Development of home care demand indicators for Chinese informal enterostomy caregivers according to the “internet + nursing” model: A Delphi study

Development of home care demand indicators for Chinese informal enterostomy caregivers according to the “internet + nursing” model: A Delphi study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Development of home care demand indicators for Chinese informal enterostomy caregivers according to the “internet + nursing” model: A Delphi study Siqing LI, Liping ZHONG, Xiaofang GUAN, Cuilian LUO, Yuxia LIU, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8509555/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Purpose To establish a home care framework for assessing Chinese informal enterostomy caregivers’ demand on the basis of the “internet + nursing” model, providing an evidence-based foundation for efforts to optimize home care platforms and enhancing service quality. Methods The two-round Delphi method was used in this study. Initial indicators were identified based on a systematic literature review and semi-structured interviews with ten Chinese informal caregivers. Sixteen experts participated in two rounds of Delphi consultations, conducted between May and June 2024. The analytic hierarchy process (AHP) was subsequently used to determine indicator weights. Results The expert response rate was 94.1% in the first round and 100% in the second round. The authority coefficients were 0.88 and 0.95, respectively. Kendall’s W values ranged from 0.146 to 0.304 ( P < 0.05), thus reflecting a consensus on a final set of 3 primary indicators: “healthcare needs,” “socioemotional support needs,” “online platform functional needs”, 8 secondary, and 32 tertiary indicators. Conclusions This validated indicator system provides a structured framework for efforts to develop “internet + nursing” platforms and address the identified gaps in caregiver training and psychosocial support, with broad applicability. Enterostomy Informal caregivers Home care Demand indicators Delphi method Introduction Colorectal cancer (CRC) is the third most commonly diagnosed cancer and the second leading cause of cancer-related mortality worldwide by 2022. China has the second highest incidence and fourth highest mortality rates worldwide[ 1 , 2 ]. Surgical resection remains the primary curative treatment for 50%-60% of patients[ 3 ]. Although enterostomy can increase the 5-year survival rate to more than 60%, it introduces considerable physical and psychological challenges because of changes in body image, bowel function, and daily life[ 4 ]. China is currently home to nearly one million individuals who live with a permanent enterostomy, with approximately 100,000 new cases reported annually[ 5 ]. Postoperative complication rates remain high, ranging from 16.3% to 53.8%, and such issues are often attributed to insufficient stoma care skills among informal caregivers[ 6 ]. This study draws on Orem’s self-care deficit nursing theory to systematically address these challenges and improve caregivers’ competency. This theory suggests that nursing support becomes essential when patients cannot meet their own therapeutic self-care demands, a principle that extends to the critical role of informal caregivers[ 7 ]. The aim of this approach is to address self-care deficits experienced by patients after enterostomy by equipping informal caregivers with structured knowledge and skills. In support of this approach, a randomized controlled trial by Li et al. demonstrated that applying Orem’s self-care model significantly improved discharge readiness and self-management efficacy in patients undergoing enterostomy[ 8 ]. Furthermore, from the perspective of the socioecological model, this study broadly conceptualizes the “social needs” of caregivers as a comprehensive construct that encompasses operational, health-related, and psychosocial demands that arise within the broader social environment of caregivers. Effective home-based stoma management remains a critical challenge. To address this challenge, Internet-based healthcare tools have been recognized as promising solutions worldwide[ 9 ]. In China, the “Internet and nursing” model has emerged to address this need, particularly in the context of an aging population and evolving family structures, as highlighted in the National Nursing Development Plan (2021–2025)[ 10 ]. The “internet + nursing” model in China specifically involves registered nurses from medical institutions using internet technologies to provide offline care to discharged patients or other groups with mobility difficulties who are managing illness, and who are operating on an “online application, offline service” basis [ 10 ]. Internationally, telehealth interventions have shown potential to facilitate the provision of ostomy care. For example, Krouse et al. reported that a hybrid model incorporating telemonitoring and home visits reduced 30-day readmission rates by 28% among cancer survivors[ 11 ], and Augestad et al. reported that 72% of ostomy patients in Norway could be managed effectively via telemedicine[ 12 ]. However, these studies focused primarily on clinical outcomes and paid limited attention to the comprehensive psychosocial and operational needs of informal caregivers[ 13 ]. In China, this gap is compounded by inadequate caregiver training and underdeveloped digital support systems[ 14 ]. Informal caregivers, who are typically unpaid family members without formal training, play a vital role in the daily management of patients undergoing enterostomy [ 15 ]. These caregivers often rely on brief discharge instructions and sporadic follow-ups that leave them inadequately prepared[ 16 ]. Although home care can reduce costs and improve patients’ quality of life[ 17 , 18 ], caregivers frequently report unmet needs, particularly concerning emergency management and emotional support[ 13 ]. Despite the potential of internet-based technologies to transform home care[ 14 ], existing “internet + nursing” platforms in China have functional limitations, such as fragmented information delivery and insufficient psychosocial support for caregivers[ 19 ]. Previous research on topics has largely concentrated on platform development and outcome evaluation[ 11 – 13 , 20 ] but has overlooked the development of a structured needs assessment. Notably, no study has systematically constructed and quantified a multilevel needs system for informal caregivers of enterostomy patients within the IPNS framework. This study aimed to address this gap by developing an evidence-based, weighted indicator system that can be used to assess the home care demands of these caregivers. Using Delphi and analytic hierarchy process (AHP) methodologies, this research provides a scientific basis for efforts to provide precise and personalized services through “internet + nursing” platforms. Materials and methods Research and Implementation Process Preliminary Indicator Development Literature Review Two trained researchers conducted a systematic literature search across multiple databases, including the China National Knowledge Infrastructure (CNKI), VIP Database, Wanfang Database, China Biology Medicine (CBM) Database, PubMed, Embase, Web of Science, Cochrane Library, Ovid, National Institute of Health and Clinical Excellence (NICE), Scottish Intercollegiate Guidelines Network, and BMJ Best Practice. The search incorporated both Medical Subject Headings (MeSH) terms and keywords, including “enterostomy,” “home care,” “family care,” “informal caregivers,” “family caregivers,” “internet-based nursing,” “telehealth,” “caregiver needs assessment,” “home-based care,” “support systems,” and “digital health interventions.” Relevant studies, clinical guidelines, and policy documents published between January 2013 and January 2023 were also retrieved. Manual searches of the reference lists from the included studies were also performed to supplement the findings. Semistructured Interviews To comprehensively explore the home care needs of informal caregivers, semi-structured interviews were conducted with reference to a purposively selected sample consisting of ten participants. The cohort included spouses (n = 4), adult children (n = 4), and parents (n = 2) of enterostomy patients with an average age of 47.8 years (range: 32–65 years) and whose average caregiving duration was 14.5 months (range: 3–36 months). This demographic diversity is intended to capture a wide spectrum of lived experiences. The interview guide included five core open-ended questions: (1) ‘Can you describe a typical day providing care for the patient at home?’ (2) “What specific practices do you use to manage the patient’s enterostomy care?” (3) “What have been the most significant challenges you encountered during the caregiving process?” (4) “What types of support or assistance do you most hope to receive?” and (5) “What has been your experience, if any, with using ‘internet + nursing’ platforms?”