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Background: Having a colostomy is a difficult time for the patient since he/she undergoes physical, psychological, and social changes that result in the modification of body self-image. Purpose and framework: this study aims to identify adaptation strategies for colostomates who experience self-image problems after a month of surgery, using the Roy Adaptation Model. Methods: a descriptive quantitative study was carried out with a sample of seventy colostomy patients in the surgery department at Farhat Hached and Sahloul Hospital in Sousse, Tunisia. To collect data, a self-completed questionnaire (OAI-23) was used after being re-written in Arabic. The descriptive statistics and the combined and multivariate regressions were used to analyze the data. Results: our study shows that 85.7% of the participants always feel sick, and that fifty-seven of them (81.4 %) cannot get over the shock of having a stoma, with 82.9% still feeling angry. Discussion: the results are discussed using the reference frame, then recommendations are formulated, followed by some limits. Conclusion: the improvement of the adaptation process of colostomized patients should be an ongoing concern of all stakeholders.