Current status and influencing factors of knowledge, attitude and practice of diet management in patients with enterostomy: a cross-sectional study

Abstract

Objectives

The incidence of malnutrition is high in enterostomy patients, which impacts their nutritional status and requires targeted dietary management strategies to improve outcomes. This study evaluated the knowledge, attitude and practice (KAP) of dietary management among enterostomy patients, identified influencing factors and provided recommendations for comprehensive nutritional care.

Design

Cross-sectional study.

Setting

43 hospitals in Hubei Province.

Participants

A convenience sample of 643 enterostomy patients was surveyed between November 2024 and April 2025. The inclusion criteria were as follows: (1) age of 18 years or older; (2) at least 4 weeks post-enterostomy surgery with recovery at home and (3) provision of informed consent and voluntary participation in the study. The exclusion criteria included: (1) inability to eat normally due to illness or other reasons and (2) presence of consciousness, cognitive or communication disorders.

Primary and secondary outcome measures

KAP questionnaire score, social alienation scale score and general information.

Results

Of 621 valid responses (96.58% valid questionnaires), the average KAP score was 185, with 79.07% achieving a passing score (≥111). Moderate social isolation was observed with a mean score of 40.04±13.98. Regression analysis revealed that social isolation (β=−0.393, p<0.001), medical insurance type (employee medical insurance: β=0.233, p<0.001; resident medical insurance: β=0.315, p<0.001) and education level (β=0.096, p=0.019) significantly influenced KAP.

Conclusions

Enterostomy patients showed moderate to high knowledge, positive attitudes and good practices in dietary management, but experienced moderate social isolation. A multidisciplinary nutrition team should assess patients’ nutritional, physiological, psychological and social support needs. Personalised dietary plans based on education level and diverse educational methods can enhance intervention effectiveness. Encouraging self-care and leveraging the ‘Internet Plus’ platform for regular progress monitoring can improve self-management capabilities. Continuous monitoring of nutrition and quality of life is essential to support enterostomy patients. These findings may have implications for enterostomy care in resource-limited settings, including low-income and middle-income countries, where multidisciplinary nutrition teams and patient education resources may be limited.

STRENGTHS AND LIMITATIONS OF THIS STUDY.

• The large-scale sample data collected from 43 medical institutions across Hubei Province significantly enhanced the representativeness and reliability of the study findings.

• Social alienation was included as an influencing factor to explore the influence of the psychosocial situation of enterostomy patients on diet management.

• The use of convenience sampling may introduce selection bias, limiting the generalisability of the findings.

• This study was designed as a cross-sectional study and thus no causal inference could be drawn.

Introduction

According to the 2024 Global Cancer Report published by the WHO, colorectal cancer (CRC) ranked third in incidence among all malignant tumours worldwide in 2022, while it ranked second in mortality.¹ Data from the China Cancer Statistics, issued by the National Cancer Centre of China, revealed that in 2022, there were 4.8247 million new cancer cases in China, with CRC constituting 10.72% of all malignant tumours, thus ranking second.² Compared with patients with other types of cancer, individuals with CRC exhibit a higher prevalence of malnutrition, attributed to the tumour’s local effects on intestinal function, such as obstruction and malabsorption.³ Approximately 35% of patients undergoing colorectal surgery experience moderate to severe malnutrition prior to the procedure.⁴ Malnutrition not only extends the duration of hospital stays and elevates the economic burden on patients but also exacerbates the incidence of complications and mortality.5,7 Enterostomy is a critical therapeutic intervention for CRC, providing relief from obstruction and extending patient survival; however, it significantly impacts nutritional status. Many patients experience challenges in meeting their nutritional requirements due to insufficient knowledge and skills in stoma care, coupled with apprehensions about the stoma itself.⁸ Current research predominantly addresses common complications associated with stoma care and overall quality of life, with limited focus on dietary management for stoma patients.^{5 6 8} An exploration of knowledge, attitudes and practices (KAP) concerning dietary management in enterostomy patients may provide valuable insights for developing strategies in low-resource settings, where nutritional support and patient education are often limited. This study aims to comprehensively examine the current status and influencing factors of knowledge, attitudes and behaviours related to dietary management among stoma patients. The goal is to inform the development of more targeted dietary management and health education strategies, thereby achieving comprehensive nutritional management, improving the nutritional status of stoma patients and enhancing their self-management capabilities.

