The Relationship between Self-esteem and Perceived Social Support in Ostomy Patients

 Colorectal cancer is a developing gastrointestinal disease that results in an ostomy operation. Meanwhile, stoma-related complications following ostomy surgery are associated with several physical and psychological diseases in patients. The present study aimed to determine the relationship between self-esteem and perceived social support in ostomy patients. 

 This was a correlational-descriptive study performed in 2017. The sample size was estimated at 390 individuals considering a 95% confidence interval, an 80% test power, and r=0.2. The participants were selected by continuous sampling, and those who were a member of the association and met the inclusion criteria (having a file in Iran ostomy association, no diagnosed physical-psychological diseases, not being in the progressive stage of the disease, having the ability to answer the questions of the questionnaire and at least six months of symptoms of the disease) were enrolled in the study. The researcher visited the association on different days of the week and distributed questionnaires among patients following explaining research objectives and how to complete the instrument and receiving written consent from the subjects. In this study, we applied three questionnaires on demographic characteristics (age, gender, marital status, occupational status, level of education, and duration of disease), self-esteem, and social support. The Rosenberg self-esteem questionnaire encompasses 10 items, which are scored based on a four-point Likert scale from zero (completely disagree) to 3 (completely agree). In this regard, the highest score is 30, and scores above 25, 15-25, and below 15 show high, moderate, and low self-esteem, respectively. The content validity of the mentioned tool was approved based on the opinions of its developers and different preliminary studies (26). In a research by Greenberger et al., the internal consistency of the scale was reported at 0.84. In addition, Pullman & Allik reported internal consistency of 0.91 for the mentioned scale. In the current research, the internal consistency of the instrument was approved at a Cronbach’s alpha of 0.90. Designed by Northouse, the perceived social support questionnaire contains 40 items in five sections the spouse, family members, friends, physician, and nurse. Each section includes eight items to assess patients’ social support perceived from their spouse, family members, friends, physician, and nurse. The items are scored based on a five-point Likert scale from 1 (completely disagree) to 5 (completely agree). The perceived social support score from each of the support sources is calculated separately from the total scores obtained for each resource and the overall perceived social support score from the total scores obtained in all sources. The range of changes in the overall perceived social support score of the five sources is from 40 to 200, and the range of changes in the perceived social support score of each resource separately is from 8 to 40. The perceived social support score is divided into three levels of low (40-92), moderate (93-146) and high (147-200), and the perceived social support score of each support source is classified into three levels of low (8-18), medium (19-29) and high (30-40). In Iran, the questionnaire was first applied by Heydari et al. (2005), who used the internal consistency method to confirm the reliability of the tool. In the end, the reliability of the tool was confirmed at a Cronbach’s alpha of 0.92. In the present research, the internal consistency of the questionnaire was approved at a Cronbach’s alpha of 0.80. After receiving approvals from the ethics committee of the university, the researcher received an introduction letter from the officials of Kashan University of Medical Sciences to enter the research setting. Afterwards, the researcher referred to the research center and gained permission from the manager and head of the center to start the research. First, the researcher selected participants based on the inclusion criteria received written consent from them, and ensured them of the confidentiality terms regarding their personal information. In the next stage, he read the questions for the subjects and wrote down their answers without any change. Data analysis was performed in SPSS version 16 using descriptive statistics (to regulate table), independent t-test (to analyze the data), as well as one-way ANOVA, Pearson’s correlation coefficient, and Tukey’s test. 

 In this study, 350 questionnaires were completed. The mean age of ostomy patients was 37.7 ± 5.87 years. In addition, 52.3% of the subjects were married, 65.4% were female, and 38.6% had a diploma degree. Moreover, 40% of the subjects were dealing with the disease for more than seven years. The mean and standard deviation of patients’ perceived self-esteem and social support were 20.56 ± 5.17 (out of 30) and 131.17 ± 15.47 (out of 200), respectively. The majority of ostomy patients (68%) had moderate self-esteem. In addition, most of the participants (84.3%) had moderate perceived social support. The relationship between the mentioned variables was assessed using a Pearson’s correlation coefficient, the results of which were indicative of a significant and direct association between perceived social support and its dimensions with self-esteem (r=0.20, P=0.001). In addition, there was a significant relationship between the mean score of self-esteem and marital status (P=0.001). In fact, the mean score of self-esteem was significantly higher in married subjects, compared to single and divorced ones (P=0.001). Moreover, we found a significant correlation between self-esteem and level of education (P=0.008), in a way that the mean self-esteem score was significantly higher in the participants with an MSc degree, compared to other levels of education (P=0.008). Furthermore, we detected a significant relationship between perceived social support and level of education (P=0.005), in a way that the mean perceived social support score was higher in those with an MSc or BSc degree, compared to other levels of education (P=0.005). There was also a significant correlation between the mean score of perceived social support and duration of the disease (P=0.005) since the mentioned variable’s score was higher in those who had the disease for two-four years, compared to other participants (P=0.005). 

 Given the significant impact of perceived social support on self-esteem it is recommended that high-risk groups (in terms of social support perception and receiving) be recognized by nurses and their support needs be assessed constantly. In fact, great attention can be paid to this psychological dimension of patients by improving their psychological health and connecting them to the community, families and friends.