Mixed-methods exploration of challenges to stoma care for ostomates in four low- and middle-income countries: STomacARe For Improvement reSearcH (STARFISH) study

Background Little is known about the challenges of stoma care and potential solutions for patients in low- and middle-income countries (LMICs). This study aimed to assess the outcomes and experience of care for patients with stomas in LMICs using a mixed methods approach. Methods A cross-sectional survey of hospitals assessed health system characteristics relevant to stoma care. A six-month retrospective audit collected data on all patients undergoing new stoma formation, and postoperative complications. Semi-structured interviews with stoma patients and informal caregivers, and key informant interviews with healthcare providers were conducted to gather information on experiences, challenges and coping strategies relating to stoma care. The results were triangulated to develop a questionnaire-based tool to assess patients’ and carers’ knowledge and attitudes towards stoma and stoma care. Results Six hospitals from the Philippines, Malawi, Nigeria and India participated in the study. Data from 446 patients demonstrated diversity case mix, outcomes and postoperative stoma counselling. Interview data from the Philippines highlighted the lack of knowledge on stoma care of the patients and carers, poor access to stoma care and resources and the lack of affordable stoma care supplies. Triangulating these inputs, a 33-item questionnaire was developed to facilitate task sharing of expert stoma care to non-expert nurses and caregivers. Conclusions This study highlighted gaps in capacity to provide stoma counselling and poor access to and affordability of stoma care supplies for patients in LMICs. This novel questionnaire can help close these gaps and improve care for new ostomates in resource limited settings. Registration The study is registered in the Philippine Health Research Registry PHRR No.210805-003783 (https://registry.healthresearch.ph/index.php/registry)