Downloaded from http://journals.lww.com/jwocnonline by BhDMf5ePHKbH4TTImqenVB5cXIaDaihKscL9/U2rKJ9hBnNeuBHV7p70of2DJgQ9 on 03/01/2019 Copyright © 2019 Wound, Ostomy and Continence Nurses Society™. Unauthorized reproduction of this article is prohibited. Ostomy Care 38 JWOCN ¿ January/February 2019 Copyright © 2019 by the Wound, Ostomy and Continence Nurses Society™ J Wound Ostomy Continence Nurs. 2019;46(1):38-43. Published by Lippincott Williams & Wilkins ABSTRACT PURPOSE: The purpose of this study was to evaluate the validity and reliability of the Italian version of the Ostomy Adjustment Inventory-23 (OAI-23). DESIGN: This is a methodological study evaluated psychometric properties of the OAI-23. SUBJECTS AND SETTING: A sample of 230 patients with an ostomy was enrolled in an Italian university hospital from May to September 2017. METHODS: This study comprised two phases; during phase 1, the cultural-linguistic translation of the OAI-23 into Italian was completed. In addition, content and face validity were tested. In phase 2, psychometric testing of the OAI-23 was conducted in a cross-section sample of 258 Italian patients with a fecal ostomy. RESULTS: The Italian version of the OAI-23 presents 23 items giving a 3-dimensional structure: acceptance, negative feelings, and social engagement. Accordingly, this 3-dimensional structure arise from an exploratory factorial analysis with the maximum likelihood robust estimator (RMSEA = 0.089 [95% CI = 0.063-0.113; P = .05], and CFI = 0.901, explaining 44% of the total variance). The internal consistency of the OAI-23 was good (Cronbach α for acceptance = 0.91; for negative feelings = 0.87; for social engagement = 0.93; for overall scale = 0.91). CONCLUSIONS: The OAI-23 provides a valid and reliable assessment of patients’ psychosocial adjustment to an ostomy. It provides important resource for clinical decision-making; for example, it may be used to design or tailor educational strategies to enhance psychosocial adjustment following creation of an ostomy. KEY WORDS: OAI-23, Ostomy, Ostomy adjustment, Psychometrics, Psychosocial adjustment, Reliability, Stoma, Tool development, Validity. INTRODUCTION Te global burden of colorectal cancer is expected to rise as much as 60% by the year 2030, 1 involving about 1.65 million new cases and almost 835,000 deaths in 2015. 2 Surgical management of colorectal cancer, due to the complexity of forming a viable anastomosis, fre- quently requires a temporary or permanent ostomy. 3 While ostomy surgery is a lifesaving procedure in this context, it also represents a dramatic life-changing event. Patients with a new ostomy may experience difculties accept- ing the presence of a stoma due to changes in physical appearance and multiple other psychosocial factors afecting daily living. 4,5 Consequently, these patients must learn new self-care routines and how to handle the complex emotional issues related to chang- es in their body image and sense of self. 6 Tis process is defned as psychosocial adjustment (PA). 7 Psychosocial adjustment, along with self-care and quality of life, is one of the most important factors that defne the follow-up process after any surgical treatment. 8,9 “Psychoso- cial” is a multidimensional term that involves both the social environment and psychological state of being. 10 However, this term is not well defned in the literature that uses the terms “adaptation” and “adjustment” interchangeably referring to the healthy rebalancing of those new occurring circumstances. 11 Psychosocial adjustment comprises 5 elements: (1) performing adaptive behaviors such as adjustment to changes in body im- age and function, along with preservation of healthy relation- ships; (2) absence of psychological disorders; (3) low negative and high positive afect; (4) adequate functional status; and (5) satisfaction and well-being in various life spheres. 10,11 For this reason, addressing PA may provide a foundation for a tailored Federica Dellafiore, MSc, RN, Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy. Gianluca Conte, RN, Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy. Irene Baroni, RN, Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy. Francesco Pittella, MSc, RN, Nursing Degree Course, University of Milan, section of IRCCS Policlinico San Donato, San Donato Milanese, Italy. Cristina Di Pasquale, RN, Division of Urology, European Institute of Oncology, Milan, Italy. Tiziana Nania, RN, Nursing Degree Course, University of Milan, Section of IRCCS Policlinico San Donato, San Donato Milanese, Italy. Carla Saracco, RN, Associazione Italiana Operatori Sanitari di Stomaterapia (AIOSS), Milan, Italy. Gabriele Roveron, RN, Associazione Italiana Operatori Sanitari di Stomaterapia (AIOSS), Milan, Italy. Rosario Caruso, PhD, MSc, RN, Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy. The authors declare no conflicts of interest. Correspondence: Federica Dellafiore, MSc, RN, Health Professions Research and Development Unit, IRCCS Policlinico San Donato, Via Agadir, 20-24, 20097 San Donato Milanese (Mi), Italy (federica.dellafiore@grupposandonato.it). Ostomy Adjustment Inventory-23 (OAI-23) Development and Testing of the Italian Version Federica Dellafiore ¿ Gianluca Conte ¿ Irene Baroni ¿ Francesco Pittella ¿ Cristina Di Pasquale ¿ Tiziana Nania ¿ Carla Saracco ¿ Gabriele Roveron ¿ Rosario Caruso DOI: 10.1097/WON.0000000000000493