The effectiveness of innovative educational techniques based on the Transtheoretical Model on the self-care ability of patients with colorectal cancer undergoing ostomy: A randomized controlled trial

Abstract

Objectives

This study aimed to explore the impact of innovative health education technologies grounded in the Transtheoretical Model (TTM) on self-care ability, stoma-related complication incidence, and satisfaction among patients with colorectal cancer undergoing enterostomy.

Methods

A randomized controlled trial involving 200 patients who underwent enterostomy and were admitted by random sampling between January 2022 and December 2022 was conducted. The patients were divided into a control group (n = 100) and an intervention group (n = 100). The control group was educated using conventional methods, whereas the intervention group was educated using innovative health education technologies grounded in the TTM. Self-care ability, stoma-related complication incidence, and satisfaction scores were compared between the two groups.

Results

All 200 patients completed the study. Before the intervention, there was no significant difference in self-care ability scores between the two groups (t = −0.295, P = 0.870). After the intervention, the intervention group (56.31 ± 13.75) had a significantly higher score than the control group (t = 22.328, P < 0.001). The comparison within each group revealed no significant change in the control group’s score (t = −0.191, P = 0.984); however, the intervention group showed a significant difference (t = −22.340, P < 0.001). The incidence of complications in the intervention group (11.0 %) was significantly lower than that in the control group (38.0 %) (χ² = 19.71, P < 0.010). The satisfaction rate in the intervention group (90.0 %) was significantly greater than that in the control group (59.0 %) (χ² = 25.29, P < 0.001).

Conclusions

Applying innovative health education technologies based on the TTM for patients with enterostomy can effectively increase educational efficiency, improve patients’ self-care ability, reduce the incidence of stoma-related complications, and enhance patients’ satisfaction with the plan, thereby promoting innovation in health education.

What is known?

• •With the rising incidence of colorectal cancer, for which enterostomy is a common surgical intervention, effective postoperative self-care is vital. Improper care can lead to various complications, severely compromising patients’ quality of life.
• •The quality of health education is associated with patients’ self-care levels after enterostomy for colorectal cancer. However, traditional health education is currently monotonous and lacks variety, making it challenging to meet the diverse needs of patients.
• •The Transtheoretical Model (TTM) can provide targeted guidance on behavioural changes based on patients’ varying levels of self-care ability at different stages.

What is new?

• •This study developed and empirically validated a novel, TTM-based staged intervention framework for health education in enterostomy care. Its innovation lies in translating theory into traceable, actionable tools that acknowledge behavioral change as a dynamic, iterative, and individualized process.
• •Specifically, the framework was instantiated through five innovative technologies: an enterostomy education garment, 3D interactive gaming software, a virtual reality training simulation system, complication demonstration models, and a multi-channel support platform.
• •This systematic intervention significantly enhanced patients’ self-care ability, reduced stoma-related complication rates, and increased patient satisfaction compared with conventional education in colorectal cancer patients with an ostomy.

1. Introduction

Colorectal cancer is the third most common cancer globally, the most prevalent malignant tumour of the digestive tract, and one of the most frequently diagnosed cancers in China [1]. For most patients, surgery is the primary treatment. In particular, enterostomy is a standard surgical procedure for specific cases. It involves creating an artificial opening by bringing a segment of the bowel to the abdominal wall, thereby diverting stool out of the body [2]. A permanent enterostomy, which requires the removal of the patient’s anus, leaves the stoma permanently on the abdomen. Consequently, the patient must excrete faeces through this abdominal opening for life [3]. It is estimated that approximately 50 % to 60 % of patients with colorectal cancer undergo this permanent procedure [4]. Following surgery, these patients confront substantial challenges in postoperative rehabilitation, psychological adaptation, and social reintegration.

For patients with newly created stomas, both self-care and family care are critical factors influencing postoperative recovery [5]. Improper stoma management can lead to various complications, underscoring the importance of health education to improve patients’ quality of life and promote rehabilitation [6]. Health professionals can support positive health behaviours by providing patients with relevant information and guidance on proper stoma care [7]. In fact, the quality of health education directly affects patients’ self-care ability with a stoma [8]. Currently, common health education formats include lectures, brochures, posters, and popular science articles [9]. However, these approaches are often unidirectional and lack interactivity, limiting participant engagement and failing to adequately stimulate patients’ interest [9].