Materials and methods

Study population

From November 2024 to April 2025, a convenience sampling approach was employed to select 643 patients with enterostomy who were hospitalised and followed up in 43 hospitals across 11 prefecture-level cities in Hubei Province for participation in the survey. The inclusion criteria were as follows: (1) age of 18 years or older; (2) at least 4 weeks post-enterostomy surgery with recovery at home and (3) provision of informed consent and voluntary participation in the study. The exclusion criteria included: (1) inability to eat normally due to illness or other reasons and (2) presence of consciousness, cognitive or communication disorders. Based on the guideline that the sample size should be at least 5 to 10 times the number of variables,⁹ and considering the questionnaire comprised 37 items with an anticipated 20% sample inefficiency rate, the required sample size was obtained according to the sample size calculation formula: 37×(5–10)/0.8 =231–463.

Survey instruments

General information questionnaire

This questionnaire was developed through a comprehensive review of existing literature and relevant materials, taking into account various factors that affect the dietary management of patients with enterostomies. These factors include gender, age, educational level, current residence, marital status, type of medical insurance, monthly family income, history of chronic diseases, primary caregiver type and type of enterostomy.

KAP assessment questionnaire of enterostomy patient dietary management

Using the KAP theoretical framework, the research team initially developed a pool of questionnaire items through a comprehensive literature review and focus group discussions. To refine the dimensions and items of the questionnaire, the Delphi expert consultation method was employed, involving two rounds of expert deliberation. A panel of eighteen experts with senior professional titles—comprising eight clinical nutrition specialists, four gastrointestinal tumour experts, three wound and stoma care specialists and three critical care experts—was invited to participate in the revision process, culminating in the development of the finalised questionnaire.

This questionnaire is structured around three key dimensions: knowledge, attitude and practice. The knowledge dimension comprises 13 items addressing aspects such as liquid intake, dietary patterns, food choices and nutritional monitoring. The attitude dimension encompasses 11 items, focusing on perspectives towards dietary changes, confidence in dietary management, attitudes towards food choices and self-management. The practice dimension includes 13 items related to behaviours such as dietary knowledge acquisition, dietary knowledge sharing, food choice behaviour and nutritional monitoring, resulting in a total of 37 items (refer to online supplemental appendix A for the complete scale). A 5-point Likert scale is employed for scoring, with a cumulative score range from 0 to 185 points, distributed as follows: 0 to 65 points for the knowledge dimension, 0 to 55 points for the attitude dimension, and 0 to 65 points for the practice dimension. Higher scores indicate more accurate dietary management knowledge, a more positive attitude and a lesser impact on daily practice. The score rate is calculated using the formula: (actual score/theoretical maximum score)×100%. Descriptive statistics are performed using 60% of the total score for each dimension as the threshold. The passing scores for the KAP dimensions are set at 39, 33 and 39, respectively, with the overall passing score for the questionnaire being 111 points.

In the initial phase of this research, a cross-sectional survey was administered to 404 ostomy patients who satisfied the predetermined inclusion and exclusion criteria. Participants were recruited from 37 grade A tertiary hospitals in Hubei Province to assess the reliability and validity of the questionnaire. The content validity of each questionnaire item ranged from 0.833 to 1.000, with a Mean Content Validity Index (CVI) of 0.946. Exploratory factor analysis indicated that the cumulative variance explained was 69.178%. Confirmatory factor analysis demonstrated a good model fit, with standardised factor loadings for the three extracted factors ranging from 0.603 to 0.849 (all >0.45, p<0.05). The mean average variance extracted (AVE) values for the three factors were 0.688, 0.573 and 0.695 (all >0.5), while the composite reliability (CR) values were 0.966, 0.936 and 0.967 (all >0.7). For the three dimensions—knowledge, attitude and behaviour—the Cronbach’s α coefficients were 0.966, 0.936 and 0.966, respectively. The overall CVI of the questionnaire was 0.977, indicating that the instrument possesses satisfactory reliability and validity for subsequent research.

