Self-Efficacy, Surgical Fear and Psychological Well-Being in Abdominal Surgery

Abdominal surgery is associated with considerable psychological stress before the operation. Patients frequently experience fear related to anesthesia, postoperative pain, surgical complications, uncertainty regarding recovery, and changes in daily functioning. Elevated levels of surgical fear have been associated with poorer psychological outcomes and may negatively affect perioperative adaptation.

Psychological well-being reflects an individual's positive psychological functioning and ability to maintain emotional balance during stressful life events. However, not all patients experiencing surgical fear demonstrate the same level of psychological well-being, suggesting that personal characteristics may influence this relationship.

Bandura's Social Cognitive Theory provides a theoretical framework for understanding these individual differences. According to the theory, self-efficacy refers to an individual's belief in their capability to successfully perform behaviors required to manage challenging situations. Patients with higher self-efficacy are expected to perceive surgical stress as more manageable, use more effective coping strategies, and maintain better psychological well-being despite experiencing surgical fear.

Although previous studies have separately investigated surgical fear, self-efficacy, and psychological well-being, evidence regarding the moderating role of self-efficacy in the relationship between surgical fear and psychological well-being among patients undergoing abdominal surgery is limited.

This single-center analytical cross-sectional study will be conducted in the General Surgery Clinic of Aydın Adnan Menderes University Research and Application Hospital. Adult patients scheduled for abdominal surgery will be recruited consecutively before surgery. Data will be collected using a Patient Information Form, the Surgical Fear Questionnaire, the Psychological Well-Being Scale, and the Self-Efficacy Scale.

The primary objective of the study is to determine whether self-efficacy moderates the relationship between surgical fear and psychological well-being. The results are expected to contribute to theory-based nursing care by improving the identification of patients at risk for poor psychological adaptation and supporting the development of individualized psychosocial interventions.

Primary outcomes

• Psychological Well-Being [Preoperative assessment (within 24 hours before surgery)]: The scale consists of a single sub-dimension and 8 items. The items are Likert-type, ranging from 1 (Strongly disagree) to 7 (Strongly agree). The lowest possible score is 8 and the highest is 56. Higher scores on the scale are interpreted as an increase in psychological well-being.

Secondary outcomes

• Surgical Fear [Preoperative assessment (within 24 hours before surgery)]: The Surgical Fear Scale will be used for assessment. The scale consists of 8 items and is an 11-point Likert-type scale, scored from 0 to 10. Each item is scored from 0, meaning "not afraid at all," to 10, meaning "very afraid." The scale measures fear of the short-term and long-term outcomes of surgery. The minimum possible score is 0, and the maximum is 40. A higher score indicates a high level of surgical fear.
• Self-Efficacy [Preoperative assessment (within 24 hours before surgery)]: The Self-Efficacy Scale consists of 23 items on a 5-point Likert scale. It is used to measure general self-efficacy perception, not specific to any particular area. It has four sub-dimensions: initiating behavior, maintaining behavior, completing behavior, and overcoming obstacles. The minimum possible score on the scale is 23, and the maximum is 115. A higher score indicates a higher perception of self-efficacy.

Sex: All, ages: 18 Years to any

Inclusion Criteria:

* Adults aged 18 years or older
* Scheduled to undergo elective abdominal surgery
* Able to read, speak, and understand Turkish
* Conscious and able to complete the questionnaires
* Willing to participate and provide informed consent

Exclusion Criteria:

* Diagnosis of dementia
* Visual or hearing impairment preventing questionnaire completion
* Undergoing abdominal surgery due to cancer
* Refusal or withdrawal of participation at any stage of the study