Comment on ‘Validity and Reliability of the Stoma Self‐Efficacy Scale in Patients With Intestinal Stoma: A Descriptive, Cross‐Sectional and Validation Study’

We read with great interest the study by Machálková et al. (2025) that examined the psychometric performance of the Czech version of the Stoma Self-Efficacy Scale in adults living with an intestinal stoma. The authors contributed meaningful data to an area where culturally adapted assessment tools remain limited. In this context, several methodological and clinical considerations warrant further discussion to support the optimal interpretation and translation of the findings into practice. The authors applied a descriptive, cross-sectional approach to linguistic adaptation and psychometric testing, which offers a clear snapshot of scale behaviours in a broad outpatient population. Nevertheless, the interpretive framework would benefit from a closer alignment between the conceptual boundaries of self-efficacy and the realities of long-term stoma management. The recruitment strategy, centred on individuals living with a stoma for more than 1 year, inherently favours those with established routines and stable health status. This limits the interpretation of self-efficacy as a construct that evolves during postoperative recovery, psychosocial adjustment and complication management. As self-efficacy heavily influences preparedness for discharge and early adaptation, the absence of perioperative participants restricts clinical generalizability in a domain where early intervention often determines trajectories of confidence and independence. In this sense, conclusions regarding the scale's utility across the full continuum of care should be tempered by the sampling framework (Villa et al. 2025). The factor analysis is thorough and yields a three-factor structure that departs from the original two-factor model. Although statistically defensible, the clinical interpretation of this expanded structure requires caution. The third component, labelled burden self-efficacy, aggregates items involving sexuality and physically demanding activities. Grouping these constructs together risks obscuring clinically distinct domains that often require tailored counselling strategies. Moreover, low average variance extracted values indicate limited shared variance within factors, which complicates the interpretation of factor coherence in practice. The authors reported a stronger confirmatory model fit among respondents with colostomies than among those with ileostomies. This discrepancy has clinical implications: ileostomy management involves more variable effluent consistency, higher output volumes and greater risk of dehydration, all of which shape day-to-day confidence. Therefore, an inferior model fit raises questions about whether the instrument fully captures the lived challenges specific to ileostomy care (Price et al. 2024). The removal of Item 13 (‘perform light housework’) on statistical grounds achieved a cleaner factor solution, yet the conceptual relevance of this item deserves scrutiny. Home-based functional activity frequently reflects patients' broader adaptation to bodily change, stamina fluctuations and symptom-related limitations. Excluding such items may inadvertently narrow the scale's sensitivity to practical domains that influence perceived autonomy. Additionally, the study reports moderately strong associations between stoma acceptance, economic status and self-efficacy. These findings underscore that clinical interpretation of scores requires contextual awareness of socioeconomic support, access to specialised supplies and the quality of nurse-led counselling. In the Czech clinical environment where stoma clinics are well integrated, self-efficacy scores may reflect structural supports not uniformly present across healthcare systems and therefore may not extrapolate without consideration of service organisation (Feng and Gu 2025). The findings support the use of the Czech SSES in ambulatory assessments, particularly for identifying patients who experience psychosocial or practical constraints in daily stoma management. However, clinicians should interpret subscale scores within each patient's clinical narrative, especially for older individuals who show reduced confidence in intimate or strenuous situations. The differentiation between colostomy and ileostomy respondents further suggests that the same score may have different clinical implications depending on the stoma type. Integrating the SSES into shared decision-making, for example, during the planning of appliance changes, dietary adjustments, or sexual health counselling requires awareness of these nuances. Longitudinal application would also allow clinicians to track changes following postoperative education, complications, or shifts in social support, offering a more dynamic understanding of patient needs than cross-sectional scoring alone. In conclusion, the authors provide a valuable linguistic and psychometric contribution, and the Czech SSES represents a promising tool for the structured assessment of stoma-related self-efficacy. Continued research incorporating perioperative patients, longitudinal designs and stoma-specific contextual variables will strengthen its clinical interpretability and enhance its integration into personalised nursing care. J.J. contributed to the conceptualization of the commentary, guided the scholarly direction and drafted the initial version of the manuscript. S.R.M. contributed to the methodological evaluation of the study, provided analytical interpretation and assisted in refining the manuscript through critical revisions. S.S. contributed to the clinical contextualization of the commentary, offering insights into therapeutic relevance and strengthening the interpretive framework. J.J. led the final synthesis of the manuscript, ensured coherence across sections and completed the editorial review, serving as the corresponding author. All authors read and approved the final version before submission. Generative AI tools (ChatGPT-5 and Paperpal) were used solely for linguistic refinement and formatting. All conceptual, analytical and interpretive content was independently developed by the authors. The authors have nothing to report. The authors have nothing to report. The authors declare no conflicts of interest. The authors have nothing to report.