomy, urostomy, or ileostomy) monitored at a stomatherapy unit of a 1,037-bed university hospital located in a metropolis in Turkey. Using convenience sampling methods, the study included patients seen for routine monitoring between March 1 and May 31, 2012.
Inclusion criteria stipulated participants must be at least 18 years old, married, and with an abdominal stoma for at least 2 months for evacuation purposes. Partners of patients also were included in the study.
Data collection. Relevant data were collected from stoma patients and their partners using custom-designed forms comprised of items based on the experience of the investigators and a thorough review of the literature.4,5,16,29,41-47 The literature review was conducted with no language or date of publication restrictions using the search terms stoma, stoma and encountered problems, and body image to ascertain the issues involved with regard to personal/partner adjustment to a stoma. The resultant questionnaires consisted of items with 3 answer options (agree, undecided, disagree) addressing: 1) body perception of the patient with a stoma on having a stoma (20 statements), 2) perception of spouses on the body of the patient with a stoma (20 statements), and 3) perception of spouses on the body of the patient with a stoma according to the patient with a stoma (20 statements) (see Table 1 and Table 2). The questions investigated the feelings of stoma patients regarding the stoma, body image of stoma patients, and factors affecting their life quality, body image relevant to the stoma, and the Patient with a Stoma Information Form developed by the Wound Ostomy Incontinence Nursing Society in Turkey.4,5,16,29,4-47 Two different data collection forms were developed — 1 for patients with a stoma and 1 for their partners.
Data collection instruments for patients with a stoma. The data collection form pertaining to patients with stomas consisted of 4 sections.
Demographic characteristics. The first section contained demographic-related characteristic questions and included age, gender, length of marriage, number of children, educational status, occupation, employment status, health insurance, diagnosis, stoma type and duration (colostomy, urostomy, or ileostomy), physical or psychosocial problems in having the stoma, and whether the person was informed preoperatively of the stoma creation. The second section contained the BCS. The BCS was developed by Secord and Jourard and adapted to the Turkish population by Hovardaoğlu,44 who examined the scale’s validity and reliability and reported a Cronbach’s alpha value of 0.91 (P <0.01). As a whole, the BCS consists of 40 items that assess a person’s feelings toward the function and level of activity of each of his/her body parts; individuals respond using a Likert scale-type response using 1 (“I do not like at all”), 2 (“I do not like”), 3 (“I am undecided/unsure”), 4 (“I like”), or 5 (“I like a lot”). Totaled scores can range from 40 to 200 on the scale, with higher total scores representing more positive evaluations of one’s body.
The third section included questions regarding the personal perceptions of patients with a stoma in terms of their body. This section comprised 20 statements in which patients were asked to indicate the response that most reflected their assessment of their body as “I agree,” “I disagree,” or “I am undecided” (see Table 1).
The fourth section included 20 statements (10 positive, 10 negative) on how the patient perceived their partner’s perceptions toward the stoma (see Table 2). Patients were asked to indicate the response that most reflected their assessment of their partners’ perceptions from the following: “I agree,” “I disagree,” or “I am undecided.”
Data collection instruments for partners.
Demographic characteristics. The data collection form pertaining to partners similarly gathered information on demographic characteristics and included age, gender, length of marriage, number of children, educational status, profession, employment status, and health insurance, as well as whether he/she was informed of the stoma creation preoperatively and how he/she felt about touching the stoma.
Partner perception of the ostomate’s body. The second section contained 20 statements (10 positive, 10 negative) regarding the perceptions partners had toward the stoma patient’s body (see Table 2). Partners of stoma patients responded to statements with “I agree,” “I disagree,” or “I am undecided.”
Data instrument assessment. After the 2 forms were developed by the investigators, they were reviewed by 2 experts whose recommendations and opinions informed the revision of the forms.
A preliminary survey in connection with the study was conducted among 10 patients who were married and >18 years old, registered at the stomatherapy unit between December 6 and 25, 2011 who had an abdominal stoma for a period of at least 2 months. The questionnaires were revised according to the results of the preliminary testing.
The purpose and method of the study were explained to couples who agreed to participate in the study. The couples were told the information would be kept confidential and not shared with partners. Participants arranged suitable times for the interviews that were conducted separately with each partner in a room suitable for interviews in the hospital. The data collection forms were completed through 30-minute to 45-minute, face-to-face interviews with patients and their partners. Data collection forms were completed by the researcher, a clinic nurse who worked in general surgery and thus had an understanding of the treatment of the patients with a stoma.
Data analysis. The data were digitized by the investigators using the Statistical Package for the Social Sciences (SPSS) 15.0 (Chicago, IL). The frequencies and percentage distributions of the related data were assessed. Mann Whitney U test and Bonferroni-corrected Kruskal Wallis H test were used to examine the difference among the groups in consequence of the normality test. The latter test was used to examine the difference between the stoma type and the scoring of the body image scale, and the Mann Whitney U test was used to examine the difference between the characteristics of the other stoma and the scoring of the body image scale (see Table 3). The Bonferroni-corrected Kruskal Wallis H test also was used to examine the difference between statements for Patients with a stoma personal perceptions of their body with a stoma, Partner perception of the ostomate’s body, Patients with stomas perception of how their partner perceives their about body with a stoma, and the scoring of the body image scale (see Table 1 and Table 2).
Ethical considerations. The study was approved by the Clinical Research Ethics Committee of Gazi University (February 22, 2012, resolution no: 084). Written permission also was obtained from the head physician’s office at the hospital where the research was conducted (March 13, 2012, s:B.30 2. GUN. 0.20-1852). All research participants were informed about the study and their written consent was obtained. All the patients fulfilling the research criteria who were monitored in the stomatherapy unit during the study period were informed about the study, and the related informed consent form was approved by all the patients who accepted to participate in the research.