Health locus of control, body image and self-esteem in individuals with intestinal stoma

Salomé, Geraldo Magela; Lima, Joelma Alves de; Muniz, Karina de Cássia; Faria, Elaine Cristina; Ferreira, Lydia Masako

doi:10.1016/j.jcol.2017.04.003

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Journal of Coloproctology (Rio de Janeiro)

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Sumário

Original Articles • J. Coloproctol. (Rio J.) 37 (3) • Jul-Sep 2017 • https://doi.org/10.1016/j.jcol.2017.04.003 copy

Health locus of control, body image and self-esteem in individuals with intestinal stoma

Lócus de controle em saúde, imagem corporal e autoestima nos indivíduos com estoma intestinal

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To evaluate the health locus of control, self-esteem, and body image in patients with an intestinal stoma.

Method

A descriptive, cross-sectional, analytical study conducted at the pole of the ostomates of the city of Pouso Alegre. The study was approved by Research Ethics Committee of Universidade do Vale do Sapucaí. Opinion: 620,459. Patients: 44 patients with an intestinal stoma. Four instruments were used: a questionnaire with demographic and stomatologic data, the Health Locus of Control Scale, the Rosenberg Self-Esteem Scale/UNIFESP-EPM, and the Body Investment Scale. Statistics: Chi-square, Pearson, Mann-Whitney and Kruskal-Wallis tests. p < 0.05 was determined.

Results

The majority of patients were over 70 years, 16 (36.4%) were female, 30 (68.2%) were married, 31 (70.5%) were retirees, 31 (70.5%) had an income of 1-3 minimum wages, 32 (72.7%) did not practice physical activity, 18 (40.9%) had an incomplete elementary education, and 35 (79.5%) participated in a support or association group. 33 (75%) participants received the stoma because of a neoplasia; and 33 (75%) had a definitive stoma. In 36 (81.8%) participants, the type of stoma used was a colostomy, and 22 (50%) measured 20-40 mm in diameter; 32 (72.7%) participants used a two-piece device. With regard to complications, there were 29 (65.9%) cases of dermatitis. The mean total score for the Health Locus of Control Scale was 62.84; for the Rosenberg Self-Esteem Scale, 27.66; and for the Body Investment Scale, 39.48. The mean scores for the dimensions internal, powerful others, and chance of the Health Locus of Control Scale were 22.68, 20.68, and 19.50, respectively. With respect to the Body Investment Scale, for the dimensions body image, body care, and body touch, the mean scores were 11.64, 11.00, and 13.09, respectively.

Conclusion

In this study, the participants showed changes in self-esteem and body image and also showed negative feelings about their body. Ostomized individuals believe that they themselves control their state of health and do not believe that other persons or entities (physician, nurse, friends, family, god, etc.) can assist them in their improvement or cure and, in addition, believe that their health is controlled by chance, without personal or other people's interference.

Keywords
Intestinal stoma; Quality of life; Self-esteem; Body image; Locus of control

Variable	N	% overall	% valid	% accumulated	p-Value
Gender
Male	18	40.90	40.90	40.90	0.039^a a Statistical significance; Pearson's Chi-squared test (p ≤ 0.05).
Female	26	59.10	59.10	100.00
Total	44	100.00	100.00

Age group
38-49 years	11	25.00	25.00	25.00	0.455^a a Statistical significance; Pearson's Chi-squared test (p ≤ 0.05).
50-59 years	06	13.60	13.60	38.60
60-69 years	11	25.00	25.00	63.60
70-87 years	16	36.40	36.40	100.00
Total	44	100.00	100.00

Marital status
Married	30	68.20	68.20	68.20	0.041^a a Statistical significance; Pearson's Chi-squared test (p ≤ 0.05).
Single	06	13.60	13.60	81.80
Widowed	08	18.20	18.20	100.00
Total	44	100.00	100.00

Occupation
Retired - "r"	31	70.50	70.50	70.50	0.049^a a Statistical significance; Pearson's Chi-squared test (p ≤ 0.05).
Unemployed - "u"	05	11.40	11.40	81.80
Working - "w"	08	18.20	18.20	100.00
Total	44	100.00	100.00

Support group
Yes	35	79.50	79.50	79.50	0.037^a a Statistical significance; Pearson's Chi-squared test (p ≤ 0.05).
No	09	20.50	20.50	100.00
Total	44	100.00	100.00

