Web-Assisted Interactive Nurse Program in Mastectomy Patients: A Mixed Method Study

Study Overview
=================
Brief Summary
-----------------
This study is planned to examine the levels of bodily value, care dependence and psychosocial cohesion-self-notification of patients in the Web Assisted Interactive Nursing Program (WDIHP) designed according to the Self Regulation Model. The mixed method is a research. One of the mixed research methods, the discovery sequenced design, will be used. The research will continue with the quantitative part, starting with the qualitative part. The quantitative part of the research is a randomized controlled experimental trial.

Detailed Description
-----------------
Complications after surgery are common in patients who undergo mastectomies, as in every surgery. Mastectomy patients need to protect the wound area and the arm on the side where a mastectomy is performed following surgery. The process of wound healing and return to the patient's daily life in the post-surgery process parallels. In the early post-operative period, patients have difficulty carrying out daily living activities and need support, while in the late-term they are able to perform daily living activities more independently from caregivers and nurses. Objective: This research was planned to examine the body value of mastectomy patients, care dependence and psychosocial adaptation-self-knowledge levels of the Web Assisted Interactive Nursing Program (WDIHP) designed according to the Self-Regulation Model. Method: The research is designed as a mixed-method study of qualitative-quantitative research methods, designed according to the Self-Regulation Model, to examine the effect of WDHP on adaptation to social life, self-efficacy, and body value in patients undergoing breast cancer surgery. This study will use exploratory hybrid methods from mixed research methods. Qualitative interviews will be held face-to-face. Interviews with participants will continue until data saturation is achieved. In the qualitative part of the research, the in-depth interview method will be selected and the Semi-Structured Interview Form will be used as a data collection tool. All interviews will be recorded in digital format, returned to writing and then transferred to qualitative analysis software MAXQDA. The quantitative part of the study will be carried out as a randomized controlled trial using the block randomization method. Randomization will be done by a statistician other than the researcher. Power analysis was calculated using G * Power 3.1.9.7 program. With 0.95 effect size, 95% power and 0.05 significance level, the required sample size was determined as 30 individuals per group, and 60 individuals in total. It was decided to include 67 individuals, 35 individuals in the intervention group and 31 individuals in the control group, by taking 15% more of the calculated sample against the possibility of sample loss during the study. The correct perceptions that may arise as a result of qualitative work will be supported in the relevant sections of the training. In the quantitative section of the research, the interactive web-assisted nurse program will take 1 week and the application will take 3 weeks. A text message will be sent to individuals to their phone to remind them to use the website. Messages will be sent twice a week, a total of 8 times. It will be used as Care Dependency, Body value, psychosocial Compliance to disease, website usability Scale measurement tools. After each assessment, the data obtained will be transferred to the Social Sciences Software Statistical Package (SPSS).

Official Title
-----------------
Effect Of Web - Supported Interactıve Nursıng Program After Mastectomy On Body Value, Care Dependence And Psychosocıal Adaptatıon To Dısease-Self-Awareness Levels Accordıng To Self-Regulatıon Model: Mıxed Method Study

Conditions
-----------------
Web Based Intervention, Mastectomy, Illness Perception, Nursing Caries

Intervention / Treatment
-----------------
* Behavioral: Web-assisted patient education intervention designed according to the self-regulation model
* Behavioral: The website where the mastectomy patients handbook


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Patients aged 18-75 who do not have communication problems, Patients who have undergone mastectomy for the first time, Patients who know their diagnosis, Patients with basic computer literacy, Patients with computer or internet access. Patients who agree to participate in the study will be included. Exclusion Criteria: Patients with hearing, vision and understanding problems, Patients with metastases Patients with breast cyst excision, Patients with arm or shoulder limitation, Patients with breast reconstruction will not be included in the study.