The Social Isolation Scale Assessment Questionnaire for CRC survivors

It was developed by Wang et al,¹⁰ comprises two dimensions: social isolation (five items) and emotional isolation (11 items), resulting in a total of 16 items. Each item is rated on a Likert scale from ‘strongly disagree’ to ‘strongly agree’, corresponding to scores from 1 to 5, with an aggregate score ranging from 16 to 80. A higher total score indicates a greater level of social isolation among CRC survivors. The Cronbach’s α coefficient for this scale is 0.923.

Data collection

The questionnaire items were formatted and uploaded onto the Wenjuanxing platform, and the entire survey was conducted in Chinese. Prior to distribution, the research team underwent standardised training on the process of questionnaire completion. Subsequently, they provided detailed explanations regarding the specific requirements and precautions for filling out the questionnaire to the hospital directors, securing their consent for participation. An online meeting was conducted to introduce the questionnaire comprehensively. Then, the hospital director invited patients who met the inclusion and exclusion criteria to participate in the survey and distributed the questionnaires to the patients using a QR code. The initial page of the questionnaire outlines the survey’s objectives, informed consent for participation and provides completion instructions. Before answering, patients need to fill out informed consent. After confirming their consent, they can continue to complete and submit the questionnaire. In instances where patients were unable to complete the questionnaire independently, designated nurses provided assistance. To prevent duplicate submissions and ensure the integrity of the data, the system was configured to allow each participant to submit only once, with submission permitted only after all questions were answered. The data collected were exported from the Wenjuanxing platform and subjected to verification by two independent reviewers. The average time required to complete the questionnaire ranged from 6 to 10 min. To maintain the quality of data collection, questionnaires completed within less than 3 min will be further reviewed. If there are logical problems or obvious regular answers, the questionnaires will be deemed invalid and deleted.

Statistical analysis

Data were input into Microsoft Excel and subsequently analysed using SPSS V.26.0. Categorical data were presented as frequencies and percentages, while continuous data adhering to a normal distribution were summarised using means and SDs. For comparisons between two groups, independent samples t-tests were employed, whereas one-way ANOVA was used for comparisons across multiple groups. In cases where data did not conform to a normal distribution, the median and IQR (M(P₂₅, P₇₅)) were reported, with the Mann-Whitney U test applied for two-group comparisons and the Kruskal-Wallis H test for multiple group comparisons. A multiple linear regression model was conducted to identify factors influencing scores on the ostomy patient dietary management KAP assessment questionnaire. The significance threshold was established at α=0.05.

Results

General information of participants

The research process is shown in figure 1. A total of 643 questionnaires were initially collected for this study. After a thorough screening process to identify and eliminate any irregular or repetitive responses, 14 questionnaires were filled out repeatedly and 8 questionnaires had logical contradictions in their results, all of which were excluded. Eventually, 621 questionnaires were considered valid, accounting for 96.58% of the collected questionnaires. Detailed information of the participants is presented in online supplemental appendix C.

Figure 1. Research flow chart. KAP, knowledge, attitude and practice.

Scores of the KAP assessment questionnaire on dietary management for enterostomy patients

In this study, the comprehensive score of the assessment questionnaire was 185 points, with a total of 491 cases scoring ≥111 points, and a pass rate of 79.07%; Among them, 479, 533 and 489 cases were qualified in the dimensions of KAP, respectively, with pass rates of 77.13%, 85.83% and 78.74%, as shown in table 1. Table 2 presents the three lowest-scoring items within each dimension alongside their respective scores.

Table 1. Dimensions and total scores of the knowledge, attitude and practice assessment questionnaire on dietary management for enterostomy patients (n=621).

Subject	Lowest score (points)	Highest score (points)	Score (points) M (P25, P75)	Qualification rate (%)
Knowledge	13	65	46 (39, 58)	77.13
Attitude	11	55	41 (35, 58)	85.83
Practice	13	65	46 (40, 58)	78.74
Total score	37	185	132 (114, 162)	79.07

Table 2. The three items with the lowest score rates in each dimension of the knowledge, attitude and practice assessment questionnaire for dietary management of enterostomy patients (n=621).

