Barriers and facilitators in preventing and managing parastomal hernias: a qualitative study from the perspective of enterostomal therapist

BACKGROUND: A parastomal hernia is a common complication of ostomies. Once developed, it is typically irreversible and can significantly impair a patient’s quality of life. Despite their prevalence, current strategies for the prevention and management of parastomal hernias remain inadequate. Previous research has explored the influencing factors from the patient’s perspective; however, there is a notable lack of in-depth analysis from the viewpoint of Enterostomal Therapists. Therefore, the present study explores the barriers and facilitators affecting the prevention and management of parastomal hernias in patients with ostomies from the perspective of Enterostomal Therapists. METHODS: This study was a descriptive qualitative research design. Using purposive snowball sampling, semi-structured interviews were conducted between August and November 2024 from 18 tertiary hospitals across 11 Chinese provinces. Based on a review of the literature and discussions within the research team, an interview outline was developed. The interview data were organized using MAXQDA 2022 software and systematically analyzed through thematic analysis. A combination of dual independent coding and respondent feedback verification was employed. RESULTS: This study included 22 Enterostomal Therapists, with an average of 15 years of experience in stoma care. The main barriers were identified in three areas: (1) Insufficient professional support, driven by limited capacity amid expanding responsibilities and fragmented collaboration that disrupted care continuity; (2) Overburdened patients struggling to cope, evident in shifting needs, psychological distress, and emotional strain; and (3) An inadequate supportive environment, marked by uneven resource distribution and an overload of information of inconsistent quality. The facilitating factors mainly included: (1) Comprehensive professional involvement, featuring full cycle professional management and continuous prevention-oriented supervision; (2) Patient empowerment and self-driven engagement, manifested through active participation, behavioral internalization, self-awareness, and continuous growth; and (3) Digital connectivity and home-based support, including technology‑assisted communication and continuous home‑oriented care. CONCLUSIONS: To improve parastomal hernia prevention and management in patients with ostomies, nursing practice and continuing education should prioritize targeted training of Enterostomal Therapists, structured multidisciplinary collaboration, stratified patient education, optimized resource allocation, and pragmatic use of digital health. CLINICAL TRIAL NUMBER: Not applicable.