The Transtheoretical Model (TTM) is a staged model of behavioural change. Its core concept is the “stages of change,” which posits that behavioural change is not a single event but a process progressing through five distinct stages: precontemplation, contemplation, preparation, action, and maintenance [10]. Unlike traditional methods, the TTM emphasizes that the impetus for change lies in an individual’s psychological motivation. Consequently, when applying this model to design individualized interventions, researchers tailor programs primarily based on the subject’s current stage and corresponding psychological needs [11,12]. This staged, personalized approach enhances participant acceptance and engagement. The TTM has been successfully applied in health education for various chronic conditions, including hypertension, knee arthritis and asthma, demonstrating positive outcomes [[13], [14], [15]]. It is particularly effective in meeting the complex needs of patients and their families [16]. For patients with an enterostomy, whose needs range from postoperative adaptation to long-term self-management, the TTM can provide targeted behavioural guidance tailored to their evolving self-care abilities at different stages [10].

Based on the TTM framework [10], this study developed a suite of innovative health education tools, including an intestinal stoma education skirt, 3D interactive teaching software, and a virtual reality (VR) simulation system. These tools were used to deliver stage-targeted nursing interventions. The study aims to improve patients’ self-care ability, reduce the incidence of stoma-related complications, enhance satisfaction with nursing care, and provide a reference for optimizing health education strategies for enterostomy patients.

2. Methods

2.1. Study design and participants

A randomized controlled trial was conducted in accordance with the Consolidated Standards of Reporting Trials (CONSORT) guidelines [17], and participants were divided into two groups. The trial was conducted at Yangpu District Central Hospital in Shanghai from January to December 2022. Participants were enrolled through random sampling, and the study was registered with the Chinese Clinical Trial Registry (Registration Number: ChiCTR2500110534).

Inclusion criteria included: 1) diagnosis of colorectal cancer and having undergone a permanent enterostomy; 2) aged between 18 and 80 years old; 3) postoperative stable condition, with no major complications such as wound infection, stoma bleeding, or anastomotic leakage; 4) absence of cognitive impairment. Exclusion criteria were as follows: 1) participated in other concurrent clinical studies; 2) had severe comorbidities affecting major organs such as the heart, liver, lungs, or kidneys.

2.2. Sample size

The formula for calculating the sample size for comparing the means of two groups is as follows: $n_1=n_2=2{\left[\frac{\left(u_{\alpha }+u_{\beta }\right)\sigma }{\delta }\right]}^2+\frac{1}{4}{u}_{\alpha }^2$ [18], where $n_1$ and $n_2$ are the required contents for the two samples; the inspection level is set as α = 0.05 and β = 0.1; μ_α = 1.96 and μ_β = 1.282; σ is the estimated value of the standard deviation of the two population samples; and δ is the difference between the means of the two samples. In line with the relevant literature, this study focuses on health education for patients with similar intestinal stomata [19]. δ/σ is approximately 0.75, which can be substituted into the formula n₁ = n₂ ≈ 38. Given a 20 % sample dropout rate, the minimum sample size per group was determined to be 46. To enhance the robustness of the study, 200 participants were ultimately enrolled, with 100 randomly assigned to each group.

2.3. Randomization and blinding

Upon hospital admission, patients were randomly assigned to either the control group or the intervention group using a computer-generated allocation sequence. The entire randomization process was automated to eliminate selection bias and avoid manual intervention. Sequentially numbered, opaque, and sealed envelopes (SNOSE) were used to implement the allocation, ensuring concealment. This trial adopted a single-blind design, meaning the patients were unaware of their group assignment. To minimize intergroup contamination, patients in the control group were hospitalized in Ward A, while those in the intervention group were in Ward B. These two wards were physically independent and located on separate floors. Each ward was staffed by dedicated healthcare teams with non-overlapping schedules, effectively preventing cross-communication. Importantly, the outcome assessors and data collectors were blinded to group assignment, thereby meeting the blinding requirements.