Dimension	Item	Score (x±s)	Score M (P25, P75)	Score rate (%)
Knowledge
	I know to monitor serum electrolytes and urine sodium levels regularly.	3.38±1.27	4 (2, 4)	70.53
	I know that I can take oral glucose saline and other rehydration salt solutions to maintain water and electrolyte balance and prevent high excretion.	3.40±1.24	4 (2, 4)	71.50
	I know that if the daily urine volume is less than 800 mL or the enterostomy output increases significantly to more than 1500 mL, I should seek medical attention promptly.	3.44±1.21	3 (3, 4)	76.33
Attitude
	I no longer worry about socially embarrassing situations such as bloating, bad odour, etc caused by improper eating.	3.61±1.09	3 (3, 4)	80.35
	I am no longer afraid that improper diet will cause harm to the enterostomy and the body.	3.62±1.10	3 (3, 4)	81.32
	I no longer feel that the dietary changes after the enterostomy have affected my life.	3.63±1.10	3 (3, 4)	81.52
Practice
	I will prepare auxiliary medicines such as probiotics according to the doctor’s advice.	3.41±1.21	3 (3, 4)	78.10
	To prevent loose stools, I eat foods that help keep stools thick (such as fermented foods like yoghurt and cheese).	3.48±1.23	4 (2, 4)	78.75
	I am happy to share my dietary experience with my fellow patients.	3.59±1.14	4 (3, 5)	80.35

Results of univariate analysis on dietary KAP among enterostomy patients

The results of univariate analysis showed that there were statistically significant differences in the KAP of dietary management among enterostomy patients with different educational levels, current residences, medical insurance types and monthly household incomes (p<0.05) (see online supplemental appendix C).

Scores of social alienation among enterostomy patients

In this survey, the total score of social alienation in enterostomy patients was 40.04±13.98 points. There was no significant difference in the social alienation scores of patients with different general data characteristics (p>0.05). There was a significant negative correlation between social alienation and the KAP scores of dietary management (r=−0.841, p<0.001).

Results of multivariate analysis on dietary KAP among enterostomy patients

The total score from the questionnaire assessing diet management KAP among enterostomy patients was used as the dependent variable. Factors demonstrating statistical significance in the univariate analysis were employed as independent variables in a multivariate linear regression analysis. The variables incorporated into the regression model included education level (categorised as junior high school and below=0, high school/technical secondary school=1, college=2, undergraduate=3, graduate and above=4), current residence (with a dummy variable using urban area as the reference category), type of medical insurance (with a dummy variable using New Rural Cooperative Medical Insurance as the reference category), monthly household incomes (≤3000=0, >3000 ~=1, >8000 ~=2, >15 000=3), and social alienation (entered as a continuous variable). The analysis revealed that education level, type of medical insurance and social alienation significantly influenced the levels of diet management KAP among enterostomy patients (p<0.05). Refer to table 3 for detailed results.

Table 3. Multiple linear regression analysis of influencing factors of the total score on dietary management knowledge, attitude and behaviour questionnaire in enterostomy patients (n=621).

Variable	B	95% CI	SE	β	T	P value	Tolerance	VIF
Constant	157.247	(146.419 to 168.074)	5.513	–	28.521	0.000	–	–
Social alienation	−0.841	(−0.988 to −0.694)	0.075	−0.393	−11.226	0.000	0.978	1.022
Education level	3.508	(0.587 to 6.428)	1.487	0.096	2.358	0.019	0.722	1.385
Current residence	3.074	(−1.707 to 7.855)	2.434	0.051	1.263	0.090	0.724	1.381
Type of medical insurance-Employee medical	16.322	(10.423 to 22.221)	3.004	0.233	5.434	0.000	0.654	1.530
Type of medical insurance-Resident medical insurance	19.075	(14.053 to 24.096)	2.557	0.315	7.460	0.000	0.670	1.492
Type of medical insurance-Self paying	8.865	(−16.725 to 34.454)	13.030	0.024	0.680	0.497	0.985	1.015
Monthly household income	−3.274	(−6.669 to 0.121)	1.729	−0.076	−1.894	0.059	0.746	1.340

Note: R2=0.266, adjusted R2=0.257; F=31.716, p<0.001; DW=1.318.

