Application And Evaluation Of Expert Patient Program In Patients With Permanent Colostomy

Background: A colostomy is known to impact negatively on patient's quality of life. Problems and concerns of patients with colostomy include incontinence, difficulties in activities of travel and leisure, difficulties of returning to work and social life. Recent researches suggested that self-efficacy and psychosocial adjustment are related positively with one's quality of life.Expert Patient Program (EPP), based on self-efficacy theory, is a peer led small group intervention attended by people with chronic disease, which aim to increase participant's self-efficacy and self-management. Researches reported that self-efficacy, psychosocial adjustment of participants were improved after participating in the EPP.There are few reports and researches on colostomatos, self-efficacy and psychosocial adjustment, especially on intervention research. The purpose of the study is to investigate the colostomatos, knowledge, self-efficacy self-management and psychosocial adjustment and to evaluate the effect of Expert Patient Program in patients with permanent colostomy. Objectives: To investigate the status of knowledge, self-efficacy, self management, psychosocial adjustment of patients with permanent colostomy; to explore the correlation between knowledge, self-efficacy, self management and psychosocial adjustment in patients with permanent colostomy; to evaluate the effectiveness of the expert patient program on knowledge, self-efficacy, self management and psychosocial adjustment of patients with permanent colostomy. Methods: A conventional sample of 109 patients with permanent colostomy from stoma outpatient clinic in one provincial general hospital in Nanjing was taken. Date were collected by the self-made personal characteristics questionnaire, the self made knowledge questionnaire, the Chinese version of self-efficacy for permanent colostomy, the self management scale, the Chinese version of psychosocial adjustment for permanent colostomy. The descriptive statistics, Pearson correlation were adopted.11 patients were trained to be Expert Patients, 81 patients were participated in the EPP and received three-weeks EPP courses. Four weeks after accomplishing the EPP courses, knowledge on colostomy, self-efficacy, self-management and psychosocial adjustment were assessed again. Paired t test was adopted to compare and analyze the parameters before and after the EPP course. Results: The average score of knowledge, self-efficacy, self-management, psychosocial adjustment were 56.08±13.95, 87.25±26.07, 129.09±22.32, 44.38±9.64 respectively, the score indicator were 62.3%, 62.3% ,70.1%,55.4% respectively .There was a statistically significant correlation between knowledge, self-efficacy, self-management and psychosocial adjustment in patients with permanent colostomy. (r=0.518,0.451,0.428 respectively, P<0.05).After participated in the EPP course, the score of knowledge, self-efficacy, self-management and psychosocial adjustment were increased(51.89±11.45 vs 89.22±19.90, 71.56±5.93 vs 85.61±14.32, 125.44±19.27 vs 140.78±15.34, 47.59±9.64 vs 53.37±10.68 ,respectively) and the differences was statistically significant (P<0.01).Conclusion: The most level of knowledge, self-efficacy, self-management and psychosocial adjustment in patients with permanent colostomy were in the middle level. Knowledge, self-efficacy, self-management in patients with permanent colostomy were correlated positively with psychosocial adjustment. Higher lever of knowledge, self-efficacy, self-management contributed to higher lever of psychosocial adjustment in patients with permanent colostomy.The application of EPP can effectively improve the lever of knowledge, self-efficacy ,self-management and psychosocial adjustment in patients with permanent colostomy.Most of the participants gave the positive assessments on the expert patient program.