2.4. Interventions

2.4.1. Unified pre‑intervention training and assessment

To ensure consistent delivery of routine care, all nursing staff in both Ward A (control group) and Ward B (intervention group) received standardized training on the conventional postoperative education protocol for patients undergoing gastrointestinal surgery. Following the training, the quality control team conducted a uniform assessment to verify competency and adherence to protocol.

2.4.2. Intervention group

As part of routine health education, the intervention group participated in an innovative programme grounded in the TTM of behavioural change. The specific measures were as follows.

2.4.2.1. Preparation before implementation

• (1)Establishment of the study team. A research team consisting of eight experienced nurses was established and divided into three subgroups: the Education and Research Group (3 members), the Clinical Practice Group (3 members), and the Quality Control Group (2 members). The education and research group categorized the development of healthy behaviours in patients with enterostomy into five stages based on the TTM: pre-intention, intention, preparation, action, and maintenance [11]. It designed and developed five innovative health education tools tailored to the needs of patients at each stage. The Clinical Practice Group was responsible for the clinical implementation of these innovative health education tools, while the Quality Control Group formulated and supervised quality evaluation standards.
• (2)Training and assessment of the innovative health education program. The training content covered the objectives, implementation procedures, key points, and evaluation indicators of the innovative health education program. Members of the Quality Control Group conducted a standardized assessment.

2.4.2.2. Specific implementation plan

• (1)Pre-intention stage. Team members created enterostomy education skirts (ZL201930645577.1) using the multilayer apron design to illustrate the digestive system’s structure, and they explained the enterostomy procedure to patients. They also used two-colour beads to indicate the location of colorectal cancer lesions and to demonstrate the postoperative stoma site and fecal collection method by attaching an ostomy bag to the educational skirt, thereby alleviating patients’ preoperative concerns.
• (2)Intention stage. Team members developed a 3D intelligent nursing teaching app (software copyright, 2021SR1370579) that integrated nursing knowledge and skills related to enterostomy care. The app adopted a question-and-answer mode to assess and consolidate enterostomy nursing knowledge, aiming to achieve both educational and entertaining effects. During gameplay, the system presented scenario-specific questions. Users completed each level on their mobile devices by following the built-in voice prompts and digital nurse reminders.
• (3)Preparation stage. Team members developed a VR training system for enterostomy care, enabling patients to learn about the procedure in an immersive manner. The program randomly selected matching game scenarios based on user selections, and patients operated with their fingers in the virtual space. In addition, VR technology could provide real-time feedback and evaluation to help patients or their family members correct improper behaviours promptly.
• (4)Action stage. Team members made the “teaching mould of clinical problems related to enterostomy” and the “integrated enterostomy complications fungus” by hand using polymer clay. The first type simulated 36 potential complications in enterostomy patients, enabling intuitive recognition of such adverse conditions. The second model featured a human torso with a rectangular hollow. This hollow was positioned along the outer third of the line connecting the right anterior superior iliac spine (ASIS) and the umbilicus, corresponding to a common site for ileostomy placement. Nurses randomly selected a stoma complication model, placed it in the hollow area, and guided patients to identify their types and master corresponding management methods.
• (5)Maintenance stage. Team members provided follow-up services via online and offline modes. Online consultations were available via the hospital’s official website, where international enterostomal therapists communicated with patients. In addition, Ward B set up a 24-h hotline to address patients’ stoma care questions in real time. Offline services included: 1) holding regular ostomy workshops in the middle of each month to provide learning and communication opportunities for enterostomy patients; 2) conducting popular science lectures and organizing monthly on-site science popularization activities to solve everyday problems.