P value 0.000 means p<0.001

DW, Durbin-Watson; VIF, Variance Inflation Factor.

Discussion

Current status of KAP of dietary management among enterostomy patients

The findings of this study indicated that enterostomy patients generally exhibit above-average proficiency in dietary management, as evidenced by an overall questionnaire score of 136.66±29.93 points and a Pass rate of 79.07%. The knowledge dimension, however, recorded the lowest score at 47.62±12.15 points, with a Pass rate of 77.13%. Notably, patients demonstrated limited understanding in areas such as monitoring nutritional indicators, managing stoma output and preventing high output. Recent years have seen an increased focus on the nutritional status of enterostomy patients and an enhancement in clinical health education, leading to improved awareness of nutritional diets. Nonetheless, challenges persist, including inadequate health education coverage across all age groups and the absence of a comprehensive educational framework.¹¹ Research has shown that a significant number of enterostomy patients do not receive or adequately comprehend the dietary guidance and support necessary postsurgery.⁸ The demographic profile of enterostomy patients predominantly comprises middle-aged and elderly individuals, particularly those over the age of 60.¹² These patients often exhibit limited capacity for assimilating and comprehending information related to their condition. Both age and educational attainment significantly influence patients’ proficiency in understanding dietary guidelines associated with enterostomy.

High stoma output is a prevalent complication following enterostomy, with an early postoperative incidence ranging from 16% to 31%,^{13 14} and it often presents challenges in identification. Consequently, it is crucial to continuously monitor stoma output, serum electrolyte levels and urinary sodium levels, promptly assess symptoms indicative of high stoma output and implement nutritional support strategies, such as oral fluid supplementation.¹⁵ Zhang et al¹⁶ identified a deficiency in the understanding and practice of managing high stoma output among nursing staff, which may result in inadequate health education and guidance for patients regarding the monitoring and prevention of complications. The attitude dimension scored a mean of 41.42±8.83 points, with a Pass rate of 85.83%, indicating that patients generally maintain a positive attitude towards postoperative dietary management related to enterostomy care. However, lower scores in the attitude dimension were primarily associated with concerns about bag bulging and odours, perceived changes in dietary habits and fears of physical harm due to improper diet. These uncertainties and fears may prompt patients to adopt overly cautious dietary behaviours, such as adhering to prolonged semiliquid diets, restricting food variety and avoiding social interactions involving meals. Consequently, this can lead to a homogeneous nutritional intake, diminished appetite and social anxiety during the postoperative period,^{17 18} ultimately impacting the patient’s nutritional status. The behavioural dimension score was 47.62±11.95, corresponding to a Pass rate of 78.74%. Notably, lower scores were observed in areas such as patient preparation of adjuvant medications, dietary modifications to thicken stools and the sharing of dietary experiences. While a positive attitude among patients with limited knowledge and skills regarding the prevention and management of enterostomy complications can enhance their coping abilities in dietary management, factors such as disease-related shame, social anxiety and an excessive fear of inappropriate dietary choices negatively impact their practical application. Therefore, nurses can optimise the dietary management process and health education strategy, pay attention to elderly patients, focus on dietary management measures for enterostomy complications, assess patients’ nutritional literacy and psychological coping ability in a timely manner, and form a systematic and targeted education and support programme covering assessment, prevention, intervention and monitoring, to build a hospital-community-family linkage dietary management process, and to further enhance the level of practice of dietary management of patients with enterostomy, to improve their nutritional status and quality of life. This will further improve the dietary management of enterostomy patients and improve their nutritional status and quality of life.

