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Enhancing bowel preparation quality and tolerability in a low health literacy population in Western China: a multicenter randomized trial

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Abstract

Background and aims

Insufficient bowel preparation (BP) presents substantial challenges to the effectiveness of outpatient colonoscopy for colorectal cancer screening, particularly within populations characterized by low health literacy and poor adherence.

Methods

We conducted a prospective, randomized, blinded, endoscopic controlled study involving 474 colonoscopy outpatients aged 18–80 years hailing from a low health literacy population with convenient access to WeChat. These patients were subsequently randomized into three groups: the control group, WeChat group, and the automatic reminder group (ARG). All people were administered 3 L of polyethylene glycol. The Boston Bowel Preparation Scale (BBPS) score of 6 or a segmental score of 2 was used as the primary outcome to evaluate BP quality. Secondary outcomes included polyp detection rate (PDR) and adverse events, etc.

Results

Our findings revealed that both the WeChat group (n = 158) and ARG (n = 158) exhibited significantly higher rates of adequate BP compared to the control group (n = 158) (WeChat vs. control, 79.1% vs. 61.4%; ARG vs. control, 74.7% vs. 61.4%; p < 0.001). Furthermore, these educationally reinforced groups displayed improved BP compliance (p < 0.05). According to the Hospital Anxiety and Depression Scale (HADS), patients in the reinforced education groups exhibited lower overall anxiety levels (p = 0.001) and experienced fewer adverse reactions (p = 0.019). Compared to the control group, the PDR in the right hemi-colon was significantly greater in the WeChat group (11.4%) (2.5%), and a similar trend was observed in the ARG (7.6%). Additionally, individuals in the WeChat group reported higher levels of satisfaction with their colonoscopy experience (p = 0.043). In a multivariate analysis, adjusting for potential confounding factors, WeChat-based re-education ([OR] 1.496, 95% CI 1.154–1.939; p = 0.002)) emerged as a protective factor for achieving adequate BP.

Conclusion

Enhanced education through WeChat can improve BP quality, and ARG applies equally to low health literacy populations.

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Data declaration

Data for this study can be obtained by contacting corresponding authors (Xiaojun-Huang, email: Huangxj@lzu.edu.cn).

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Funding

The research was funded by the special fund project for the doctoral training program of Lanzhou University Second Hospital (Item Number: PR5124007) and the Cuiying Scientific and Technology Innovation Program of “Lanzhou University Second Hospital” (Item Number: 2020QN-12).

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Authors and Affiliations

  1. Department of Gastroenterology, Lanzhou University Second Hospital, No. 82 Cuiying Men, Cheng Guan District, Lanzhou, 730030, Gansu Province, China

    Xiaxia Zhao, Lihong Yang, Xiaoyu Hu, Guixiang Kong & Xiaojun Huang

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  1. Xiaxia Zhao
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  2. Lihong Yang
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  4. Guixiang Kong
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Contributions

XZ participated in the design of the article and the writing of the entire article. XH participated in the design of the article and the implementation of the protocol. XH participated in the data collection. LY and GK revised the manuscript.

Corresponding author

Correspondence to Xiaojun Huang.

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All authors declare no conflicts of interest, and data and graphs are original and agreed to be published in this journal. The authors alone are responsible for the content and writing of the paper.

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The study protocol was registered with Clinical Trials.gov on 04/06/2022 (registration number: ChiCTR2200060518), and written informed consent was obtained from all enrolled patients.

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Zhao, X., Yang, L., Hu, X. et al. Enhancing bowel preparation quality and tolerability in a low health literacy population in Western China: a multicenter randomized trial. J Cancer Res Clin Oncol 149, 17957–17971 (2023). https://doi.org/10.1007/s00432-023-05493-5

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