2.4.3. Control group

Upon admission, patients were introduced to the department’s environment, the attending physician, the primary nurse, and the precautions for various examinations. One day before surgery, the attending nurse and the patient jointly determined the stoma site. When patients returned to the ward postoperatively, attending nurses provided dietary guidance and demonstrated the use of stoma products to patients and their families. A video on stoma care was played for 20 min every Thursday on the department’s educational display screen. Before discharge, primary nurses guided patients and their families in performing stoma care effectively. Additionally, patients were invited to follow the hospital’s WeChat official account. Telephone follow-up was conducted one week after discharge, followed by monthly calls. One month after discharge, an outpatient follow-up was conducted to evaluate the patient’s rehabilitation and provide targeted guidance.

2.5. Measures

2.5.1. General information questionnaire

A self-designed general questionnaire was used, including questions on age, sex, educational level, marital status, and the method used to pay medical expenses.

2.5.2. Self-Care Ability Assessment Subscale

Evers et al. [20] developed the Self-Care Ability Assessment Scale (ASAS) in 1993, which was subsequently translated into Chinese by Guo et al. [21] in 2014 and named the Self-Care Ability Assessment Scale Revised Chinese (ASAS-R-C). The authors have authorized the use of this scale, which is now widely adopted [21]. This scale consists of three dimensions: general self-care ability, developmental self-care ability, and self-care ability during illness, with a total of 15 items. A 5-point Likert scale (1 = “completely disagree,” 5 = “completely agree”) is used for scoring, with a total score ranging from 15 to 75. Higher scores indicate stronger self-care ability. The Cronbach’s α coefficient of the scale is 0.77, the test-retest reliability is 0.83, and the content validity index is 0.97, indicating good reliability and validity.

2.5.3. Incidence of stoma-related complications

The Stoma Assessment Scale (SAS) was designed and developed by Teng et al. [22]. The authors have approved this scale. Its test-retest and split-half reliabilities both exceed 0.8, and it has good face and content validity. This scale covers six complication types: peristomal skin problems, stenosis, prolapse, parastomal hernia, retraction, and mucocutaneous separation. Symptoms for each complication are rated on a scale of 1 to 3, yielding a total score of 3 to 7. This scale was used first to identify the presence of complications in patients and then to count the number of affected cases. Thus, the actual scale scores were not utilized. In the hospital setting, nurses guided patients and their families in using the SAS, providing systematic training and education. During post-discharge follow-up, an international enterostomal therapist assessed the number of complications that had occurred.

2.5.4. Patient satisfaction with the intervention

An extensive review of domestic and international literature on health education evaluation was conducted using databases including Web of Science, Embase, PubMed, ScienceDirect, the Cochrane Library, CINAHL, China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform, and China Biomedical Literature Service System (SinoMed). The literature was screened and selected based on its relevance to the study topic, methodological quality, and novelty. Based on the evaluation results and the analysis of literature quality, three high-quality articles [[23], [24], [25]] were ultimately selected. The feasibility of reference [19] is examined throughout the process of producing the satisfaction questionnaire, and the other two references constitute the questionnaire’s main content. Considering China’s cultural background, a preliminary dimension and item pool of patient satisfaction with health education have been formed. The final questionnaire uses a 3-point rating scale, with scores of 2, 1, and 0 corresponding to “very satisfied,” “relatively satisfied,” and “dissatisfied,” respectively. It comprises two dimensions—format and experience—and five items: comprehensibility of content, diversity of format, method engagement, process immersion, and outcome effectiveness. We paid attention to the comprehensibility of the educational content and assessed whether the patient truly understood it through verbal inquiry and practical application. The reliability and content validity of the questionnaire were evaluated, with a Cronbach’s α coefficient of 0.90. For content validity evaluation, the revised questionnaire was sent to five experts with relevant professional backgrounds. We consulted each expert via online meetings. Through two rounds of inquiries, one-on-one feedback, and revisions, expert opinions gradually converged to reach a consensus. The final expert validity of the questionnaire was 0.80. The questionnaire was written in Chinese to meet the needs of most patients. A total score of 8–10 points indicate “very satisfied,” 6–7 points indicate “relatively satisfied,” and a score below 6 points indicates “dissatisfied” [26]. The total number of satisfied patients was calculated as the sum of “very satisfied” and “relatively satisfied” patients.