Patients experiencing lower levels of social alienation are more likely to exhibit enhanced KAP related to dietary management in enterostomy care

The findings of this study suggest that enterostomy patients experience a moderate degree of social alienation, aligning with the results reported by Wang et al.¹⁹ Social alienation is defined as the perceived separation between an individual and their social groups. Numerous studies have demonstrated that social alienation adversely impacts the quality of life and rehabilitation progress of enterostomy patients. Those experiencing lower levels of social alienation are more likely to adopt positive health behaviours, such as maintaining appropriate dietary habits and adhering to regular lifestyle patterns.^{20 21} The results of this survey revealed a negative correlation between social alienation scores and scores related to diet management KAP. Reduced social alienation indicates that patients benefit from a more extensive social support network, greater utilisation of social resources, enhanced ability and autonomy in stoma care, and elevated levels of self-management optimism.22,24 A cross-sectional study examining individuals with intestinal ostomies revealed that effective communication with family, friends and healthcare professionals can alleviate the psychological burden associated with the condition and the stoma, enhance patients’ self-efficacy and mitigate the sense of social alienation.²⁵ Consequently, it is advisable to establish a multidisciplinary team comprising physicians, stoma care nurses, nutrition nurses, dietitians and psychological counsellors to collaboratively develop and implement diagnostic and care plans. In providing dietary management guidance to enterostomy patients, clinical healthcare providers should systematically screen for and accurately assess patients experiencing social alienation, employing structured strategies and interactive methods. Diverse educational techniques should be used, and regular assessments of patients’ learning progress and skill acquisition should be conducted. Additionally, attention should be directed towards the family and social support systems of outpatients. Using ‘Internet Plus’ as a platform, interventions such as home visits, patient exchange meetings or psychological support groups can facilitate the development of a robust multilevel social support network and enable continuous monitoring of patients’ dietary management. Simultaneously, assessment indicators may be selectively modified to thoroughly encompass the physical, psychological, social and functional dimensions of patients. Furthermore, nursing plans can be adaptively revised in accordance with assessment outcomes to promptly identify and address the social alienation experienced by enterostomy patients.

Enterostomy patients with higher educational attainment tend to possess greater KAP regarding dietary management

This study identified a correlation between higher educational attainment and elevated levels of dietary management KAP among stoma patients. This relationship may be attributed to the enhanced cognitive abilities, information processing skills and practical application capabilities associated with higher educational levels, which facilitate a more effective comprehension, assimilation and internalisation of knowledge.²⁶ Consequently, healthcare providers should customise health education content and delivery methods to align with the educational backgrounds of patients, thereby optimising their acquisition of knowledge and skills. The study’s participants predominantly possessed lower educational levels, with over 60% having attained only a junior high school education or less. Therefore, it is imperative that the content of dietary management health education be adjusted in terms of depth and complexity. Employing multimedia tools, such as graphic explanations and video interpretations, can ensure that patients fully comprehend and apply the information in their daily lives.²⁷ Moreover, interactive educational strategies, including patient exchange meetings, workshops and real-time Question and Answer (Q&A) sessions, have the potential to significantly enhance patients’ learning motivation and self-efficacy. Given the extended duration of home rehabilitation for patients with CRC, implementing a comprehensive and systematic approach to home dietary guidance and follow-up is crucial for improving nutritional status and facilitating postoperative recovery. This approach can be further augmented by integrating virtual reality technology for real-time online guidance. Tailored dietary courses and plans can be designed based on individual patient characteristics, while mobile applications, smart stoma bags and other Internet of Things (IoT) devices can be employed to monitor patients’ nutritional conditions through self-assessment and data uploads. Additionally, the development of digital peer support tools and group support resources can further aid patients in autonomous learning and practice within the home environment.

The variability in medical insurance types influences enterostomy patients’ KAP approaches to dietary management

The multivariate regression analysis results indicated that enterostomy patients enrolled in the new rural medical insurance programme scored significantly lower on the dietary management KAP questionnaire compared with their counterparts. The observed disparity may be attributed to the fact that these patients often experience unstable employment and face greater economic challenges.²⁸ In contrast, patients with urban or employee medical insurance benefit from sufficient economic security to cover related healthcare expenses, while self-paying patients typically hail from more affluent backgrounds, facilitating their access to professional dietary guidance and nutritional support services. Consequently, these favourable conditions enable higher dietary compliance and assist patients in effectively translating acquired knowledge and health beliefs into practice.²⁹ Research suggests that the substantial economic burden associated with adhering to scientifically validated dietary plans poses significant challenges for patients. The financial demands of purchasing oral nutritional supplements and adjuvant medications often serve as barriers to compliance with these dietary regimens, thereby impeding improvements in patients’ nutritional status.^{19 30} Therefore, when offering dietary guidance to enterostomy patients, healthcare professionals should consider the role of medical insurance and advise patients on optimising this resource. Additionally, it is imperative to tailor dietary plans to align with the patient’s financial circumstances, ensuring both the rationality and feasibility of the proposed regimen. Enhancing medical insurance policies is crucial for improving the overall quality of life for enterostomy patients. Future efforts should focus on providing increased support to rural enterostomy patients by continuously refining policies, broadening insurance coverage and elevating protection levels. Such measures would enable a greater number of patients to benefit, thereby alleviating the treatment burden associated with enterostomy care.

