Self-efficacy, self-management, and quality of life in people with a stoma.

Following stoma formation surgery quality of life can be impaired. Although this can improve over time, people with a stoma still report quality of life lower than that of people without a stoma years after stoma formation. Self-management interventions have been devised to increase an individual's self-efficacy to self-manage their stoma and thus improve their quality of life. However, we do not know whether all people with a stoma experience quality of life in the same way and how individuals’ experiences may differ. We also do not have an understanding of whether quality of life and self-efficacy can fluctuate from day-to-day and what factors influence this. Understanding these gaps in the research may help us to develop more tailored and adaptive self-management interventions in the future. Study 1 was a systematic review of previous self-management interventions and identified some of the key characteristics of these interventions which were associated with improvements in quality of life, self-management skills and self-efficacy. Studies 2 and 3 utilised secondary data of individuals with a stoma to identify quality of life derived profiles. Results suggest that people with a stoma are not a homogenous group in regard to their quality of life and the different profiles are associated with certain demographic and clinical characteristics and advice received from healthcare professionals. Study 4 was an ecological momentary assessment study with repeated surveys 3 times a day over the course of a week. Findings suggest that quality of life and self-efficacy fluctuate within individuals, with quality of life increasing as the day goes on and self-efficacy higher when individuals are at home. The studies in this thesis contribute to a greater understanding of how future self-management interventions might be tailored to enhance an individual’s self-efficacy and improve their quality of life. Dynamic and adaptive interventions should be considered to tailor the type of advice and support delivered at the right time for individuals living with a stoma.