2.6. Data collection and quality control

Before data collection commenced, our study team prioritized explaining the purpose and significance of this study to the participating patients. Their personal information was uniformly collected through the hospital’s electronic medical record system. One day before a patient’s discharge, the responsible nurse, under our team’s oversight, distributed the ASAS-R-C to the patients and provided standardized guidance for completing the on-site questionnaire. Each item was meticulously reviewed to ensure no omissions and the completed questionnaires were collected immediately. At the one-month post-discharge follow-up, a certified enterostomal therapist assessed the patient for stoma-related complications and evaluated satisfaction, recording the findings immediately.

2.7. Data analysis

Data entry was performed independently by two researchers using dual electronic records. All analyses were conducted with SPSS 22.0 (IBM Corp). Continuous variables with a normal distribution are presented as mean and standard deviation, while categorical variables are summarized as frequencies and percentages. For intragroup comparisons of pre- and post-intervention outcomes, the paired-samples t-test or the Wilcoxon signed-rank test was selected based on the distribution of differences. For intergroup comparisons, measurement data that met the normality and homogeneity-of-variance assumptions were analyzed using the independent sample t-test. Count data were analyzed using the Chi-square test or Fisher’s exact test. P < 0.05 indicated a statistically significant difference.

2.8. Ethical considerations

This study was approved by the Ethics Committee of District Central Hospital (No. LL-2021-SCI-011). All of the patients signed informed consent forms.

3. Results

3.1. Characteristics of the participants

All 200 patients completed the study without dropping out during the intervention and follow-up (Appendix A). The analysable sample comprised 100 patients in the intervention group and 100 in the control group. The study participants consisted of patients aged 51 to 70 years. Males accounted for 51.5 % and females for 48.5 %. Regarding education, 37.0 % had attended junior college, and 46.0 % were married. There were no significant differences in general characteristics between the two groups (P > 0.05), indicating that their baseline levels were consistent and comparable (Table 1).

Table 1.

Comparison of the general data between the two groups.

Characteristics	Total (n = 200)	Intervention group (n = 100)	Control group (n = 100)	χ2	P
Age (years)
30–50	20 (10.0)	10 (10.0)	10 (10.0)	0.02	0.988
51–70	115 (57.5)	57 (57.0)	58 (58.0)
≥71	65 (32.5)	33 (33.0)	32 (32.0)
Gender
Male	103 (51.5)	54 (54.0)	49 (49.0)	0.50	0.479
Female	97 (48.5)	46 (46.0)	51 (51.0)
Educational level
Junior high school and below	40 (20.0)	21 (21.0)	19 (19.0)	1.10	0.777
Technical secondary school or high school	67 (33.5)	30 (30.0)	37 (37.0)
Junior college	74 (37.0)	39 (39.0)	35 (35.0)
Bachelor's degree or above	19 (9.5)	10 (10.0)	9 (9.0)
Marital status
Married	92 (46.0)	40 (40.0)	52 (52.0)	2.99	0.224
Unmarried	24 (12.0)	14 (14.0)	10 (10.0)
Other	84 (42.0)	46 (46.0)	38 (38.0)
Payment methods for medical expenses
Medical insurance	180 (90.0)	92 (92.0)	88 (88.0)	0.88	0.346
Self funded	20 (10.0)	8 (8.0)	12 (12.0)

Note: Data are n (%).

3.2. Comparison of self-care ability between the two groups

Before the intervention, there was no significant difference in self-care ability scores between the two groups (t = −0.295, P = 0.870). After the intervention, the intervention group (56.31 ± 13.75) had a significantly higher score than the control group (23.28 ± 5.46) (t = 22.328, P < 0.001). The comparison within each group revealed no significant change in the control group’s score (t = −0.191, P = 0.984); however, the intervention group showed a significant difference (t = −22.340, P < 0.001).

3.3. Comparison of the incidence of stoma-related complications between the two groups at one month after discharge

The incidence of stoma-related complications was 11.0 % in the intervention group and 38.0 % in the control group. The results revealed that the incidence of complications significantly decreased at one month after discharge (χ² = 19.71, P < 0.010).