Conclusions

This study identified that enterostomy patients generally possess a moderate to high level of KAP concerning dietary management. Key factors influencing these levels include educational attainment, type of medical insurance and perceived social alienation. Consequently, it is advisable to establish a multidisciplinary nutrition team to conduct a comprehensive evaluation of the nutritional status, physiological and psychological indicators, social support and economic conditions of enterostomy patients. Tailored dietary guidance plans should be formulated based on the patient’s educational background, and a variety of educational methods should be used to ensure the interventions’ feasibility, accuracy and efficacy. Patients and their families should be encouraged to engage in self-care practices. Using the ‘Internet+Healthcare’ platform, regular assessments of patients’ learning progress and skill acquisition should be performed, alongside ongoing monitoring of their nutritional status and quality of life. The sample in this study is confined to medical institutions within Hubei Province, potentially introducing selection bias. Future research should consider expanding the sample size, employing high-quality cohort study designs, exploring additional potential influencing factors and tracking longitudinal changes in patients’ dietary management behaviours. Such efforts would facilitate a more comprehensive investigation into the sustained impact of these behaviours on quality of life and provide a foundation for the development of more effective nursing strategies.

Strengths and limitations

Our study has several strengths and limitations worth discussion. This study presents significant implications and offers notable advantages in the areas of dietary guidance, social support and self-care for patients with enterostomy. By systematically evaluating patients’ existing KAP concerning dietary management, as well as considering influencing factors such as social alienation, type of health insurance and educational level, this study advocates for the creation of a multidisciplinary nutrition team. This team would integrate personalised dietary plans with diverse educational strategies and enhance continuous monitoring and follow-up mechanisms using ‘Internet Plus’ technologies. The study surpasses the limitations of traditional unidirectional dietary education by aiming for precise, comprehensive assessment and intervention that encompass nutritional literacy, psychological well-being and social support for enterostomy patients. Additionally, by empowering patients and their families to participate actively in self-care, the study effectively improves dietary practice capabilities and the management of long-term quality of life.

These findings provide essential insights into enterostomy care within resource-constrained environments, particularly in low-income and middle-income countries, where the limited availability of multidisciplinary nutrition teams and patient education resources presents significant challenges. Accordingly, the model proposed in this study—which incorporates psychosocial support, offers tailored guidance based on educational attainment and employs cost-effective digital platforms for follow-up monitoring—constitutes a promising and practical framework for enhancing comprehensive nutritional care and reducing the global disparities in enterostomy management.

This study is characterised by its multicentre design, encompassing 43 hospitals, and a substantial sample size of 643 enterostomy patients. However, the sample was restricted to medical institutions within Hubei Province and was obtained through convenience sampling, which may introduce selection bias and thereby limit the generalisability of the findings. Furthermore, the cross-sectional design of the study precludes the ability to make causal inferences. The reliance on self-reported data also poses the risk of response bias. Future research should aim to broaden the scope of sampling and employ cluster sampling techniques to enhance the generalisability of the results. It is recommended that longitudinal study designs be used, incorporating objective measures to validate and extend the current findings, explore additional potential influencing factors and monitor longitudinal changes in patients’ dietary management behaviours. Such methodologies would enable a more comprehensive investigation of the sustained impact on patients’ quality of life and inform the development of more effective nursing strategies.

The funders had no role in study design, data collection, analysis, decision to publish, or preparation of the manuscript.

Data availability statement

Data are available on reasonable request.