Self-Care and Associated Factors of Patients with Permanent Colostomies: A Structural Equation Model

To investigate the structural relationships between eHealth literacy, health-promoting behaviors, depression, disease stigma, self-efficacy and self-care in Chinese patients with permanent colostomies. A cross-sectional multi-stage random sampling study was conducted between October 2022 and July 2023. The study involved 280 participants with permanent colostomies recruited from four general hospitals in Yancheng City, China. Data were collected using a questionnaire package to assess model variables, including health-promoting behaviors, eHealth literacy, depression, disease stigma, self-efficacy and self-care. Structural equation modeling was employed to analyze the data. The model explained 81.8% of the total variance. Health-promoting behaviors (β ​= ​0.41, P ​< ​0.001), eHealth literacy (β ​= ​0.16, P ​< ​0.001), and depression (β ​= ​-0.17, P ​< ​0.001) influenced self-care directly. On the other hand, health-promoting behaviors, depression and disease stigma influenced self-care indirectly through self-efficacy mediation. The total, direct, and indirect effects of health-promoting behaviors and depression on self-care were 0.53 and -0.26, 0.41 and -0.17, and 0.12 and 0.09, respectively, in patients with colostomies. This study highlights the importance of improving health-promoting behaviors, eHealth literacy, and self-efficacy in patients with colostomies. The study also suggests that reducing depression and disease stigma could enhance patients' self-care. Health care professionals can leverage these findings to develop appropriate programs to improve patients' self-care.