. Data collection continued until thematic saturation was achieved, indicating that subsequent interviews no longer yielded new substantive information regarding caregiver needs. All interviews were audio-recorded, transcribed verbatim within 24 hours of completion, and subsequently analyzed by conducting a qualitative content analysis. This process involved repeated reading of the transcripts to achieve familiarity, the generation of initial codes, and subsequently the assignment of these codes to different categories on the basis of similarities and differences. This systematic process directly informed the initial item pool of the Delphi survey. Draft System A preliminary indicator framework that consisted of 4 primary (“healthcare needs,” “stoma care needs,” “socioemotional support needs,” and “online platform functional needs), 11 secondary, and 25 tertiary indicators was systematically developed on the basis of the synthesis of the sources presented above. Expert Selection Purposive sampling was used to recruit 16 experts from 15 tertiary hospitals in three major Chinese regions: Guangdong Province (eastern), Anhui Province (central), and Guizhou Province (western). This selection strategy encompassed areas that exhibited significant disparities in socioeconomic development and healthcare resources: Guangdong represents a high-resource, developed coastal region, Anhui represents a median-resource, central province, and Guizhou represents an emerging resource in the western region. This approach ensured a diverse and representative national perspective. The expert inclusion criteria used in this research were (1) a bachelor’s degree or higher and an intermediate or senior professional title, (2) at least 10 years of clinical experience in enterostomy care, (3) certification by the World Council of Enterostomal Therapists (WCET), and (4) informed consent to voluntarily participate in two rounds of expert consultation. The sample size of 16 is in line with the recommended panel sizes for Delphi studies, which typically range from 10 to 15 experts[ 21 ]. Expert Consultation The Delphi questionnaire included three parts: (1) a cover letter that detailed the research background, aims, and the Delphi procedure; (2) an expert profile survey that aimed to collect demographic and professional information; and (3) the main evaluation form, which allowed the experts to rate the importance and feasibility of each proposed indicator on a 5-point Likert scale (1=“very unimportant/infeasible”, 5=“very important/feasible”). Prior to the formal survey, the initial questionnaire was pretested by two senior enterostomy care specialists to assess the clarity, appropriateness, and comprehensiveness of the items, which led to minor revisions. Two rounds of expert consultation were conducted via email on May 8, 2024, and May 22, 2024; these rounds were separated by a two-week interval to allow time for analysis and questionnaire refinement. The quantitative criteria used to reach consensus on indicator retention were predefined according to established methodological guidelines[ 22 , 23 ]. An indicator was retained if it simultaneously met all of the following thresholds: a mean importance score ≥ 4.00, a full-score ratio (percentage of experts rating it a ‘5’) ≥ 20%, and a coefficient of variation (CV) ≤ 0.25. Data analysis Data were analyzed using IBM SPSS (version 26.0; IBM Corp., Armonk, NY, USA). Expert enthusiasm was assessed based on response rates (≥ 70% was considered acceptable). The authority coefficient (Cr) was calculated as (Cs + Ca)/2, where Cs (familiarity) and Ca (judgement basis) ranged from zero to one. A coefficient of variation (CV) 0.3 indicating moderate consensus) were tested using chi-square tests. AHP was performed using Yaahp 12 software to determine indicator weights and consistency ratios. Ethical Considerations The study was approved by the Ethics Committee of the Fifth Affiliated Hospital, Sun Yat-sen University (No: 2023-L008-1) and conducted in accordance with the principles of the Declaration of Helsinki. Written informed consent was obtained from all participants who were informed of their right to voluntarily withdraw at any time. Results Expert Demographics Sixteen experts, who were between the ages of 35 and 59 years (48.50 ± 7.39) and had 10–27 years of clinical experience each (15.06 ± 5.11), participated. Thirteen experts held bachelor’s degrees, whereas three held master’s degrees. Furthermore, three experts possessed senior professional titles, whereas thirteen held associate senior titles. The response rates for the two rounds of expert consultation were 94.12% and 100% in the first and second rounds, respectively. In terms of qualitative feedback, 12.5% (2/16) of the experts provided specific written comments to support the refinement in the second round. Detailed expert characteristics are presented in Table 1 . Table 1 General Information Regarding the Experts ( n = 16). Characteristics Mean ( SD ) n ( % ) Age (years) 48.50 (7.39) Professional experience in wound&ostomy (years) 15.06 (5.11) Gender: female 16(100.00) Educational level Bachelor 13 (81.25) Masters 3 (18.75) Career focus Nursing management 8 (50.00) Nursing education 3 (18.75) Nursing practice 5 (31.25) Job title level Senior title 3 (18.75) Associate senior title 13 (81.25) Abbreviations: SD = standard deviation. Expert Authority and Consensus Levels During the first Delphi round, the familiarity coefficient (Cs) was 0.888, judgement coefficient (Ca) was 0.863, and authority coefficient (Cr) was 0.875. In the second round, these coefficients increase to Cs = 0.975, Ca = 0.919, and Cr = 0.947, all of which exceed the acceptable threshold of 0.7. A consensus was reached, with Kendall’s W values of 0.146 (Round 1) and 0.304 (Round 2); both were statistically significant ( χ² = 164.80, P < 0.0001; χ² = 140.99, P < 0.0001). Details regarding the expert authority across the two rounds are presented in Table 2 . Table 2 Statistics Regarding Expert Authority. Content Cs Ca Cr Kendall’s W χ² P Round 1 0.888 0.863 0.875 0.146 164.80 < 0.0001 Round 2 0.975 0.919 0.947 0.304 140.99 < 0.0001 Final Indicator System During the two rounds of expert consultation, 17 suggestions for revision were made. Following the first round, one primary indicator “stoma care needs” was removed. The items “alleviating patients’ negative emotions (anxiety, fear, depression)” and “enhancing patients’ positive emotions (confidence, optimism)” were reclassified into the “socioemotional support needs” socioemotional support needs domai n . The domain was expanded to include “emotional and financial support for primary caregivers.” Moreover, the “online platform function needs” domain was augmented with two new items: “incorporating science popularization via platforms such as TikTok or Kuaishou” and “establishing WeChat/QQ communication groups for primary caregivers”. In the second round, two tertiary indicators, “exercise methods suitable for enterostomy patients” and “seasonal differences in winter/summer stoma care”, were removed. Conversely, two new tertiary indicators were added: “home emergency management of stoma bleeding” and “home emergency management of stoma prolapse” and stoma prolapse. Additionally, the item “sexual life precautions for enterostomy patients” was merged into the secondary indicator “daily life guidance”. The final indicator system includes three primary indicators, eight secondary indicators, and 32 tertiary indicators. The importance scores, coefficients of variation, and weights of all the indicators are presented in Table 3 . Table 3 Home Care Needs Indicator System for Enterostomy Caregivers. Indicator Importance CV Weight 1. Healthcare needs 4.94 ± 0.25 0.05 0.350 1.1 Ostomy care knowledge 4.97 ± 0.18 0.04 0.280 1.1.1 Stoma assessment: colour, height, shape, output volume, etc. 4.98 ± 0.12 0.02 0.120 1.1.2 Stoma bag replacement procedure and precautions 4.95 ± 0.18 0.04 0.115 1.1.3 Timing and frequency of stoma bag replacement 4.94 ± 0.20 0.04 0.110 1.1.4 How to choose the appropriate stoma bag 4.91 ± 0.25 0.05 0.105 1.1.5 Selection of stoma accessories (e.g., skin powder, protective film, adhesive paste, etc.), and information on purchasing channels 4.89 ± 0.28 0.06 0.100 1.1.6 Identification of stoma and peristomal skin complications (e.g., bleeding, oedema, hernia, prolapse, etc.) 4.88 ± 0.30 0.06 0.095 1.2 Dietary guidance knowledge 4.93 ± 0.25 0.05 0.265 1.2.1 Foods that may cause diarrhoea in stoma patients 4.89 ± 0.28 0.06 0.085 1.2.2 Foods that may cause constipation in stoma patients 4.85 ± 0.32 0.07 0.090 1.2.3 Foods that may cause flatulence in stoma patients 4.82 ± 0.35 0.07 0.085 1.3 Daily life guidance 4.88 ± 0.34 0.07 0.220 1.3.1 Clothing precautions for stoma patients 4.82 ± 0.35 0.07 0.075 1.3.2 Bathing and hygiene precautions for stoma patients 4.80 ± 0.38 0.08 0.080 1.3.3 Travel precautions for stoma patients (e.g., air travel) 4.78 ± 0.40 0.08 0.075 1.3.4 Sleeping precautions for stoma patients (e.g., sleeping position, presleep care) 4.75 ± 0.42 0.09 0.070 1.3.5 Daily activities and exercise guidance for stoma patients (e.g., hiking, climbing) 4.73 ± 0.45 0.10 0.065 1.3.6 Sexual life precautions for enterostomy patients (e.g., positions, special stoma bag use) 4.70 ± 0.48 0.10 0.060 1.4 Emergency management guidance 4.85 ± 0.37 0.08 0.160 1.4.1 Emergency management of stoma bag leakage 4.78 ± 0.40 0.08 0.070 1.4.2 Information on stoma clinic hours and hospital contact details 4.68 ± 0.50 0.11 0.055 1.4.3 Home emergency management of stoma bleeding 4.65 ± 0.52 0.11 0.050 1.4.4 Home emergency management of stoma prolapse 4.63 ± 0.55 0.12 0.045 2. Socioemotional support needs 4.91 ± 0.29 0.06 0.348 2.1 Emotional support for patients 4.89 ± 0.31 0.06 0.200 2.1.1 Alleviating patients’ negative emotions (anxiety, fear, depression) 4.85 ± 0.33 0.07 0.090 2.1.2 Enhancing patients’ positive emotions (confidence, optimism) 4.60 ± 0.58 0.13 0.040 2.2 Family and social support 4.78 ± 0.42 0.09 0.180 2.2.1 Emotional and financial support for primary caregivers 4.73 ± 0.48 0.10 0.065 2.2.2 Support and assistance from other family caregivers 4.58 ± 0.60 0.13 0.035 2.2.3 Support from community and nongovernmental organizations 4.55 ± 0.62 0.14 0.030 2.2.4 Peer education and home visits from fellow stoma patients 4.53 ± 0.65 0.14 0.025 2.2.5 Inclusion of internet nursing home services and stoma products in medical insurance coverage 4.50 ± 0.68 0.15 0.020 3. Online platform functional needs 4.83 ± 0.38 0.08 0.302 3.1 Online consultation guidance 4.75 ± 0.45 0.09 0.150 3.1.1 Online consultation with nurses at home 4.68 ± 0.55 0.12 0.055 3.1.2 Establishment of personal electronic health records 4.48 ± 0.70 0.16 0.015 3.1.3 Sharing of electronic health records and educational materials with medical institutions 4.45 ± 0.72 0.16 0.010 3.1.4 Development of stoma prevention and rehabilitation knowledge modules 4.43 ± 0.75 0.17 0.005 3.2 Access to health information 4.69 ± 0.52 0.11 0.130 3.2.1 Incorporating science popularization via platforms such as TikTok or Kuaishou 4.40 ± 0.78 0.18 0.003 3.2.2 Establishing WeChat/QQ communication groups for primary caregivers 4.38 ± 0.80 0.18 0.002 Abbreviations: CV = coefficient of variation. Discussion This study presents the design and development of a structured, comprehensive home care needs assessment framework for informal caregivers of enterostomy patients, grounded in the “internet + nursing” service model. This framework is intended to support healthcare teams and digital platform developers in China to address the identified gaps in supportive care for this caregiver population. This study highlights the feasibility and significance of integrating Orem’s self-care deficit theory and a socioecological perspective into systematic needs evaluation. The identification of three primary dimensions—healthcare needs, socioemotional support needs, and online platform functional needs—reflects a holistic approach to assessing