Developing a Stoma Acceptance Questionnaire to improve motivation to adhere to enterostoma self-care


stoma self-care
educational needs
educational diagnosis form
Mokken scaling



In stoma care, patient education is often weak in terms of improving patientsâ level of acceptance of living with a stoma. Self-care educational interventions in enterostomal patients, which according to Oremâs Theory should take into account these patientsâ specific needs, require instruments that measure patientsâ stoma acceptance to improve motivation based on the resumption of activities they used to carry out before having a stoma. 




The aim was to develop an instrument that measures the level of stoma acceptance to improve motivation to adhere to enterostoma self-care.

Aspects that improve stoma acceptance and consequently motivation to adhere to enterostoma self-care were identified through 10 focus groups. In the focus groups, the motivation indicators were grouped, categorised and results entered into a Stoma Acceptance Questionnaire (SAQ). The SAQ was then piloted with 104 enterostomal patients from three general hospitals. The SAQ latent structure was explored using nonparametric item response theory.



A three-factor structure was demonstrated for the 16 items of the SAQ: Autonomy and normality; Self-determination and normality; and Trust and burden. Mokken Scaling identified the âresumption of enterostomal patientsâ normal activitiesâ as a measure of stoma acceptance. 



The SAQ could enable nurses to adopt a standardized approach to the assessment of enterostomal patientsâ motivation to resume their normal activities and identify needs linked to this. The SAQ could also be used to measure the effectiveness of psychosocial and educational interventions aimed at improving stoma acceptance.


Simmons KL, Smith JA, Bobb K-A, et al. Adjustment to colostomy: stoma acceptance, stoma care self-efficacy and interpersonal relationships. J Adv Nurs 2007;60: 627â35.

Orem DE. Nursing: Concepts of Practice (4th Edition). St Louis, MO: Mosby-Year Book Inc. 1991.

Rauch P, Miny J, Conroy T, et al. Quality of life among disease-free survivors of rectal cancer. J Clin Oncol 2004;22(2):354-60.

Wicksell RK, Melin L, Lekander M, et al. Evaluating the effectiveness of exposure and acceptance strategies to improve functioning and quality of life in longstanding pediatric pain - a randomized controlled trial. Pain 2009;141(3):248-57.

Chaumier D. Therapeutic education at the heart of the patient treatment pathway. Rev Infirm 2012;181:30-1.

Brown H, Randle J. Living with a stoma: a review of the literature. J Clin Nurs 2005;14:74â81.

Cheng F, Xu Q, Dai XD, et al. Evaluation of the expert patient program in a Chinese population with permanent colostomy. Cancer Nurs 2012;35:E27-E33.

Burton J, Allison J, Smart N, et al. Impact of stoma care on enhanced recovery after colorectal surgery. Gastrointest Nurs 2011;9:15-19.

Tao H, Songwathana P, Isaramalai SA, et al. Personal awareness and behavioural choices on having a stoma: a qualitative metasynthesis. J Clin Nurs 2014;23:1186-200.

Watson R, van der Ark LA, Lin L-C, et al. Item response theory: how Mokken scaling can be used in clinical practice. J Clin Nurs 2012;21:2736â46.

Kuijpers RE, van der Ark LA, Croon MA. Standard errors and confidence intervals for scalability coefficients in Mokken scaling analysis using marginal models. Sociol Methodol 2013;43:42-69.

Mooij T. A Mokken scale to assess secondary pupils' experience of violence in terms of severity. J Psychoeduc Assess 2012;30:496-508.

Straat JH, van der Ark LA, Sijtsma K. Minimum Sample Size Requirements for Mokken Scale Analysis. Educ Psychol Meas 2014 DOI: 10.1177/0013164414529793 (Only online at the moment).

Thorpe G, McArthur M, Richardson B. Healthcare experiences of patients following faecal output stoma-forming surgery: A qualitative exploration. Int J Nurs Stud 2014;51:379-89.