3.4. Comparison of patient satisfaction with the intervention between the two groups at one month after discharge

The satisfaction rate was 90.0 % in the intervention group and 59.0 % in the control group, respectively. These findings revealed that the patients in the intervention group were significantly more confident than those in the control group (χ² = 25.29, P < 0.001).

4. Discussion

4.1. This programme can improve the self-care ability of patients with an enterostomy

This study aims to develop innovative TTM-based health education methods to improve patients’ self-care abilities. For instance, a custom-made enterostomy education skirt helps patients with psychological preparation and stoma acceptance, which, in turn, enhances their enthusiasm and ability for postoperative self-care. These findings are consistent with those of Shi et al. [6], who reported that preoperative stoma experience can improve patients’ postoperative self-care abilities. The stage-matched stoma education intervention proved more engaging for patients, thereby increasing their participation and interest in self-care learning. During the intention and preparation stages, 3D teaching software and VR technology are combined to deliver health education to patients at various post-surgical stages, tailored to their ability to get out of bed. The development of this series of technologies aligns with the national trend to enhance the frameworks of nursing information and innovate nursing service models [27]. This immersive learning experience enables patients and their families to gain a deeper understanding of enterostomy care operations. Riaz et al. [28] reported that an immersive VR experience can concretize abstract and complex knowledge, ultimately enhancing patients’ self-care ability. Furthermore, TTM-based innovative health education technologies can enhance the self-care abilities of enterostomy patients, consistent with the findings of Ren et al. [29]. The difference lies in the incorporation of self-developed innovative technologies in this study. During the action stage, the personalized model is used for health education, providing a more intuitive learning experience. Additionally, real-time assessments are conducted to address knowledge gaps relevant to each patient, aligning with the study findings of Kwong et al. [30]. A 3D-printed stoma care mould supports patients with a stoma and significantly improves their self-care. Building on self-developed enterostomy complication models, the current study integrated evaluation content to enhance the comprehensiveness of health education. The model developed in this study is designed to address multiple stoma-related complications, thereby enhancing patients’ self-management capability. Providing both online and offline services for continuous care during the maintenance stage can play a complementary role in enhancing patients’ self-care abilities, aligning with the study results of Liu et al. [31] and Zhu et al. [32], who used WeChat groups for follow-up and achieved satisfactory results.

4.2. This programme can significantly reduce the incidence of stoma-related complications

In this study, during the action stage (i.e., before discharge), the use of a teaching model for clinical problems related to stomas effectively reduced the incidence of postoperative complications. One study [33] revealed that improving patients’ awareness of stoma-related complications enables them to fully grasp the key points of prevention, identification, and treatment. This finding is consistent with the results of Lin et al. [34], who demonstrated that experiential health education for patients reduced the incidence of enterostomy-related complications. However, the study by Lin et al. [34] focused on general preoperative experiential health education. In the current study, the TTM was integrated, and experiential learning was incorporated into its action stage. Experiential learning focused on clinical problem scenarios can better translate patients’ willingness to learn into a practical ability to prevent complications. In addition, this study describes the development of an integrated stoma complication model based on the teaching model of stoma-related clinical problems. This model evaluated patients’ mastery and answered their questions in real time, thereby significantly improving the understanding of stoma management among patients and their families. Simulated operations were used to teach patients how to prevent and address stoma complications effectively. Kwong et al. [30] used 3D printing to create stoma models for operational training, focusing on visualizing the stoma structure. In contrast, this study employs simulation operations grounded in an integrated complication model. This approach not only achieves visualization but also emphasizes scenario-based training for managing complications. Moreover, Zhang et al. [35] reported that regular follow-up management of patients with enterostomy can reduce the incidence of stoma-related complications. Our study team employed a follow-up approach that combined online and offline methods.