caregivers’ requirements. The highest priority accorded to healthcare needs (weight: 0.350) is consistent with global healthcare trends that emphasize patient-centered, skill-based, and supportive care. The structured weighting system established a clear hierarchical framework to guide targeted caregiver training, digital platform optimization, and psychosocial intervention strategies. Scientific Rigor This study successfully developed a home care needs indicator system for informal caregivers of enterostomy patients under the “internet + nursing” service model on the basis of a two-round Delphi method. The expert consultation process was characterized by high levels of engagement and authority. The expert response rates were 94.12% and 100.00%, respectively, across the two rounds, and the expert authority coefficients (Cr) were 0.875 and 0.947 (both > 0.7), indicating reliable and credible expert input. Additionally, Kendall's W values of 0.146 and 0.304 (Round 2) were statistically significant (both P < 0.05), and all the coefficients of variation (CV) were below 0.25. These results indicate strong expert consensus underscoring the scientific rigor and reliability of the developed indicator system. Significance of the Indicator System The establishment of this indicator system is timely, particularly given China's aging population and the country’s shift towards nuclear family structures, which have weakened traditional caregiving capabilities. These changes have exacerbated the challenges associated with providing effective home care to patients with enterostomies. The high priority assigned by experts to the “healthcare needs” domain (weight: 0.350) aligns with global research, such as the study by Mohamed et al.[ 25 ], which identified complication management as the foremost concern for caregivers, thus highlighting the universal criticality of core clinical skills for safe home-based care. While the “internet + nursing services” model has made initial progress in enterostomy care, its functional design and service offerings remain inadequate to the task of addressing the diverse needs of informal caregivers[ 19 , 26 ]. Informal caregivers play a critical role in enterostomy care; however, their training and psychological support needs are often overlooked. Our finding that the “socioemotional support needs” domain received significant weighting strongly echoes Kirkland-Kyhn et al. ’s work [ 18 ], which emphasized the profound emotional burden experienced by these caregivers. This study fills this gap by moving beyond the mere identification of such needs to provide a scientifically validated, standardized framework that systematically integrates psychosocial needs with operational and platform functional demands. This comprehensive approach addresses a recognized gap in studies that have often focused predominantly on clinical outcomes, as noted by Mohamed et al [ 25 ]. In line with the National Health Commission’s National Nursing Development Plan (2021–2025), which emphasizes the expansion of the “internet + nursing services” to meet diverse health demands[ 10 ], the indicator system supports systematic training for informal caregivers through innovative tools such as online courses, video tutorials, and virtual reality (VR) simulations. The integration of psychological counselling and online support groups into platforms could also alleviate caregivers’ emotional burdens. Thus, the system not only addresses current care gaps but also aligns with national health policies; thus, it has significant practical and policy implications. Rationality of the Indicator Analysis and Weight Determination AHP was used to determine indicator weights at all levels, yielding a clear priority structure that complements the consensus findings reported earlier. The results revealed that the primary indicator “healthcare needs” had the highest weight (0.350), highlighting the priority of direct medical care for patients with stoma. Within this domain, the secondary indicator “ostomy care knowledge” (weight: 0.280) was identified as a core component, thus emphasizing the need for caregivers to master essential care skills. Tertiary indicators such as “stoma assessment” and “stoma bag replacement procedures” received high importance scores with low CVs, thereby reflecting strong expert consensus concerning their significance. Although the overall consensus across most indicators reinforces the reliability of the framework, the observed divergence in expert opinions on certain items, signaled by higher CV values, offers equally meaningful insights. This divergence does not diminish the validity of the system but rather enriches our understanding of the tensions inherent in translating structured needs into practical interventions. A notable example is the lack of agreement on the use of platforms such as TikTok and Kuaishou for science popularization (CV: 0.18). This disagreement stems from the tension between information accessibility and perceived authority in digital health communications. Some experts see short-video platforms as vital for reaching broad populations with limited health literacy, whereas others are concerned about potential compromises in information reliability and professional tone in healthcare contexts. This contrast highlights an ongoing debate in digital health strategy between outreach and credibility, and directly shapes how the “online platform functional needs” dimension of our system could be operationalized in different settings. Similarly, the divergence observed for indicators related to health insurance coverage reflects the ongoing challenges associated with China’s healthcare policy reforms. Experts’ differing perspectives on this topic may be influenced by their firsthand experiences with regional disparities in insurance reimbursement policies and the practical difficulties associated with integrating new services, such as those provided under the “internet + nursing” model, into existing payment schemes. This highlights the intricate link between developing effective caregiver support tools and the broader need for conducive health policies and financing environments. Finally, the lower weight assigned to the “online platform functional needs” (0.302) may reflect the current supplementary role of digital tools in home care. Although these tools provide valuable support, their integration into care practices is still evolving and their full potential remains unrealized. Relevance to Clinical Practice This validated indicator system offers direct guidance for clinical practice based on its prioritized structure. Weighted indicators support three key applications in enterostomy care. First, the quantified weights enabled the stratification of informal caregiver training. Core clinical skills, including stoma assessment, complication recognition, and pouch management, should form essential training modules, whereas psychoemotional support should represent an advanced training component. Second, it strategically guides the development of digital health platforms. High-priority indicators require integrated core features such as stoma assessment tools, procedural video libraries, and emergency guidance systems, and psychological support services must be integrated into the platform architecture. Furthermore, this framework served as a structured clinical assessment tool. Healthcare providers can systematically identify informal caregivers’ knowledge gaps and unmet needs during follow-up visits, thereby facilitating the development of personalized interventions beyond standardized education. Limitations This study had several limitations. First, despite rigorous expert consultation, the process was confined to a specific cultural and regional context, which potentially limits the generalizability of the findings. Future studies should include a more diverse panel of experts to validate the system in different settings. Second, although expert opinions are authoritative, they may not fully capture the perspectives of informal caregivers and patients. The integration of feedback provided by these groups in future research could enhance the relevance and applicability of the system. Conclusions In this study, a scientifically rigorous, reliable indicator system for the home care needs of informal caregivers of enterostomy patients was developed on the basis of the “internet + nursing services” model. The system highlights the priorities of direct medical care, while addressing the psychological and social needs of caregivers. These findings align with national health policies and provide a foundation for efforts to optimize digital health platforms to enhance home care quality. Future research should prioritize refining the system, particularly in domains characterized by high expert divergence, and exploring innovative approaches to integrate digital tools into care practices. Accordingly, this indicator system can serve as a valuable resource for efforts to improve the care provided to enterostomy patients and to support their caregivers. Declarations Ethics Approval This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the Fifth Affiliated Hospital, Sun Yat-sen University (2023-L008-1). Competing Interests The authors have no relevant financial or non-financial interests to disclose. Consent to participate Informed consent was obtained from all individual participants included in the study. Funding This study was supported by the Social Development Program of the Zhuhai Science and Technology Bureau (Grant No. 2320004000239). The funders had no role in the study design, collection, analysis, interpretation of data, writing of the report, or decision to submit the article for publication. Author Contribution Siqing Li and Liping Zhong: Conceptualisation, formal analysis, drafting-original version. Xiaofang Guan: Formal analysis, data curation, methodology. Cuilian Luo: Investigation, data curation. Yuxia Liu: Project management, supervision, coping editing. Wenxin Luo: Conceptualisation, revision of the draft, funding acquisition. All authors approved the content of the manuscript. Data Availability The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. References Bray F et al (2024) Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. 