Ages Eligible for Study
-----------------
Minimum Age: 18 Years
Maximum Age: 75 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Experimental: Interventional group<br>The web-supported interactive nursing program intervention will take 3 weeks. The first week of the training will begin with the patient's admission to the clinic. Shoulder and Arm Exercises, Lymphedema in the Arm and Prevention of Its Development, and qualitative study, the themes of misperception determined in this area will be emphasized. In the second week, they will be asked to continue their Shoulder and Arm Exercises training, to examine the Other Side Breast Examination Training and Adaptation Process to Life Activities, Skin Care and Post-Surgery Cancer Treatment and Breast Reconstruction. In the last week of the training, it will be requested to review the contents again. Correct perceptions that may emerge as a result of the qualitative study will be supported in the relevant parts of the training. During the study, short mobile phone messages containing reminders and motivations will be sent regularly twice a week (8 times). | Behavioral: Web-assisted patient education intervention designed according to the self-regulation model<br>* Implementation of patient education with the website created about care and compliance needs in mastectomy patients obtained as a result of qualitative research.<br>|
| Active Comparator: Behavioral:<br>The handbook developed within the scope of the Women's Return to Social Life After Mastectomy Project on the website of the Continuing Education, Research and Solidarity Association will be used on the website of the participants assigned to the control group. | Behavioral: The website where the mastectomy patients handbook<br>* The site where the patient booklet is available as pdf<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Body Appreciation Scale | It was developed in order to evaluate the extent to which individuals have positive thoughts about their own bodies and whether they respect these thoughts. Body Value Scale-2 is a 5-point Likert type measurement tool and consists of 10 items.There is no reverse item in the Body Value Scale and a minimum of 10 and a maximum of 50 points can be obtained from the scale. A total score is obtained by summing the scores of the items in the scale. A low score from the scale indicates that individuals have negative body values, while high scores indicate positive body values. | Before application | 
| Care Dependency Scale | The care dependency scale is a scale consisting of a total of 17 items, including activities of daily living, and graded with 5-point Likert-type scoring. Grading 1 = completely dependent, 5 = immediately, immediately / completely independent. The lowest score to be taken from the scale is 17 and the highest score is 85. A high scale score indicates that the patient is independent in meeting his/her self-care needs, while a low scale score indicates that patients are dependent on others to meet their care needs. | Before application | 
| Psychosocial Adjustment to Illness-Self-Report Scale | It measures the interaction of individuals with other individuals and institutions that make up the sociocultural environment. The scale consists of 46 items. The questions in the scale are divided into 7 areas of psychosocial adjustment to the disease. In the scale, four descriptive expressions were used to determine the varying levels of agreement for each question. The subject can choose the answer that best describes his or her personal experience. The items in the scale are given scores ranging from 0 to 3, and the answers are converted into numerical values. For each item in the scale, mostly negative changes since the disease are evaluated with 3 points, no change or positive changes are evaluated with 0 points. Low scores on the PAIS-SR scale indicate good psychosocial adjustment to the disease, and high scores indicate poor psychosocial adjustment to the disease. In the PAIS-SR, scores below 35 indicate good psychosocial adjustment, scores between 35 and 51 indicate | Before application | 
| Body Appreciation Scale | It was developed in order to evaluate the extent to which individuals have positive thoughts about their own bodies and whether they respect these thoughts. Body Value Scale-2 is a 5-point Likert type measurement tool and consists of 10 items.There isno reverse item in the Body Value Scale and a minimum of 10 and a maximum of 50 points can be obtained from the scale. A total score is obtained by summing the scores of the items in the scale. A low score from the scale indicates that individuals have negative body values, while high scores indicate positive body values. | Immediately after application (1st week) | 
| Care Dependency Scale | The care dependency scale is a scale consisting of a total of 17 items, including activities of daily living, and graded with 5-point Likert-type scoring. Grading 1 = completely dependent, 5 = immediately, immediately / completely independent. The lowest score to be taken from the scale is 17 and the highest score is 85. A high scale score indicates that the patient is independent in meeting his/her self-care needs, while a low scale score indicates that patients are dependent on others to meet their care needs. | Immediately after application (1st week) | 
| Psychosocial Adjustment to Illness-Self-Report Scale | It measures the interaction of individuals with other individuals and institutions that make up the sociocultural environment. | Immediately after application (1st week) | 
| Body Appreciation Scale | It was developed in order to evaluate the extent to which individuals have positive thoughts about their own bodies and whether they respect these thoughts. Body Value Scale-2 is a 5-point Likert type measurement tool and consists of 10 items. There is no reverse item in the Body Value Scale and a minimum of 10 and a maximum of 50 points can be obtained from the scale. A total score is obtained by summing the scores of the items in the scale. A low score from the scale indicates that individuals have negative body values, while high scores indicate positive body values. | Immediately after application (3st week) | 
| Care Dependency Scale | The care dependency scale is a scale consisting of a total of 17 items, including activities of daily living, and graded with 5-point Likert-type scoring. Grading 1 = completely dependent, 5 = immediately, immediately / completely independent. The lowest score to be taken from the scale is 17 and the highest score is 85. A high scale score indicates that the patient is independent in meeting his/her self-care needs, while a low scale score indicates that patients are dependent on others to meet their care needs. | Immediately after application (3st week) | 
| Psychosocial Adjustment to Illness-Self-Report Scale | It measures the interaction of individuals with other individuals and institutions that make up the sociocultural environment. | Immediately after application (3st week) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Website Usability Scale | The scale consists of a total of 25 questions with four sub-dimensions (ease of navigation = 10 questions, design = 7 questions, ease of access = 4 questions, ease of use = 4 questions). The answers to the items of the scale are collected with a Likert-type five-point rating scale. The scale consists of Strongly agree (5), Agree (4), Undecided (3), Disagree (2) and Strongly disagree (1). 21 of the items in the scale are positive and 4 of them are negative items. The lowest score to be taken from the scale is 25 and the highest score is 125. | Immediately after application | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Mastectomy, body value, adaptation to illness, care addiction