Income
<1 minimum wage	02	4.50	4.50	04.50	0.048^a a Statistical significance; Pearson's Chi-squared test (p ≤ 0.05).
1-3 minimum wages	31	70.50	70.50	75.00
3-4 minimum wages	10	22.70	22.70	97.70
≥5 minimum wages	01	2.30	2.30	100.00
Total	44	100.00	100.00

Practices physical activity
Yes	12	27.30	27.30	27.30	0.043^a a Statistical significance; Pearson's Chi-squared test (p ≤ 0.05).
No	32	72.70	72.70	100.00
Total	44	100.00	100.00

Education
Incomplete elementary education	18	40.90	40.90	40.90	0.076^a a Statistical significance; Pearson's Chi-squared test (p ≤ 0.05).
Complete elementary education	07	15.90	15.90	15.90
Can read and write	19	43.20	43.20
Total	44	100.00	100.00	100.00

Variable	N	% overall	% valid	% accumulated	p-Value
Cause of ostomy
Neoplasia	33	75.00	75.00	75.00	0.049^a a Statistical significance; Pearson's Chi-squared test (p ≤ 0.05).
Inflammatory bowel disease	09	20.50	20.50	95.50
Trauma	01	2.30	2.30	97.70
Others	01	2.30	2.30	100.00
Total	44	100.00	100.00

Type of stoma
Colostomy	36	81.80	81.80	81.80	0.043^a a Statistical significance; Pearson's Chi-squared test (p ≤ 0.05).
Ileostomy	08	18.20	18.20	100.00
Total	44	100.00	100.00

Stoma diameter (mm)
0-20	11	25.00	25.00	25.00	0.301^a a Statistical significance; Pearson's Chi-squared test (p ≤ 0.05).
20-40	22	50.00	50.00	75.00
40-60	08	18.20	18.20	93.20
60-80	03	6.80	6.80	100.00
Total	44	100.00	100.00

Complication
Dermatitis	29	65.90	65.90	65.90	0.011^a a Statistical significance; Pearson's Chi-squared test (p ≤ 0.05).
Fistula	01	2.30	2.30	68.20
Granuloma	02	4.50	4.50	72.70
Bleeding	01	2.30	2.30	75.00
Peristomal herniation	03	6.80	6.80	81.80
Peristomal herniation + dermatitis	03	6.80	6.80	88.60
Pseudo-verrucous injury	02	4.50	4.50	93.20
Pseudo-verrucous injury + dermatitis	01	2.30	2.30	95.50
No complications	02	4.50	4.50	100.00
Total	44	100.00	100.00

Device type
One piece	12	27.30	27.30	27.30	0.049^a a Statistical significance; Pearson's Chi-squared test (p ≤ 0.05).
Two pieces	32	72.70	72.70	100.00
Total	44	100.00	100.00

Time of stoma use (in years) (range)
<1 year	08	18.20	18.20	18.20	0.047^a a Statistical significance; Pearson's Chi-squared test (p ≤ 0.05).
1-10 years	27	61.40	61.40	79.50
10-22 years	09	20.50	20.50	100.00
Total	44	100.00	100.00

Stoma character
Definitive	33	75.00	75.00	75.00	0.045^a a Statistical significance; Pearson's Chi-squared test (p ≤ 0.05).
Temporary	11	25.00	25.00	100.00
Total	44	100.00	100.00

Descriptive level	Health Locus of Control Scale	Rosenberg Self-esteem Scale	Body Investment Scale
Mean	62.84	27.66	39.48
Median	63.00	29.00	38.00
Standard deviation	8.061	3.791	5.928
Minimum	45	19	27
Maximum	81	40	51
p-Value	0.038^a a p ≤ 0.05.	0.049^a a p ≤ 0.05.	0.045^a a p ≤ 0.05.

	Mean	Median	Standard deviation	Minimum	Maximum	p-Value
Health Locus of Control Scale
Internal HLC	22.68	23.00	2.466	16	28	0.038^a a p ≤ 0.05.
Powerful others HLC	20.68	20.00	4.208	12	29	0.027^a a p ≤ 0.05.
Chance HLC	19.50	20.00	4.995	10	30	0.035^a a p ≤ 0.05.

Body Investment Scale
Body image	11.64	11.00	1.753	10	16	0.021^a a p ≤ 0.05.
Body care	15.00	13.50	4.666	10	28	0.019^a a p ≤ 0.05.
Body touch	13.09	12.0	2.868	10	19	0.020^a a p ≤ 0.05.

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[1] *Corresponding author. E-mail: geraldoreiki@hotmail.com (G.M. Salomé).