Teach-Back Communication Versus Pictorial-Based Learning on Self-Care Knowledge and Adherence, Self-Efficacy and Peristomal Skin Healing in Patients After Emergency Surgery Colostomy: A 3-Arm, Randomised, Controlled Trial

Abstract

Aim: To compare the effects of two different education techniques, Teach-back communication and Pictorial-based learning, on new colostomates' knowledge and adherence to self-care, self-efficacy and peristomal skin lesions. Design: A three-arm randomised controlled clinical trial was conducted. Methods: Self-care education can bring about numerous benefits for colostomy patients; thus, it is important to choose an appropriate educational approach for postoperative ostomates. A total of 111 new ostomates admitted to the surgical wards were randomly assigned into three groups using a permuted-block design. All participants received routine education. The two intervention groups received education that included the same educational topics during 30–40 min sessions over 3 days using Teach-back or pictorial-based methods. The demographic and clinical information form, self-care knowledge questionnaire, self-care adherence checklist, stoma self-efficacy scale and peristomal skin checklist were completed before the intervention (the day after surgery) and at follow-ups (on day four and 1 month after surgery). Analysis of covariance in SPSS-21 software was used for data analysis with a significance level of 0.05 or less. Results: After taking confounding variables into account (supplementary insurance status, place of residence, smoking history and diet), both Teach-back and pictorial-based groups demonstrated a significant improvement in colostomy self-care knowledge and adherence as well as in self-efficacy compared to the control group (all p < 0.001). Additionally, at the follow-up stage, patients in the Teach-back group had higher levels of self-efficacy than those in the pictorial-based group (p = 0.036). At this point, all three groups had similar erythematous lesions all around peristomal skin. Patient or Public Contribution: Implementing either teach-back or pictorial-based resulted in improved knowledge of colostomy care and adherence as well as enhanced self-efficacy. However, it was reported that teach-back communication was more effective in sustaining overall self-efficacy than pictorial-based education. In light of this, nurses should use these strategies to provide more effective and enduring training for new colostomy patients. Trial Registration: Iranian Clinical Trial Registration Center: IRCT20160110025929N27.