Iran Journal of Nursing

Introduction
Colorectal cancer is one of the significant health concerns. The global increase in colorectal cancer has led to a rise in ostomy surgeries. Intestinal ostomy refers to the opening of the abdomen and removal of part of the intestinal segment by surgery to divert the stool, which may be temporary or permanent. Although ostomy is a common surgery and is considered a chance to survive again in people with colorectal cancer, patients experience postoperative complications, leading to more extended hospital stays and Increasing hospital admissions. Psychological difficulties such as depression, issues related to social and intimate relationships, and sexual function are also common after this treatment. Recreational and sports professionals are in trouble.
 Living with a temporary or permanent ostomy generally affects quality of life (QoL) and self-efficacy. Since QoL is an essential indicator in life and includes many dimensions such as physiological aspects of a person's performance, it is necessary to pay attention to it; self-efficacy is an individual's belief in the ability that a person can perform one's duties and also means trusting and believing in one's ability to control one's thoughts, feelings, activities, and function effectively in stressful situations. 
To promote self-efficacy and improve the QoL of ostomy patients, educational interventions and counseling through the guidance of a health care professional at the time of discharge or when returning to the community are essential. Performing interventions such as self-care training courses can improve self-efficacy, physical condition, and social well-being and reduce anxiety in ostomy patients. Proper self-care training also improves patients' ability, daily activities, and independence, and trained individuals report better social performance, a more hopeful life, and a higher QoL. 
This study aimed to determine the effectiveness of absentee self-care training on self-efficacy and QoL of patients with intestinal ostomy referred to selected hospitals in Kermanshah province in 2020-2021.

Materials and Methods
This single-group intervention study was performed on 61 patients with ostomies referred to the oncology centers of Imam Reza and Taleghani hospitals in Kermanshah province who were selected from April to July 2021 using a simple sampling method. The study's objectives were explained to the participants in the survey. They were given written consent, and while obtaining an active mobile phone number from them, individuals became members of the relevant WhatsApp group. First, Scherrer et al.'s self-efficacy questionnaire and Weber and Sherborn's QoL questionnaires were completed by patients. Then, the self-care program developed by the researcher in eight forty-five-minute group sessions was implemented through discussion and virtual education (by WhatsUp) for patients to use self-care at home. 
After two months of this type of distance intervention training, the questionnaires were completed again by the patients under study. Inclusion criteria include patient self-management ability, using virtual networks and literacy, having a permanent or temporary intestinal ostomy, and being at least 18. At most 75 years old, at least one month after surgery, willingness to participate in the study, mental health, speech, vision, and hearing. The exclusion criteria included unwillingness to continue cooperation, disconnecting the telephone for 2 weeks, hospitalization during the study, cancer metastasis, and death of the patient. 
The collected data were analyzed using SPSS software v. 20, and descriptive statistics (number, percentage, mean and standard deviation) and inferential statistics (paired t, Wilcoxon) were used to analyze the data. 

Results
Most patients in the present study (63.9%) were male and married (90.2%). (45.9%) had 28 undergraduate degrees, and ostomy in (75.4%) 46 was temporary. Also, most patients (39.4%) were between 56 and 70. The Mean±SD age in the studied units was 57.62±13.93 years. The Mean±SD patients' self-efficacy score before the intervention was 50.40±4.57, which after the intervention reached 51.18±5.3, this difference was significant (P=0.036). 
The Mean±SD of the score after the desire to initiate patients' behavior before the intervention was 18.44±3.58, which after the intervention reached 19.04±3.75, and this difference was significant (P=0.05). But the Mean±SD desire to expand the effort to complete the task before the intervention was 15.55±2.20, which after the intervention reached 15.78±2.19; the difference was not significant (P=0.18). The Mean±SD regarding the dimension of resistance in facing obstacles was 13.18±1.39 before the intervention, getting 13.21±1.511 after the intervention; the difference was insignificant (P=0.90). 
The Mean±SD of patients' QoL score before the intervention was 34.05±16.53, which reached 49.63±21.59, and based on the statistical test, this difference was significant (P<0.001). There was a statistically significant difference between the mean of all aspects of patients' QoL except general health before and after the intervention (P<0.05).

Dissection
The present study showed that distance education could affect the QoL and self-efficacy of patients with an ostomy and improve the QoL and self-efficacy of these patients; in other words, the use of distance education in the education of patients with an ostomy can be effective in the continuity of care and patient independence and also control some possible problems in the care, which leads to increased self-efficacy of patients and thus improve their QoL. Therefore, it seems that the results of this study can be used in addition to the clinical department in the management, education, and nursing research departments. In the management department, nursing managers can provide facilities for using mass media and social networks in hospitals to improve self-care, self-efficacy, and QoL in patients with an ostomy. 
In the education department, nursing education administrators can use the results of this study to pay more attention to distance education in teaching patient education methods to students. The use of modern technology and its application in the patient education process can be included in the content of continuing education in universities. In the research section, the results of the items of the present study can be an introduction to other research on the impact of using non-educational education, Presence in promoting self-care, self-efficacy, and QoL in other patients. 

Ethical Considerations

Compliance with ethical guidelines
This research was carried out after receiving the code of ethics at IR.IAU.NAJAFABAD.REC.1400-030 from the ethics committee of Islamic Azad University, Najafabad Branch and obtaining entry permits for hospitals from the research department of this university and all ethical considerations in the field of patients It is observed.

Funding
This article is the result of MSc. dissertation, Sattar Baab, MSc. student of Medical Surgical Nursing, School of Nursing and Midwifery, Islamic Azad University, Najafabad Branch.

Authors' contributions
Conceptualization: Mehrdad Azarbarzin and Sattar Baab; Analysis, research and study: Sattar Baab, Mehrdad Azarbarzin and Maryam Moghimian; Editing, finalizing and managing the project: Mehrdad Azarbarzin.

Conflict of interest
The authors declared no conflict of interest.

Acknowledgments
The Vice Chancellor for Research of the Islamic Azad University, Najafabad Branch, the officials and staff of the oncology centers of Imam Reza (AS) and Taleghani Hospitals in Kermanshah province and all the participants in this research are thanked and appreciated.

 

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