Evidências de validade do formulário de avaliação da competência da pessoa com estomia para o autocuidado (COPE -AC): subsídios para gestão do cuidado

Abstract

Introduction: Brazil undertook commitments aligned with global agendas aimed at building fairer and more sustainable societies, particularly through the Sustainable Development Goals, with emphasis on reducing inequalities and promoting the well-being of vulnerable populations. People with ostomy were recognized as persons with disabilities and became part of this group, facing ongoing challenges in ostomy management, complication prevention, and rehabilitation. Strengthening self-care, understood as the ability to make responsible and autonomous decisions regarding one’s own health, constituted a fundamental element for improving health outcomes. However, unlike countries such as Portugal, Spain, and Italy, Brazil still lacked measurement instruments with validity evidence capable of assessing these individuals’ competence for self-care. This limitation compromised the personalization of interventions, resulted in generic care plans, contributed to a fragmented nursing process, and hindered care management by weakening priority setting, action organization, and systematic monitoring of needs. Objective: To assess validity evidence of the adapted version of the CAO:EI-ESEP based on internal structure and relationships with other variables. Materials and Methods: A psychometric study grounded in the Standards for Educational and Psychological Testing was conducted, investigating validity evidence based on internal structure and relationships with other variables. The study took place in seven Health Care Services for People with Ostomy (Saspo) in the state of Minas Gerais, Brazil. A non-probabilistic convenience sampling strategy was used. Data collection occurred between May and October 2024 and included 591 participants, carried out by nine nurses working in the SASPO services. The adapted CAO:EI-ESEP and the City of Hope Quality of Life–Ostomy Questionnaire were administered. Data were analyzed using descriptive statistics (frequencies, percentages, and measures of dispersion). Subsequently, exploratory and confirmatory factor analyses and score standardization were performed. Associations with independent variables were tested using the Mann–Whitney and Kruskal–Wallis tests, and correlations between self-care competence scores and quality-of-life scores were analyzed using Spearman’s correlation. Effect sizes were estimated for all tests, and statistical significance was set at p < 0.05. Analyses were conducted using JASP and Factor software. The study was approved by the Research Ethics Committee of the Federal University of Minas Gerais (approval no. 6,912,595), and all participants provided written informed consent. Results: The sample had a median age of 62 years and a median schooling of seven years; 54.5% were men and 70.2% were undergoing reassessment. Left-sided colostomies (54.1%), temporary ostomies (66.2%), absence of preoperative marking (85.3%), and oncological etiology (63.1%) predominated. Complications were observed in 59.4% of participants, mainly peristomal dermatitis (41.1%). Exploratory factor analysis identified a two-dimensional model with 23 items, explaining 69.47% of the variance (KMO = 0.95; Bartlett’s χ² = 4572.6; p < 0.001). Factor loadings ranged from 0.52 to 0.96, with high internal consistency (α = 0.95; ω = 0.96; G-H = 0.98 and 0.93). Confirmatory analysis corroborated a second-order model with excellent fit (CFI = 0.98; TLI = 0.98; NFI = 0.97; GFI = 0.99; RMSEA = 0.09). Score standardization defined three competence levels (low, intermediate, and high), confirmed by discriminant analysis (λ = 0.195–0.305; p < 0.001; canonical correlations = 0.775–0.939). In light of these modifications, the new version was named the Assessment Form for the Level of Competence of the Person with Ostomy for Self-Care (COPE-Ac). Overall competence was predominantly intermediate (41.3%), with better performance in the knowledge dimension. Significant associations were found with anatomical ostomy location (p < 0.001), pouch closure system (p < 0.01), marital status (p < 0.01), employment status (p < 0.01), ostomy temporality (p < 0.001), and preoperative marking (p = 0.02). Higher competence scores were observed among ostomies located in lower abdominal quadrants (p < 0.001), definitive ostomies (p < 0.001), use of plastic connectors (p < 0.01), participants with preoperative marking (p = 0.02), formally employed individuals (p < 0.01), and single participants (p < 0.01). Positive associations were also found with evaluation by an enterostomal therapy nurse (p < 0.001), reassessment visits (p < 0.001), and presence of a caregiver (p < 0.001), with moderate to large effects. Smaller effects were observed for schooling (p < 0.05) and previous contact with people with ostomy (p < 0.01). Among complications, only mucocutaneous separation showed a significant association (p < 0.01), while barrier film use showed a negative correlation (p ≤ 0.05). Regarding convergent validity, positive correlations were identified between self-care competence and psychological (p < 0.001), social (p ≤ 0.01), and spiritual well-being (p ≤ 0.03), with no significant association with physical well-being (p > 0.05). Implications: In clinical practice, use of the COPE-Ac supports the nursing process by guiding diagnoses, goals, and individualized interventions, aligning follow-up with the person’s level of autonomy and optimizing resource use. In management, it supports decision-making and workforce planning, enabling indicator development and staffing according to case complexity. In education, it enhances clinical reasoning and strengthens integration between theory and practice, improving training focused on the care of people with ostomy. In research, it provides a comparative basis to identify persistent gaps and to understand factors influencing self-care and quality of life. In public policy, it promotes integration across levels of care, professional training, resource allocation, and organization of specialized services. Conclusion: The COPE-Ac demonstrated validity evidence supporting its use to measure self-care competence in people with intestinal elimination ostomy. Most individuals exhibited intermediate competence, with relevant gaps in the development of skills required for safe care. Sociodemographic and clinical variables influenced competence levels, and positive correlations were found between competence and quality of life in specific domains. The findings indicate that the COPE-Ac enhances the nursing process, supports autonomy of people with ostomy, and provides relevant input for the organization and management of specialized care.