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J MED INTERNET RES 23(9):e26545. https://doi.org/10.2196/preprints.26545 . Hasson F, Keeney S, McKenna H (2000) Research guidelines for the Delphi survey technique. J ADV NURS 32(4):1008–1015. [None DOI, PMID: 11095242] Wilkes L (2015) Using the Delphi technique in nursing research. Nurs Stand 29(39):43–49. https://doi.org/10.7748/ns.29.39.43.e8804 . McPherson S, Reese C, Wendler MC (2018) Methodology Update: Delphi Studies. NURS RES 67(5):404–410. https://doi.org/10.1097/NNR.0000000000000297 . Diamond IR et al (2014) Defining consensus: a systematic review recommends methodologic criteria for reporting of Delphi studies. J CLIN EPIDEMIOL 67(4):401–409. https://doi.org/10.1016/j.jclinepi.2013.12.002 . Mohamed NE et al (2016) Unmet informational and supportive care needs of patients following cystectomy for bladder cancer based on age, sex, and treatment choices. UROL ONCOL-SEMIN ORI 34(12):531–537. https://doi.org/10.1016/j.urolonc.2016.06.010 . Han Y et al (2020) Qualitative research on operation management experience of "Internet + Nursing Service" by nursing managers. JOURNAL OF NURSING SCIENCE 35(22):52–56. https://doi.org/CNKI:SUN:HLXZ .0.2020-22-016 [In Chinese]. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 11 Feb, 2026 Editor assigned by journal 11 Feb, 2026 Submission checks completed at journal 20 Jan, 2026 First submitted to journal 03 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8509555","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":589907886,"identity":"65ede627-39ad-4cc6-b742-dbbffd232486","order_by":0,"name":"Siqing LI","email":"","orcid":"","institution":"Fifth Affiliated Hospital of Sun Yat-sen University","correspondingAuthor":false,"prefix":"","firstName":"Siqing","middleName":"","lastName":"LI","suffix":""},{"id":589907906,"identity":"c75a8796-2c2e-4020-8796-64c9af41df03","order_by":1,"name":"Liping ZHONG","email":"","orcid":"","institution":"Fifth Affiliated Hospital of Sun Yat-sen University","correspondingAuthor":false,"prefix":"","firstName":"Liping","middleName":"","lastName":"ZHONG","suffix":""},{"id":589907908,"identity":"61c6ca5b-5aca-406b-877d-549dffcd7309","order_by":2,"name":"Xiaofang GUAN","email":"","orcid":"","institution":"Fifth Affiliated Hospital of Sun Yat-sen University","correspondingAuthor":false,"prefix":"","firstName":"Xiaofang","middleName":"","lastName":"GUAN","suffix":""},{"id":589907910,"identity":"ba6f2b27-7160-46db-a41a-8c6449896906","order_by":3,"name":"Cuilian LUO","email":"","orcid":"","institution":"Fifth Affiliated Hospital of Sun Yat-sen University","correspondingAuthor":false,"prefix":"","firstName":"Cuilian","middleName":"","lastName":"LUO","suffix":""},{"id":589907918,"identity":"bfd9ba09-b833-44f1-866d-690371359890","order_by":4,"name":"Yuxia LIU","email":"","orcid":"","institution":"Fifth Affiliated Hospital of Sun Yat-sen University","correspondingAuthor":false,"prefix":"","firstName":"Yuxia","middleName":"","lastName":"LIU","suffix":""},{"id":589907925,"identity":"04b171eb-7d72-4d9d-8a4c-462b3e22883d","order_by":5,"name":"Wenxin LUO","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4UlEQVRIiWNgGAWjYBACPjBZwcDAxg4XS8CvhQ1EHDgDZDCTpOVgG5AgXotE8rHPH+dtk+djZmD+zPPnMAM/e44Bw88d+LSkJc84uO22YRszA5s0b9thBsmeNwaMvWfwackxZgBqYQRpYeZtOMxgcCPHgJmxjZCWObft22AOsydOS8PtRKAWBmkeNqAtEoS08DxLZjhz7HZyG1CZ5Ny2dB6JM88KDvbi0cLPnnyYoaLmtu389ubDH978sZbjb0/e+OAnHi1IgLGBiYeBgQfEPECUBrCmH0QrHQWjYBSMgpEEAFRhR8U8Q30OAAAAAElFTkSuQmCC","orcid":"","institution":"Fifth Affiliated Hospital of Sun Yat-sen University","correspondingAuthor":true,"prefix":"","firstName":"Wenxin","middleName":"","lastName":"LUO","suffix":""}],"badges":[],"createdAt":"2026-01-04 01:53:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8509555/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8509555/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":103504220,"identity":"d9c7b963-3e1e-4256-962c-2c2b468e6340","added_by":"auto","created_at":"2026-02-26 13:18:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":816037,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8509555/v1/8433858d-d380-4f8f-870c-e341926126d9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Development of home care demand indicators for Chinese informal enterostomy caregivers according to the “internet + nursing” model: A Delphi study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eColorectal cancer (CRC) is the third most commonly diagnosed cancer and the second leading cause of cancer-related mortality worldwide by 2022. China has the second highest incidence and fourth highest mortality rates worldwide[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Surgical resection remains the primary curative treatment for 50%-60% of patients[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Although enterostomy can increase the 5-year survival rate to more than 60%, it introduces considerable physical and psychological challenges because of changes in body image, bowel function, and daily life[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. China is currently home to nearly one million individuals who live with a permanent enterostomy, with approximately 100,000 new cases reported annually[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Postoperative complication rates remain high, ranging from 16.3% to 53.8%, and such issues are often attributed to insufficient stoma care skills among informal caregivers[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study draws on Orem\u0026rsquo;s self-care deficit nursing theory to systematically address these challenges and improve caregivers\u0026rsquo; competency. This theory suggests that nursing support becomes essential when patients cannot meet their own therapeutic self-care demands, a principle that extends to the critical role of informal caregivers[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The aim of this approach is to address self-care deficits experienced by patients after enterostomy by equipping informal caregivers with structured knowledge and skills. In support of this approach, a randomized controlled trial by Li et al. demonstrated that applying Orem\u0026rsquo;s self-care model significantly improved discharge readiness and self-management efficacy in patients undergoing enterostomy[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Furthermore, from the perspective of the socioecological model, this study broadly conceptualizes the \u0026ldquo;social needs\u0026rdquo; of caregivers as a comprehensive construct that encompasses operational, health-related, and psychosocial demands that arise within the broader social environment of caregivers.\u003c/p\u003e \u003cp\u003eEffective home-based stoma management remains a critical challenge. To address this challenge, Internet-based healthcare tools have been recognized as promising solutions worldwide[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. In China, the \u0026ldquo;Internet and nursing\u0026rdquo; model has emerged to address this need, particularly in the context of an aging population and evolving family structures, as highlighted in the National Nursing Development Plan (2021\u0026ndash;2025)[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The \u0026ldquo;internet\u0026thinsp;+\u0026thinsp;nursing\u0026rdquo; model in China specifically involves registered nurses from medical institutions using internet technologies to provide offline care to discharged patients or other groups with mobility difficulties who are managing illness, and who are operating on an \u0026ldquo;online application, offline service\u0026rdquo; basis [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Internationally, telehealth interventions have shown potential to facilitate the provision of ostomy care. For example, Krouse et al. reported that a hybrid model incorporating telemonitoring and home visits reduced 30-day readmission rates by 28% among cancer survivors[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], and Augestad et al. reported that 72% of ostomy patients in Norway could be managed effectively via telemedicine[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. However, these studies focused primarily on clinical outcomes and paid limited attention to the comprehensive psychosocial and operational needs of informal caregivers[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In China, this gap is compounded by inadequate caregiver training and underdeveloped digital support systems[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eInformal caregivers, who are typically unpaid family members without formal training, play a vital role in the daily management of patients undergoing enterostomy [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. These caregivers often rely on brief discharge instructions and sporadic follow-ups that leave them inadequately prepared[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Although home care can reduce costs and improve patients\u0026rsquo; quality of life[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], caregivers frequently report unmet needs, particularly concerning emergency management and emotional support[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite the potential of internet-based technologies to transform home care[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], existing \u0026ldquo;internet\u0026thinsp;+\u0026thinsp;nursing\u0026rdquo; platforms in China have functional limitations, such as fragmented information delivery and insufficient psychosocial support for caregivers[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Previous research on topics has largely concentrated on platform development and outcome evaluation[\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] but has overlooked the development of a structured needs assessment. Notably, no study has systematically constructed and quantified a multilevel needs system for informal caregivers of enterostomy patients within the IPNS framework. This study aimed to address this gap by developing an evidence-based, weighted indicator system that can be used to assess the home care demands of these caregivers. Using Delphi and analytic hierarchy process (AHP) methodologies, this research provides a scientific basis for efforts to provide precise and personalized services through \u0026ldquo;internet\u0026thinsp;+\u0026thinsp;nursing\u0026rdquo; platforms.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eResearch and Implementation Process\u003c/h2\u003e \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e \u003ch2\u003ePreliminary Indicator Development\u003c/h2\u003e \u003cdiv id=\"Sec5\" class=\"Section4\"\u003e \u003ch2\u003eLiterature Review\u003c/h2\u003e \u003cp\u003e Two trained researchers conducted a systematic literature search across multiple databases, including the China National Knowledge Infrastructure (CNKI), VIP Database, Wanfang Database, China Biology Medicine (CBM) Database, PubMed, Embase, Web of Science, Cochrane Library, Ovid, National Institute of Health and Clinical Excellence (NICE), Scottish Intercollegiate Guidelines Network, and BMJ Best Practice. The search incorporated both Medical Subject Headings (MeSH) terms and keywords, including \u0026ldquo;enterostomy,\u0026rdquo; \u0026ldquo;home care,\u0026rdquo; \u0026ldquo;family care,\u0026rdquo; \u0026ldquo;informal caregivers,\u0026rdquo; \u0026ldquo;family caregivers,\u0026rdquo; \u0026ldquo;internet-based nursing,\u0026rdquo; \u0026ldquo;telehealth,\u0026rdquo; \u0026ldquo;caregiver needs assessment,\u0026rdquo; \u0026ldquo;home-based care,\u0026rdquo; \u0026ldquo;support systems,\u0026rdquo; and \u0026ldquo;digital health interventions.\u0026rdquo; Relevant studies, clinical guidelines, and policy documents published between January 2013 and January 2023 were also retrieved. Manual searches of the reference lists from the included studies were also performed to supplement the findings.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e\n\u003ch3\u003eSemistructured Interviews\u003c/h3\u003e\n\u003cp\u003eTo comprehensively explore the home care needs of informal caregivers, semi-structured interviews were conducted with reference to a purposively selected sample consisting of ten participants. The cohort included spouses (n\u0026thinsp;=\u0026thinsp;4), adult children (n\u0026thinsp;=\u0026thinsp;4), and parents (n\u0026thinsp;=\u0026thinsp;2) of enterostomy patients with an average age of 47.8 years (range: 32\u0026ndash;65 years) and whose average caregiving duration was 14.5 months (range: 3\u0026ndash;36 months). This demographic diversity is intended to capture a wide spectrum of lived experiences.\u003c/p\u003e \u003cp\u003eThe interview guide included five core open-ended questions: (1) \u0026lsquo;Can you describe a typical day providing care for the patient at home?\u0026rsquo; (2) \u0026ldquo;What specific practices do you use to manage the patient\u0026rsquo;s enterostomy care?\u0026rdquo; (3) \u0026ldquo;What have been the most significant challenges you encountered during the caregiving process?\u0026rdquo; (4) \u0026ldquo;What types of support or assistance do you most hope to receive?\u0026rdquo; and (5) \u0026ldquo;What has been your experience, if any, with using \u0026lsquo;internet\u0026thinsp;+\u0026thinsp;nursing\u0026rsquo; platforms?\u0026rdquo;. Data collection continued until thematic saturation was achieved, indicating that subsequent interviews no longer yielded new substantive information regarding caregiver needs.\u003c/p\u003e \u003cp\u003eAll interviews were audio-recorded, transcribed verbatim within 24 hours of completion, and subsequently analyzed by conducting a qualitative content analysis. This process involved repeated reading of the transcripts to achieve familiarity, the generation of initial codes, and subsequently the assignment of these codes to different categories on the basis of similarities and differences. This systematic process directly informed the initial item pool of the Delphi survey.\u003c/p\u003e\n\u003ch3\u003eDraft System\u003c/h3\u003e\n\u003cp\u003eA preliminary indicator framework that consisted of 4 primary (\u0026ldquo;healthcare needs,\u0026rdquo; \u0026ldquo;stoma care needs,\u0026rdquo; \u0026ldquo;socioemotional support needs,\u0026rdquo; and \u0026ldquo;online platform functional needs), 11 secondary, and 25 tertiary indicators was systematically developed on the basis of the synthesis of the sources presented above.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eExpert Selection\u003c/h2\u003e \u003cp\u003ePurposive sampling was used to recruit 16 experts from 15 tertiary hospitals in three major Chinese regions: Guangdong Province (eastern), Anhui Province (central), and Guizhou Province (western). This selection strategy encompassed areas that exhibited significant disparities in socioeconomic development and healthcare resources: Guangdong represents a high-resource, developed coastal region, Anhui represents a median-resource, central province, and Guizhou represents an emerging resource in the western region. This approach ensured a diverse and representative national perspective.\u003c/p\u003e \u003cp\u003eThe expert inclusion criteria used in this research were (1) a bachelor\u0026rsquo;s degree or higher and an intermediate or senior professional title, (2) at least 10 years of clinical experience in enterostomy care, (3) certification by the World Council of Enterostomal Therapists (WCET), and (4) informed consent to voluntarily participate in two rounds of expert consultation. The sample size of 16 is in line with the recommended panel sizes for Delphi studies, which typically range from 10 to 15 experts[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eExpert Consultation\u003c/h3\u003e\n\u003cp\u003eThe Delphi questionnaire included three parts: (1) a cover letter that detailed the research background, aims, and the Delphi procedure; (2) an expert profile survey that aimed to collect demographic and professional information; and (3) the main evaluation form, which allowed the experts to rate the importance and feasibility of each proposed indicator on a 5-point Likert scale (1=\u0026ldquo;very unimportant/infeasible\u0026rdquo;, 5=\u0026ldquo;very important/feasible\u0026rdquo;). Prior to the formal survey, the initial questionnaire was pretested by two senior enterostomy care specialists to assess the clarity, appropriateness, and comprehensiveness of the items, which led to minor revisions.\u003c/p\u003e \u003cp\u003eTwo rounds of expert consultation were conducted via email on May 8, 2024, and May 22, 2024; these rounds were separated by a two-week interval to allow time for analysis and questionnaire refinement. The quantitative criteria used to reach consensus on indicator retention were predefined according to established methodological guidelines[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. An indicator was retained if it simultaneously met all of the following thresholds: a mean importance score\u0026thinsp;\u0026ge;\u0026thinsp;4.00, a full-score ratio (percentage of experts rating it a \u0026lsquo;5\u0026rsquo;)\u0026thinsp;\u0026ge;\u0026thinsp;20%, and a coefficient of variation (CV)\u0026thinsp;\u0026le;\u0026thinsp;0.25.\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eData were analyzed using IBM SPSS (version 26.0; IBM Corp., Armonk, NY, USA). Expert enthusiasm was assessed based on response rates (\u0026ge;\u0026thinsp;70% was considered acceptable). The authority coefficient (Cr) was calculated as (Cs\u0026thinsp;+\u0026thinsp;Ca)/2, where Cs (familiarity) and Ca (judgement basis) ranged from zero to one. A coefficient of variation (CV)\u0026thinsp;\u0026lt;\u0026thinsp;0.25 indicated high agreement[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Kendall\u0026rsquo;s W values (\u0026gt;\u0026thinsp;0.3 indicating moderate consensus) were tested using chi-square tests. AHP was performed using Yaahp 12 software to determine indicator weights and consistency ratios.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eEthical Considerations\u003c/h2\u003e \u003cp\u003e The study was approved by the Ethics Committee of the Fifth Affiliated Hospital, Sun Yat-sen University (No: 2023-L008-1) and conducted in accordance with the principles of the Declaration of Helsinki. Written informed consent was obtained from all participants who were informed of their right to voluntarily withdraw at any time.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eExpert Demographics\u003c/h2\u003e \u003cp\u003eSixteen experts, who were between the ages of 35 and 59 years (48.50\u0026thinsp;\u0026plusmn;\u0026thinsp;7.39) and had 10\u0026ndash;27 years of clinical experience each (15.06\u0026thinsp;\u0026plusmn;\u0026thinsp;5.11), participated. Thirteen experts held bachelor\u0026rsquo;s degrees, whereas three held master\u0026rsquo;s degrees. Furthermore, three experts possessed senior professional titles, whereas thirteen held associate senior titles. The response rates for the two rounds of expert consultation were 94.12% and 100% in the first and second rounds, respectively. In terms of qualitative feedback, 12.5% (2/16) of the experts provided specific written comments to support the refinement in the second round. Detailed expert characteristics are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eGeneral Information Regarding the Experts (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;16).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eMean\u003c/em\u003e (\u003cem\u003eSD\u003c/em\u003e)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003en\u003c/em\u003e (\u003cem\u003e%\u003c/em\u003e)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e48.50 (7.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProfessional experience in wound\u0026amp;ostomy (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15.06 (5.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender: female\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16(100.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducational level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBachelor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13 (81.25)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMasters\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (18.75)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCareer focus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNursing management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8 (50.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNursing education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (18.75)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNursing practice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (31.25)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJob title level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSenior title\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (18.75)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAssociate senior title\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13 (81.25)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eAbbreviations: SD\u0026thinsp;=\u0026thinsp;standard deviation.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eExpert Authority and Consensus Levels\u003c/h2\u003e \u003cp\u003eDuring the first Delphi round, the familiarity coefficient (Cs) was 0.888, judgement coefficient (Ca) was 0.863, and authority coefficient (Cr) was 0.875. In the second round, these coefficients increase to Cs\u0026thinsp;=\u0026thinsp;0.975, Ca\u0026thinsp;=\u0026thinsp;0.919, and Cr\u0026thinsp;=\u0026thinsp;0.947, all of which exceed the acceptable threshold of 0.7. A consensus was reached, with Kendall\u0026rsquo;s W values of 0.146 (Round 1) and 0.304 (Round 2); both were statistically significant (\u003cem\u003eχ\u0026sup2;\u003c/em\u003e = 164.80, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001; \u003cem\u003eχ\u0026sup2;\u003c/em\u003e = 140.99, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). Details regarding the expert authority across the two rounds are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eStatistics Regarding Expert Authority.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eContent\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCs\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCa\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCr\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eKendall\u0026rsquo;s W\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eχ\u0026sup2;\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRound 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.888\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.863\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.875\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.146\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e164.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt; 0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRound 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.975\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.919\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.947\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.304\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e140.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt; 0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eFinal Indicator System\u003c/h2\u003e \u003cp\u003eDuring the two rounds of expert consultation, 17 suggestions for revision were made. Following the first round, one primary indicator \u0026ldquo;stoma care needs\u0026rdquo; was removed. The items \u0026ldquo;alleviating patients\u0026rsquo; negative emotions (anxiety, fear, depression)\u0026rdquo; and \u0026ldquo;enhancing patients\u0026rsquo; positive emotions (confidence, optimism)\u0026rdquo; were reclassified into the \u0026ldquo;socioemotional support needs\u0026rdquo; socioemotional support needs domai\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003en\u003c/span\u003e. The domain was expanded to include \u0026ldquo;emotional and financial support for primary caregivers.\u0026rdquo; Moreover, the \u0026ldquo;online platform function needs\u0026rdquo; domain was augmented with two new items: \u0026ldquo;incorporating science popularization via platforms such as TikTok or Kuaishou\u0026rdquo; and \u0026ldquo;establishing WeChat/QQ communication groups for primary caregivers\u0026rdquo;.\u003c/p\u003e \u003cp\u003eIn the second round, two tertiary indicators, \u0026ldquo;exercise methods suitable for enterostomy patients\u0026rdquo; and \u0026ldquo;seasonal differences in winter/summer stoma care\u0026rdquo;, were removed. Conversely, two new tertiary indicators were added: \u0026ldquo;home emergency management of stoma bleeding\u0026rdquo; and \u0026ldquo;home emergency management of stoma prolapse\u0026rdquo; and stoma prolapse. Additionally, the item \u0026ldquo;sexual life precautions for enterostomy patients\u0026rdquo; was merged into the secondary indicator \u0026ldquo;daily life guidance\u0026rdquo;. The final indicator system includes three primary indicators, eight secondary indicators, and 32 tertiary indicators. The importance scores, coefficients of variation, and weights of all the indicators are presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eHome Care Needs Indicator System for Enterostomy Caregivers.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndicator\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eImportance\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCV\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWeight\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Healthcare needs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.94\u0026thinsp;\u0026plusmn;\u0026thinsp;0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.350\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.1 Ostomy care knowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.97\u0026thinsp;\u0026plusmn;\u0026thinsp;0.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.280\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.1.1 Stoma assessment: colour, height, shape, output volume, etc.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e4.98\u0026thinsp;\u0026plusmn;\u0026thinsp;0.12\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.02\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.120\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.1.2 Stoma bag replacement procedure and precautions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e4.95\u0026thinsp;\u0026plusmn;\u0026thinsp;0.18\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.04\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.115\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.1.3 Timing and frequency of stoma bag replacement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.94\u0026thinsp;\u0026plusmn;\u0026thinsp;0.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.110\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.1.4 How to choose the appropriate stoma bag\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.91\u0026thinsp;\u0026plusmn;\u0026thinsp;0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.105\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.1.5 Selection of stoma accessories (e.g., skin powder, protective film, adhesive paste, etc.), and information on purchasing channels\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.89\u0026thinsp;\u0026plusmn;\u0026thinsp;0.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.1.6 Identification of stoma and peristomal skin complications (e.g., bleeding, oedema, hernia, prolapse, etc.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.88\u0026thinsp;\u0026plusmn;\u0026thinsp;0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.095\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.2 Dietary guidance knowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.93\u0026thinsp;\u0026plusmn;\u0026thinsp;0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.265\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.2.1 Foods that may cause diarrhoea in stoma patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.89\u0026thinsp;\u0026plusmn;\u0026thinsp;0.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.085\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.2.2 Foods that may cause constipation in stoma patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.85\u0026thinsp;\u0026plusmn;\u0026thinsp;0.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.090\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.2.3 Foods that may cause flatulence in stoma patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.82\u0026thinsp;\u0026plusmn;\u0026thinsp;0.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.085\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.3 Daily life guidance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.88\u0026thinsp;\u0026plusmn;\u0026thinsp;0.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.220\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.3.1 Clothing precautions for stoma patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.82\u0026thinsp;\u0026plusmn;\u0026thinsp;0.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.075\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.3.2 Bathing and hygiene precautions for stoma patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.80\u0026thinsp;\u0026plusmn;\u0026thinsp;0.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.080\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.3.3 Travel precautions for stoma patients (e.g., air travel)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.78\u0026thinsp;\u0026plusmn;\u0026thinsp;0.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.075\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.3.4 Sleeping precautions for stoma patients (e.g., sleeping position, presleep care)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.070\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.3.5 Daily activities and exercise guidance for stoma patients (e.g., hiking, climbing)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.73\u0026thinsp;\u0026plusmn;\u0026thinsp;0.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.065\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.3.6 Sexual life precautions for enterostomy patients (e.g., positions, special stoma bag use)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.70\u0026thinsp;\u0026plusmn;\u0026thinsp;0.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.060\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.4 Emergency management guidance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.85\u0026thinsp;\u0026plusmn;\u0026thinsp;0.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.160\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.4.1 Emergency management of stoma bag leakage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.78\u0026thinsp;\u0026plusmn;\u0026thinsp;0.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.070\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.4.2 Information on stoma clinic hours and hospital contact details\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.68\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.055\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.4.3 Home emergency management of stoma bleeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.65\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.050\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.4.4 Home emergency management of stoma prolapse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.63\u0026thinsp;\u0026plusmn;\u0026thinsp;0.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.045\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.\u0026nbsp;Socioemotional support needs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.91\u0026thinsp;\u0026plusmn;\u0026thinsp;0.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.348\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.1 Emotional support for patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.89\u0026thinsp;\u0026plusmn;\u0026thinsp;0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.200\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.1.1 Alleviating patients\u0026rsquo; negative emotions (anxiety, fear, depression)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.85\u0026thinsp;\u0026plusmn;\u0026thinsp;0.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.090\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.1.2 Enhancing patients\u0026rsquo; positive emotions (confidence, optimism)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.60\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.040\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.2 Family and social support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.78\u0026thinsp;\u0026plusmn;\u0026thinsp;0.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.180\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.2.1 Emotional and financial support for primary caregivers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.73\u0026thinsp;\u0026plusmn;\u0026thinsp;0.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.065\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.2.2 Support and assistance from other family caregivers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.58\u0026thinsp;\u0026plusmn;\u0026thinsp;0.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.035\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.2.3 Support from community and nongovernmental organizations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.55\u0026thinsp;\u0026plusmn;\u0026thinsp;0.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.030\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.2.4 Peer education and home visits from fellow stoma patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.2.5 Inclusion of internet nursing home services and stoma products in medical insurance coverage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.020\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. Online platform functional needs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.83\u0026thinsp;\u0026plusmn;\u0026thinsp;0.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.302\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.1 Online consultation guidance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.150\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.1.1 Online consultation with nurses at home\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.68\u0026thinsp;\u0026plusmn;\u0026thinsp;0.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.055\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.1.2 Establishment of personal electronic health records\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.48\u0026thinsp;\u0026plusmn;\u0026thinsp;0.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.1.3\u0026nbsp;Sharing of electronic health records and educational materials with medical institutions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.1.4 Development of stoma prevention and rehabilitation knowledge modules\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.43\u0026thinsp;\u0026plusmn;\u0026thinsp;0.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.2 Access to health information\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.69\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.130\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.2.1 Incorporating science popularization via platforms such as TikTok or Kuaishou\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.40\u0026thinsp;\u0026plusmn;\u0026thinsp;0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.2.2 Establishing WeChat/QQ communication groups for primary caregivers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.38\u0026thinsp;\u0026plusmn;\u0026thinsp;0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eAbbreviations: CV\u0026thinsp;=\u0026thinsp;coefficient of variation.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003e This study presents the design and development of a structured, comprehensive home care needs assessment framework for informal caregivers of enterostomy patients, grounded in the \u0026ldquo;internet\u0026thinsp;+\u0026thinsp;nursing\u0026rdquo; service model. This framework is intended to support healthcare teams and digital platform developers in China to address the identified gaps in supportive care for this caregiver population. This study highlights the feasibility and significance of integrating Orem\u0026rsquo;s self-care deficit theory and a socioecological perspective into systematic needs evaluation. The identification of three primary dimensions\u0026mdash;healthcare needs, socioemotional support needs, and online platform functional needs\u0026mdash;reflects a holistic approach to assessing caregivers\u0026rsquo; requirements. The highest priority accorded to healthcare needs (weight: 0.350) is consistent with global healthcare trends that emphasize patient-centered, skill-based, and supportive care. The structured weighting system established a clear hierarchical framework to guide targeted caregiver training, digital platform optimization, and psychosocial intervention strategies.\u003c/p\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eScientific Rigor\u003c/h2\u003e \u003cp\u003eThis study successfully developed a home care needs indicator system for informal caregivers of enterostomy patients under the \u0026ldquo;internet\u0026thinsp;+\u0026thinsp;nursing\u0026rdquo; service model on the basis of a two-round Delphi method. The expert consultation process was characterized by high levels of engagement and authority. The expert response rates were 94.12% and 100.00%, respectively, across the two rounds, and the expert authority coefficients (Cr) were 0.875 and 0.947 (both \u0026gt;\u0026thinsp;0.7), indicating reliable and credible expert input. Additionally, Kendall's W values of 0.146 and 0.304 (Round 2) were statistically significant (both \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and all the coefficients of variation (CV) were below 0.25. These results indicate strong expert consensus underscoring the scientific rigor and reliability of the developed indicator system.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eSignificance of the Indicator System\u003c/h2\u003e \u003cp\u003eThe establishment of this indicator system is timely, particularly given China's aging population and the country\u0026rsquo;s shift towards nuclear family structures, which have weakened traditional caregiving capabilities. These changes have exacerbated the challenges associated with providing effective home care to patients with enterostomies. The high priority assigned by experts to the \u0026ldquo;healthcare needs\u0026rdquo; domain (weight: 0.350) aligns with global research, such as the study by Mohamed et al.[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], which identified complication management as the foremost concern for caregivers, thus highlighting the universal criticality of core clinical skills for safe home-based care.\u003c/p\u003e \u003cp\u003eWhile the \u0026ldquo;internet\u0026thinsp;+\u0026thinsp;nursing services\u0026rdquo; model has made initial progress in enterostomy care, its functional design and service offerings remain inadequate to the task of addressing the diverse needs of informal caregivers[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Informal caregivers play a critical role in enterostomy care; however, their training and psychological support needs are often overlooked. Our finding that the \u0026ldquo;socioemotional support needs\u0026rdquo; domain received significant weighting strongly echoes Kirkland-Kyhn et al. \u0026rsquo;s work [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], which emphasized the profound emotional burden experienced by these caregivers. This study fills this gap by moving beyond the mere identification of such needs to provide a scientifically validated, standardized framework that systematically integrates psychosocial needs with operational and platform functional demands. This comprehensive approach addresses a recognized gap in studies that have often focused predominantly on clinical outcomes, as noted by Mohamed et al [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn line with the National Health Commission\u0026rsquo;s National Nursing Development Plan (2021\u0026ndash;2025), which emphasizes the expansion of the \u0026ldquo;internet\u0026thinsp;+\u0026thinsp;nursing services\u0026rdquo; to meet diverse health demands[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], the indicator system supports systematic training for informal caregivers through innovative tools such as online courses, video tutorials, and virtual reality (VR) simulations. The integration of psychological counselling and online support groups into platforms could also alleviate caregivers\u0026rsquo; emotional burdens. Thus, the system not only addresses current care gaps but also aligns with national health policies; thus, it has significant practical and policy implications.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eRationality of the Indicator Analysis and Weight Determination\u003c/h2\u003e \u003cp\u003eAHP was used to determine indicator weights at all levels, yielding a clear priority structure that complements the consensus findings reported earlier. The results revealed that the primary indicator \u0026ldquo;healthcare needs\u0026rdquo; had the highest weight (0.350), highlighting the priority of direct medical care for patients with stoma. Within this domain, the secondary indicator \u0026ldquo;ostomy care knowledge\u0026rdquo; (weight: 0.280) was identified as a core component, thus emphasizing the need for caregivers to master essential care skills. Tertiary indicators such as \u0026ldquo;stoma assessment\u0026rdquo; and \u0026ldquo;stoma bag replacement procedures\u0026rdquo; received high importance scores with low CVs, thereby reflecting strong expert consensus concerning their significance.