The Role of Family Care on the Quality of Life of Patients With Permanent Enterostomies: A Chain‐Mediated Effect of Inner Strength and Patient Activation

BACKGROUND: Permanent enterostomy significantly affects patients' lives, making their postoperative quality of life (QoL) a critical concern in clinical practice. Understanding the psychosocial mechanisms that improve QoL is essential for developing effective interventions. OBJECTIVE: Grounded in the conservation of resources (COR) theory, this study aimed to investigate the mechanism through which family care influences the QoL of patients with permanent enterostomies, specifically by testing the chain-mediating roles of inner strength (as a psychological resource) and patient activation (as a behavioural resource). METHODS: A cross-sectional survey was conducted among 315 patients with permanent enterostomies from a tertiary hospital. Data were collected using a general information questionnaire, the Family APGAR Index, the Inner Strength Scale (ISS), the Patient Activation Measure (PAM), and the Stoma Quality of Life Scale (Stoma-QoL). The hypothesized chain mediation model was examined using SPSS PROCESS Macro (Model 6), controlling for key demographic variables. RESULTS: Family care was significantly positively correlated with inner strength, patient activation, and QoL (all p < 0.01). Inner strength and patient activation were also significantly correlated with each other and with QoL (all p < 0.01). The chain mediation analysis revealed that family care not only directly predicted QoL but also exerted its influence through three significant indirect pathways: the independent mediation of inner strength, the independent mediation of patient activation, and the chain mediation from inner strength to patient activation. The total indirect effect was significant. CONCLUSION: Family care, as an external resource, may enhance QoL by fostering patients' inner strength, which in turn promotes proactive health behaviours. These findings support a "resource-psychology-behaviour" transformation pathway. They highlight the potential importance of moving beyond purely physiological care. To optimize long-term outcomes, healthcare professionals could consider developing interventions that integrate family support, psychological empowerment, and behavioural skills training.