Study design and population. In this cross-sectional study, data were collected from May 2017 to August 2018 using a convenience sampling method in 3 general hospitals in Guangdong Province, China. The authors recruited patients visiting the stoma clinic of each hospital; the purpose and significance of the study were explained to the patient and consent to participate was obtained. Inclusion criteria stipulated participants must be adults 18 to 70 years of age with an ostomy more than 1 month, who were discharged from the hospital in stable condition, in a relationship with a regular sexual partner, able to read, and willing to provide written informed consent. Patients who had a urostomy, a history of mental illness, preoperative SD, or tumor recurrence or metastasis were excluded from this study. The required sample size was determined using power analysis.27 A pilot study determined an alpha level of 0.05, a power of 0.80, and an effect size of 0.133. With these data, the required sample size was 97.
Before completing the questionnaire, participants were notified about the purpose and the process of the survey. Given that sexual experience is a sensitive topic, participants were informed survey data would remain anonymous and all of the information they provided would be kept in confidence. After signing an informed consent form, each respondent was given the questionnaires. Respondents completed the paper-and-pencil questionnaires independently in a quiet place alone, and the investigators did not interrupt them. Investigators provided standard explanations when necessary.
Measurement tools. The Chinese version of the Arizona Sexual Experience Scale (C-ASEX), the Chinese version of the Social Impact Scale (C-SIS), and a demographic and ostomy-related questionnaire developed by the authors for this study were used to obtain demographic information and assess the extent of sexual experience and stigma among the participants.
Sexual experience. The Arizona Sexual Experience Scale (ASEX) was created and validated by McGahuey et al28 in 2000 and translated into Chinese (C-ASEX) by Zhang et al29 in 2011. The items in this instrument address desire (How strong is your sex drive?), arousal (How easily are you sexually aroused?), penile erection or vaginal lubrication (Can you easily get and keep an erection? or How easily does your vagina become moist or wet during sex?), orgasm (How easily can you reach an orgasm?), and satisfaction: (Are your orgasms satisfying?). Item 1 is scored from 1 to 6 where 1 = extremely strong, 2 = very strong, 3 = somewhat strong, 4 = somewhat weak, 5 = very weak, and 6 = no sex drive. Items 2 through 5 are scored as 1 = extremely easily, 2 = very easily, 3 = somewhat easily, 4 = somewhat difficult, 5 = very difficult, and 6 = never aroused. Total scores range from 5 to 30; higher scores indicate less perceived quality of sexual experience. SD is defined as a total score of 19 or higher, 5 or higher on any item, or 4 or higher on 3 items. The Cronbach’s α coefficient was 0.950.
Social impact. The Social Impact Scale (SIS) was developed by Fife and Wright30 in 2000 and translated into Chinese (C-SIS) by Pan et al31 in 2007. It was initially applied to measure the level of stigma in cancer patients and AIDS patients. This scale comprises 24 items and 4 dimensions (social rejection, internalized shame, social isolation, and financial insecurity). Each item was scored from strongly agree to strongly disagree (1–4) for a total score ranging from 24 to 96. The level of stigma for each item was classified into low (1–1.99), moderate (2–2.99), or high (3–4) based on average item scores and then totaled in each categorization. The Cronbach’s α coefficient was 0.937 in the study.
Demographic data. Demographic (age, gender, educational level, occupation, geographic place of residence, and monthly family income) and ostomy-related data (type of ostomy, time since surgery, insurance coverage, ostomy-related complications, and sexual guidance [ie, guidance about sexuality received from enterostomal therapists]) also were collected using a demographic and ostomy-related questionnaire, which was developed by authors based on a descriptive study.32
Data analysis. Quantitative data from the questionnaires were entered into SPSS, version 20.0 (SPSS, Inc; Chicago, IL) by 2 researchers. All continuous variables were presented as mean ± standard deviation. The categorical variables were expressed as numbers and percentages. Continuous variables were compared using the independent t test or one-way analysis of variance. Pearson’s correlation analysis was used to investigate the association between sexual experience and stigma. The statistically significant parameters from the univariate analysis were included in the multivariate analysis. Multiple linear regression (stepwise regression procedure) was used to identify the association between sexual experience and stigma and explore the main influencing factors of sexual experience in Chinese patients with an ostomy. A 2-tailed value P <.05 was considered statistically significant.
Ethical considerations. This study was approved by Nanfang Hospital Medical Ethics Committee of University in Guangdong Province, China, and an Ethical Approval Certification was obtained. Participant informed consent was obtained before the investigation. Participants were told that all of the information received would be kept confidential and that they could stop study participation at any time without repercussion.