\u003c/p\u003e \u003cp\u003eAlthough the overall consensus across most indicators reinforces the reliability of the framework, the observed divergence in expert opinions on certain items, signaled by higher CV values, offers equally meaningful insights. This divergence does not diminish the validity of the system but rather enriches our understanding of the tensions inherent in translating structured needs into practical interventions. A notable example is the lack of agreement on the use of platforms such as TikTok and Kuaishou for science popularization (CV: 0.18). This disagreement stems from the tension between information accessibility and perceived authority in digital health communications. Some experts see short-video platforms as vital for reaching broad populations with limited health literacy, whereas others are concerned about potential compromises in information reliability and professional tone in healthcare contexts. This contrast highlights an ongoing debate in digital health strategy between outreach and credibility, and directly shapes how the \u0026ldquo;online platform functional needs\u0026rdquo; dimension of our system could be operationalized in different settings.\u003c/p\u003e \u003cp\u003eSimilarly, the divergence observed for indicators related to health insurance coverage reflects the ongoing challenges associated with China\u0026rsquo;s healthcare policy reforms. Experts\u0026rsquo; differing perspectives on this topic may be influenced by their firsthand experiences with regional disparities in insurance reimbursement policies and the practical difficulties associated with integrating new services, such as those provided under the \u0026ldquo;internet\u0026thinsp;+\u0026thinsp;nursing\u0026rdquo; model, into existing payment schemes. This highlights the intricate link between developing effective caregiver support tools and the broader need for conducive health policies and financing environments.\u003c/p\u003e \u003cp\u003eFinally, the lower weight assigned to the \u0026ldquo;online platform functional needs\u0026rdquo; (0.302) may reflect the current supplementary role of digital tools in home care. Although these tools provide valuable support, their integration into care practices is still evolving and their full potential remains unrealized.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eRelevance to Clinical Practice\u003c/h2\u003e \u003cp\u003eThis validated indicator system offers direct guidance for clinical practice based on its prioritized structure. Weighted indicators support three key applications in enterostomy care. First, the quantified weights enabled the stratification of informal caregiver training. Core clinical skills, including stoma assessment, complication recognition, and pouch management, should form essential training modules, whereas psychoemotional support should represent an advanced training component. Second, it strategically guides the development of digital health platforms. High-priority indicators require integrated core features such as stoma assessment tools, procedural video libraries, and emergency guidance systems, and psychological support services must be integrated into the platform architecture. Furthermore, this framework served as a structured clinical assessment tool. Healthcare providers can systematically identify informal caregivers\u0026rsquo; knowledge gaps and unmet needs during follow-up visits, thereby facilitating the development of personalized interventions beyond standardized education.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis study had several limitations. First, despite rigorous expert consultation, the process was confined to a specific cultural and regional context, which potentially limits the generalizability of the findings. Future studies should include a more diverse panel of experts to validate the system in different settings. Second, although expert opinions are authoritative, they may not fully capture the perspectives of informal caregivers and patients. The integration of feedback provided by these groups in future research could enhance the relevance and applicability of the system.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn this study, a scientifically rigorous, reliable indicator system for the home care needs of informal caregivers of enterostomy patients was developed on the basis of the \u0026ldquo;internet\u0026thinsp;+\u0026thinsp;nursing services\u0026rdquo; model. The system highlights the priorities of direct medical care, while addressing the psychological and social needs of caregivers. These findings align with national health policies and provide a foundation for efforts to optimize digital health platforms to enhance home care quality. Future research should prioritize refining the system, particularly in domains characterized by high expert divergence, and exploring innovative approaches to integrate digital tools into care practices. Accordingly, this indicator system can serve as a valuable resource for efforts to improve the care provided to enterostomy patients and to support their caregivers.\u003c/p\u003e"},{"header":"Declarations","content":" \u003cp\u003e \u003cstrong\u003e \u003cb\u003eEthics Approval\u003c/b\u003e \u003c/strong\u003e \u003cp\u003e This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the Fifth Affiliated Hospital, Sun Yat-sen University (2023-L008-1).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCompeting Interests\u003c/strong\u003e \u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent to participate\u003c/strong\u003e \u003cp\u003e Informed consent was obtained from all individual participants included in the study.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis study was supported by the Social Development Program of the Zhuhai Science and Technology Bureau (Grant No. 2320004000239). The funders had no role in the study design, collection, analysis, interpretation of data, writing of the report, or decision to submit the article for publication.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eSiqing Li and Liping Zhong: Conceptualisation, formal analysis, drafting-original version. Xiaofang Guan: Formal analysis, data curation, methodology. Cuilian Luo: Investigation, data curation. Yuxia Liu: Project management, supervision, coping editing. Wenxin Luo: Conceptualisation, revision of the draft, funding acquisition. All authors approved the content of the manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBray F et al (2024) Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA-CANCER J 74(3):229\u0026ndash;263. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3322/caac.21834\u003c/span\u003e\u003cspan address=\"10.3322/caac.21834\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHan B et al (2024) Cancer incidence and mortality in China, 2022. 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JOURNAL OF NURSING SCIENCE 35(22):52\u0026ndash;56. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/CNKI:SUN:HLXZ\u003c/span\u003e\u003cspan address=\"https://doi.org/CNKI:SUN:HLXZ\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.0.2020-22-016 [In Chinese].\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Enterostomy, Informal caregivers, Home care, Demand indicators, Delphi method","lastPublishedDoi":"10.21203/rs.3.rs-8509555/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8509555/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eTo establish a home care framework for assessing Chinese informal enterostomy caregivers\u0026rsquo; demand on the basis of the \u0026ldquo;internet\u0026thinsp;+\u0026thinsp;nursing\u0026rdquo; model, providing an evidence-based foundation for efforts to optimize home care platforms and enhancing service quality.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe two-round Delphi method was used in this study. Initial indicators were identified based on a systematic literature review and semi-structured interviews with ten Chinese informal caregivers. Sixteen experts participated in two rounds of Delphi consultations, conducted between May and June 2024. The analytic hierarchy process (AHP) was subsequently used to determine indicator weights.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe expert response rate was 94.1% in the first round and 100% in the second round. The authority coefficients were 0.88 and 0.95, respectively. Kendall\u0026rsquo;s W values ranged from 0.146 to 0.304 (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), thus reflecting a consensus on a final set of 3 primary indicators: \u0026ldquo;healthcare needs,\u0026rdquo; \u0026ldquo;socioemotional support needs,\u0026rdquo; \u0026ldquo;online platform functional needs\u0026rdquo;, 8 secondary, and 32 tertiary indicators.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThis validated indicator system provides a structured framework for efforts to develop \u0026ldquo;internet\u0026thinsp;+\u0026thinsp;nursing\u0026rdquo; platforms and address the identified gaps in caregiver training and psychosocial support, with broad applicability.\u003c/p\u003e","manuscriptTitle":"Development of home care demand indicators for Chinese informal enterostomy caregivers according to the “internet + nursing” model: A Delphi study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-17 13:57:41","doi":"10.21203/rs.3.rs-8509555/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-02-11T19:14:15+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-11T19:12:14+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-20T23:21:27+00:00","index":"","fulltext":""},{"type":"submitted","content":"Supportive Care in Cancer","date":"2026-01-04T01:46:12+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"b9b50fa2-0a4e-421c-b528-d57d61854495","owner":[],"postedDate":"February 17th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-17T13:57:41+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-17 13:57:41","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8509555","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8509555","identity":"rs-8509555","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}