4.3. This programme can improve patient satisfaction with plans

This model provides patients with easily accessible health education technologies tailored to the characteristics of each stage of care. A previous study [24] noted that the primary needs of patients during specific periods should be analyzed, and that corresponding health education measures should be implemented. The findings of the current study were consistent with those of Westland et al. [36]. It was thought that behavioural changes could enhance patients’ cognitive abilities, improve satisfaction levels, and enhance treatment compliance [36]. In comparison, the behavioural changes in this study are more targeted. During the pre-intention stage, the enterostomy education skirt provided patients with sufficient psychological preparation for the operation and relieved their tension. In this study, stoma positioning was no longer performed directly; instead, the nursing staff personally wore an intestinal stoma education dress to explain the location to patients before positioning. This process enhanced emotional communication with patients. During the contemplation and preparation stages, interactive gaming software was used to deliver health education. This approach boosted patient interest and content interactivity, which, in turn, stimulated learning motivation and encouraged mastery of stoma self-care skills. These findings are consistent with those of Reichlin et al. [37], who reported that gaming software can stimulate patients’ enthusiasm and interest in learning, thereby addressing their significant needs. This study provides tailored game software to support patients’ postoperative self-care. This differs from the single-game mode used in previous studies [33]. The combination of 3D games and VR simulation games can further help patients consolidate knowledge and improve their satisfaction levels. During the action stage, complex complications were transformed into intuitive physical models for patient education. These models were also used for assessment, comprehensively improving patients’ ability to identify complications and laying a foundation for subsequent home care. Similarly, Dagash et al. [38] reported the effectiveness of stoma moulds for teaching technical and cognitive skills; however, it is a simple model of an enterostomy and does not address its related complications. This study further improved the development of enterostomy complication models. During the maintenance stage, a multi-channel support system was established, encompassing a 24-h hotline, online consultations, and stoma association networks. This system provided timely responses to patient inquiries and disseminated key information, which improved overall satisfaction with the care plan. This finding is consistent with the results of van der Storm et al. [39], who reported that appropriate use of the internet can significantly increase patients’ satisfaction with their education plan.

In contrast to previous studies [34,38,39], this study developed stage-specific educational programmes tailored to each phase of disease progression. As a result, it increased the intervention’s relevance and acceptability among patients. Timely and context-appropriate support was provided throughout the care process.

5. Limitations

This study was conducted at a single tertiary hospital in Shanghai, limiting the generalizability of the findings. Despite the baseline balance, the sample is not sufficiently representative. Future multicenter studies are warranted to validate these results in different settings and thereby improve the diversity of the participant pool. Due to time and funding constraints, the intervention duration was relatively short, potentially limiting the ability to observe long-term effects. Future studies should extend the follow-up period to explore the sustained impact of the intervention.

6. Conclusions

The findings of this study demonstrate that this scheme incorporates stage-specific programs tailored to different disease phases. This stage-specific design is a key strength, as it enables targeted interventions that align with patients’ dynamic needs throughout their disease trajectory. The findings confirm the feasibility of applying our team’s targeted, stage-specific, innovative health education technologies to improve patients’ self-care abilities, reduce stoma-related complication rates, and increase patient satisfaction compared with conventional education. Clinical nurses can leverage these technologies to deliver targeted educational services to colorectal cancer patients at different disease stages. Future studies should increase sample sizes and conduct multi-centre studies across hospitals of varying levels to evaluate the long-term applicability and effects.

Data availability statement

The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.

CRediT authorship contribution statement

Jing Wang: Conceptualization, Methodology, Validation, Formal analysis, Investigation, Resources, Data curation, Writing - review & editing, Supervision, Project administration. Yaping Yang: Conceptualization, Methodology, Validation, Formal analysis, Investigation, Resources, Data curation, Writing - review & editing. Xiaoyan Yang: Conceptualization, Methodology, Validation, Formal analysis, Investigation, Data curation, Writing - original draft, Writing - review & editing, Project administration. Tan Lv: Conceptualization, Methodology, Validation, Formal analysis, Data curation, Writing - original draft, Writing - review & editing, Project administration.

Funding

List of approved projects associated with the “Three-Year Action Plan for Discipline Construction of the School of Nursing” (No. JS2210205). The funding organization provided financial support for the design, implementation and analysis of the investigation.

Declaration of competing interest

The authors declare that they have no conflicts of interest.

Appendices. Supplementary data

The following are the Supplementary data to this article: