Study design and sample. In this cross-sectional multisite descriptive study, data were collected between December 31, 2019, and March 31, 2020, in Turkey. The study population consisted of 180 patients who underwent tracheostomy in 3 university hospitals’ otorhinolaryngology services, who were discharged with a tracheostomy, and who continued home care for at least 1 month and at most 3 months after discharge. Patients were eligible if they agreed to participate in the study voluntarily, had no sensory or hearing loss, were age 18 years or older, were literate, and continued home care for 1 to 3 months after discharge. All consecutive patients were invited to participate in the study prior to discharge; telephone numbers and addresses were obtained from patients who chose to participate and met the inclusion criteria. Interviews were conducted at their homes within 1 to 3 months after they were discharged. As a result of the power analysis performed (according to 180 patients), the sample size of the study that reflected the population was determined to be 123 individuals, with a 95% confidence interval, 0.05 margin of error, and a degree of impact of 0.80. The sample consisted of 123 patients with tracheostomy who met the research inclusion criteria and were reached on the specified dates.
Ethics committee approval. Before the start of the study, institutional permission was obtained from the hospitals where the research was conducted, and ethics committee approval was obtained from the Regional Public Hospital’s Ethics Committee for Non-Interventional Clinical Research. In addition, the purpose, methods, and expected benefits and risks were explained to the patients, and their written informed consent was obtained.
Data collection methods. The data were collected by the researcher using paper-and-pencil questionnaires via face-to-face interviews. Interviews were conducted during home care visits, and each interview took approximately 20 to 30 minutes. Interviews were conducted once, and all took place between 1:00 PM and 4:00 PM. In addition, patients were given the telephone number of the researcher to contact as needed regarding care practices and problems encountered.
Data collection tools.
The Sociodemographic Characteristics Form. This form was developed by the researchers according to the literature.2,4–6,8,14 Expert opinions were obtained from 1 instructor in the Surgical Diseases Nursing Department, 1 instructor in the Fundamentals of Nursing Department, 2 instructors in the Department of Public Health Nursing, and 1 physician in the Otorhinolaryngology Department regarding the items developed, and changes were made in line with their recommendations. The form contains 15 items encompassing patient-specific information about the place of tracheostomy surgery, date of tracheostomy surgery, date of discharge with tracheostomy, regular outpatient care, sex, age, marital status, body mass index (BMI; calculated by measuring height and weight by the same researcher and using the same measurement tools at each patient interview), education level, income level, amount of money allocated to care, health insurance, smoking status, presence or absence of chronic disease, and reason for tracheostomy.
Self-Care Agency Scale (SCAS). The scale used to measure self-care ability of an individual to care for himself or herself was the 35-item Turkish Short Form of the scale developed by Kearney and Fleischer,15 which consisted of 43 items. The Turkish validity and reliability study of this scale was conducted by Nahcivan.16 The scale focuses on the self-assessment of individuals about their self-care activities. Each item is scored in the range of 0 to 4. The individuals’ self-care orientation is determined by their responses on the 5-point Likert-type scale. Participants scored each item with responses ranging from 0 = “very uncharacteristic of me” to 4 = “very characteristic of me.” On the Turkish version of the scale, 8 items (third, sixth, ninth, 13th, 19th, 22nd, 26th, and 31st items) include negative statements and are reverse-coded. The maximum score is 140 points. Higher scores on the scale indicate an increased self-care agency and ability. There is no cut-off value.16
ADL Scale. The scale used to evaluate ADL in persons with chronic conditions and the older population was developed by Katz et al,17 and its Turkish validity and reliability study was carried out by Yardimci.18 The scale is focused on 6 activities that include transferring, continence, bathing, dressing, toileting, and feeding. Each activity is scored using a 3-point rating scale as: dependent or unable to perform activity independently (3), partially dependent or requiring some assistance (2) and independent or being able to perform activity indepently (1). On the ADL scale, a score of 0 to 6 points is considered dependent, 7 to 12 points is considered partially dependent, and 13 to 18 points is considered independent; dependency decreases as the score increases.18
Perception of Health Scale (PHS). This scale measures previous health, current health, health outlook, resistance/susceptibility to disease, health concern, disease orientation, denial of patient role, and attitude toward seeing a doctor. The 15-item, 5-point Likert-type scale was developed by Diamond et al19 to evaluate health perception, and its Turkish validity and reliability study was carried out by Kadioğlu and Yildiz.20 The scale is focused on the following 4 subdimensions: center of control (minimum, 5; maximum, 25), self-awareness (minimum, 3; maximum, 15), certainty (minimum, 4; maximum, 20), and importance of health (minimum, 3; maximum, 15); the sum of the scores from the subdimensions gives the total health perception score. The items numbered 1, 5, 9, 10, 11, and 14 are positive attitude statements, whereas the items numbered 2, 3, 4, 6, 7, 8, 12, 13, and 15 contain negative statements. Positive statements are scored using the following points: 5 = strongly agree, 4 = agree, 3 = neutral, 2 = disagree, and 1 = strongly disagree. The negative statements are reverse-coded. The lowest and highest total scores of the scale are 15 and 75, respectively. High scores on the scale indicate that individuals perceive their health positively, and low scores indicate that individuals perceive their health negatively.20
Data analysis. Data were gathered from patient interviews (demographic data and outcomes measures) and entered into SPSS for Windows version 22.0. BMI was grouped as underweight (< 18.50 kg/m2), healthy (18.50–24.99 kg/m2), pre-obese (25.00–29.99 kg/m2), and obese (> 30.00 kg/m2). The minimum monthly wage in Turkey is 373 US dollars (USD), and the poverty threshold in Turkey is 185 USD. Because of that, monthly income and monthly budget for tracheostomy care were grouped into 3 outcomes: 0–185 USD, 186–373 USD, and ≥ 373 USD. According to the inclusion criteria, patients had been receiving home care for 1 to 3 months; therefore, time since tracheostomy surgery was grouped into 2 outcomes (< 45 days and ≥ 45 days) In the statistical analysis of the data, percentiles, independent sample t-test, analysis of variance, and Pearson correlation analysis were used. P < .05 was accepted as the level of significance.