Exploring the barriers and enablers of the self-management ability in colorectal cancer patients with enterostomy: a qualitative study based on social ecological model

Abstract

Background:Since enterostomy surgery changes the way a patient defecates, it is essential for the patient to be self-managing in order to adapt to this change. Objective:We aimed to explore the barriers and enablers affecting the self-management ability of colorectal cancer patients with enterostomy from the perspectives of social ecological model, to provide insight for developing self-management intervention programs to better meet the needs of patients. Methods:An exploratory qualitative study guided by social ecological model and followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines was conducted . A total of 11 colorectal cancer patients with enterostomy from in the gastrointestinal surgery ward and ostomy clinic of a Grade A tertiary hospital in Shandong Province from January 2023 to April 2023 were recruited, and semi-structured in-depth interviews were used to collect data. Colaizzi data analysis and Nvivo 11.0 software were used to analyze the interview data. Results:Facilitators relating to self-management ability included perceived benefits of self-management, acquisition of enterostomy knowledge and skills, positive psychological adjustment, family responsibility drive, and improvement of the health care system. Barriers included lack of ostomy knowledge and skills, adverse experience of the disease, family barriers, social negative environmental influences, limited access to medical care, and barriers to information access. Conclusion:This study indicated that factors from the aspects of microsystem(e.g.,lack of ostomy knowledge and skills, adverse experience of the disease), mesosystem(e.g.,family barriers, social negative environmental influences), macrosystem(e.g.,limited access to medical care, and barriers to information access) would potentially affect the self-management ability of the colorectal cancer patients with enterostomy, interventions taget n these aspects might improve patients' self-management ability.