Cross-cultural Adaptation and Validation of the Stoma Quality of Life Questionnaire for Patients With a Colostomy or Ileostomy in Brazil: A Cross-sectional Study.

Many studies examining the quality of life of stoma patients utilize questionnaires that have not been validated specifically for these patients in their native language. Owing to the large and increasing prevalence of intestinal stomas, a cross-sectional study was conducted among patients of a stoma patient health care service in Juiz de Fora, Brazil between September 2014 and August 2015 to validate the Stoma Quality of Life (Stoma-QoL) questionnaire in Portuguese (Brazilian variant). In addition, the effect of sociodemographic, clinical, and eating habit variables on the quality of life of people with a colostomy or ileostomy was assessed. Eating habit variables included eating comfort in the postoperative period, excluding foods for a period of time, fear of eating, and excluding foods that may cause odor, gas, diarrhea, and/or constipation. All patients with a colostomy or ileostomy served by 1 ostomy care center were invited to participate. Patients who were at least 18 years of age, provided signed informed consent, and had the physical and mental capacity to complete the questionnaire were eligible to participate. The sociodemographic, clinical history, eating behavior, and Stoma-QoL questionnaires were administered by trained researchers as part of patient nutritional care. A sample of 11 (10% of all study participants) also completed the 12-item Short Form Health Survey (SF-12), which includes a Mental Component Summary (MCS) and a Physical Component Summary (PCS), to establish convergent validity. All participant response data were collected using a standardized form developed for this study and stored in electronic files. The identities of patients were kept anonymous, and patients had the option to refuse to participate during the assessment. Data were analyzed descriptively; the Mann-Whitney and Kruskal-Wallis tests were used to analyze associations among the variables collected. Normal distribution of the Stoma-QoL total scores was assessed using the Kolmogorov-Smirnov test. Internal consistency was assessed as a whole using Cronbach's alpha, and agreement and reproducibility were determined using the intraclass correlation coefficient. Relationships between the Stoma-QoL and the SF-12 items were examined using the Pearson correlation coefficient. The majority of the 111 participants were men (57, 51.4%), most (94, 84.7%) were 50 years of age or older, 70 (63.1%) had a colostomy, and 41 (36.9%) had an ileostomy. Most stomas (79, 71.2%) were created to treat cancer of the colon and rectum. The mean overall Stoma-QoL score for study participants was 58.7 ± SD 12.0 (range 32.0-78.0). The internal consistency of the translated Stoma-QoL was .87, demonstrating a high degree of reliability. The convergent validity of the Stoma-QoL with the SF-12 confirmed higher correlation among the items regarding emotional aspects, mental health, social aspects, and vitality, with a higher correlation with the MCS (r = .52; P = .02) and lower correlation between the PCS and the items that assess general health, functional capacity, physical aspects, and pain (r = .38; P = .04), although both were significant. A moderate and significant association was noted between the questionnaires. Women (P = .02) and patients who deprived themselves of food for a certain period of time had a lower quality of life (P = .05). Persons who excluded foods out of fear of repercussions also had significantly lower QoL scores (P <.001). Colostomy and ileostomy patients had a similar quality of life. This study confirms the Stoma-QoL is a valid research tool for colostomy and ileostomy patients in Brazil. Further studies are recommended in the field of food and nutrition to verify observed concerns related to the eating behavior of intestinal stoma patients and the relationship to their quality of life.