Design and sample. A descriptive, cross-sectional survey was conducted at the stomatherapy unit connected to the general surgery department of a university hospital in Ankara, Turkey, between October 2013 and June 2015. Three (3) wound, ostomy, continence (WOC) nurses working in the stomatherapy unit provided training, counseling, and care services for inpatients and their relatives beginning in the preoperative period and served all clinics of the hospital, including the ileostomy, colostomy, and urostomy clinics. After the patient had been discharged, the same services continued for outpatients.
At the start of the study, hospital records indicated 100 patients had presented to the stomatherapy unit within the previous year. The sample size was calculated to be 80 according to the formula used to determine the sample size for a known research universe. The study was conducted among individuals who were receiving care in the stomatherapy unit and met the inclusion criteria, which stipulated study participants must be at least 18 years of age, literate, live with family, have had a stoma for at least 2 months, and be willing to participate in the research. Patients with a diagnosis of mental illness, intellectual disability, and/or deterioration of cognitive abilities were excluded. All consecutive patients who visited clinic starting in October 2013 were invited to participate in the study during the their regularly scheduled clinic visit.
Data collection tools. The Information Form for the Individual with a Stoma, the Multidimensional Scale of Perceived Social Support (MSPSS), the McMaster Family Assessment Scale (FAS), and the Ostomy Adjustment Inventory scale (OAI-23) were used as data collection tools in the study.
Information Form for the Individual with Stoma. This form was developed based on the literature and the experience of the researchers. The form contained 6 questions regarding sociodemographic characteristics (ie, age, gender, marital status, graduation status, working status, income status) and 10 questions about stoma-related characteristics (stoma duration, surgery type, status of preoperative stoma site marking, stoma type, preoperative information, stoma nature, reason for the stoma opening, who cared for the stoma, stoma complications, and support received).
Multidimensional Scale of Perceived Social Support (MSPSS). This scale was developed by Zimet et al21 and adapted to Turkish by Eker et al.22 The MSPSS comprises 12 items in 3 groups of sources of support; each includes 4 items: 1) family (items 3, 4, 8, and 11), 2) friends (items 6, 7, 9, and 12), and 3) special person (items 1, 2, 5, and 10). Each item is scored on a scale of 1 to 7, where 1 = very strongly disagree, 2 = strongly disagree, 3 = mildly disagree, 4 = neutral, 5 = mildly agree, 6 = strongly agree, and 7 = very strongly agree. The total score for the subscale is the sum of the 4 items (range 4–28); subscale scores are summed for the total score (range 12–84). The higher the score obtained, the higher the perceived social support; a low score indicates no perception of support or that support is lacking. Eker et al22 found the Cronbach’s alpha coefficient for the total score was 0.89; the Cronbach’s alpha coefficient was 0.85 for the family subscale, 0.88 for the friend subscale, and 0.92 for the special person subscale. In this study, the total Cronbach’s alpha coefficient was 0.87.
McMaster Family Assessment Device (FAS). This instrument was developed by Epstein et al,23 and its validity and reliability for Turkey was determined by Butler.4 The 60-question, self-notification scale comprises statements presented in 7 subscales: problem-solving (items 2, 12, 24, 38, 50, and 60), communication (items 3, 14, 18, 22, 29, 35, 43, 52, and 59), family roles (items 4, 8, 10, 15, 23, 30, 34, 40, 45, 53, and 58), being able to react emotionally (items 9, 19, 28, 39, 49, and 57), due consideration (items 5, 13, 25, 33, 37, 42, and 54), behavioral control (items 7, 17, 20, 27, 32, 44, 47, 48, and 55), and general functions (eg, “When we face trouble and sadness, we support each other”; and “We don’t tell each other about our troubles at home”; items 1, 6, 11, 16, 21, 26, 31, 36, 41, 46, 51, and 56). The number of items in the subscales ranges from 6 to 12. The instrument enables a family to evaluate how it functions according to the perceptions of family members. The participant evaluates the items as: 1 = totally agree, 2 = mostly agree, 3 = agree a little, or 4 = disagree. Subscale items are summed for the subscale score, and the total score for the scale is obtained by summing the subscale scores and dividing the total by 7. Thus, individual scale scores range from 1 (best functioning) to 4 (worse functioning). An increase in score for each subscale indicates a greater degree of deterioration in functioning. In addition, a score of 1 indicates that the situation is “healthy” and a score of 4 indicates that it is “unhealthy.” A score of 2 constitutes the medium value. A score of ≤2 can be evaluated as “healthy,” and a score of >2 as “unhealthy.” In this study, the total Cronbach’s alpha coefficient was 0.89.
Ostomy Adjustment Inventory-23 (OAI-23). The OAI-23 was developed by Simmons et al24 in order to determine the level of adaptation of individuals with a stoma. The validity and reliability of the scale in Turkey was assessed by Karadag et al.25 The instrument comprises a 23-item self-assessment scale consisting of 4 subfactors: accepting (items 1, 3, 4, 6, 9, 14, 15, 19, and 23), anxiety/concern (items 12, 13, 17, 20, and 21), social integration (items 5, 7, 8, and 11), and anger (items 2 and 10). Three (3) additional items (16, 18, and 22) are not included in any subfactor. Each item on the scale is evaluated on a 5-point Likert type scale from 0 to 4 (definitely agree, agree, not sure, disagree, definitely disagree); a high score for each item shows that adaptation is increasing. The 12 items in the scale that contain negative statements (2, 5, 7, 8, 10, 11, 12, 13, 16, 17, 18, and 21) are scored in reverse. Items in the subscale are summed, and the total score is obtained by the sum of all the subscale scores. Thus individual scale scores range from 0 (worst adaptation) to 92 (best adaptation). The reliability coefficient of the overall scale was 0.874, and the correlation coefficient obtained by the test-retest method was 0.766. In this study, the total Cronbach’s alpha coefficient was calculated as 0.86.25
Data collection and analysis. Data were collected in the stomatherapy outpatient unit. The patients completed the data collection tools used in this study after they had received the necessary explanations during a face-to-face interview. The study continued until the sample size was reached. In the end, 80 patients met the study criteria, but 5 refused to participate; as such, 75 patients who met the patient selection criteria took part in the study (participation rate 93.8%). When the target sample size is not reached in research, post hoc power analysis can be performed to calculate the power of the study; the calculated power should be at least 80%.26,27 Post hoc power analysis was performed with the G Power 3.1 program in order to eliminate doubts about the adequacy of the sample size, and the power of the study was found to be 86%, showing a sufficient sample size for the study.
Data were input directly from the study instruments into SPSS, version 21 (IBM Corp, Armonk, New York). Number and percentile calculations, Mann-Whitney U test, and Spearman correlation analysis were performed. The Mann-Whitney U test was used to compare the differences between the patients’ mean scores on the OAS, MSPSS, and FAS according to their sociodemographic characteristics. Spearman correlation analysis was performed to evaluate the relationship between these scales. Statistical significance was accepted at P <.05.
Ethical considerations. Institutional Review Board (IRB) approval was obtained from the university (No:77082166-604.01.02). The second stage involved one-on-one interviews with patients presenting at the stomatherapy unit, during which their written consent was obtained following an explanation of the aims of the study, the manner of application, the content of the data collection tools, and the confidentiality of personal information (each participant’s personal information was collected by numeric code to ensure confidentiality, and the identity of the participants was not identified in the collected raw data). Patients who voluntarily consented to participate were enrolled in the study.