High cancellation rates and suboptimal bowel preparation increase patient discomfort, drive economic waste, and compromise clinical outcomes. Despite guideline emphasis on adequate preparation quality, there is no standard on how or when instructions should be delivered. This study compares three common patient education modalities-usual care verbal counseling, written tri-lingual pamphlet, and visual media via smartphone QR code-to determine which yields the best bowel preparation quality as assessed by the Boston Bowel Preparation Scale (BBPS) in an outpatient endoscopy setting.
Age 18 years or older
Outpatients scheduled for elective colonoscopy at Hospital Sibu Endoscopy Unit
Ability to provide written informed consent
Access to smartphone or computer with functional internet connectivity
History of non-compliance with prescribed medical regimens
Cognitive impairment, dementia, or significant mental health disorder compromising informed consent
Illiteracy or inability to read materials in provided languages
Prior colonic resection or colostomy
Parallel
Verbal Counseling
BehavioralStandard verbal instructions delivered by physician or nurse regarding bowel preparation regimen, timing, dietary restrictions, and what to expect during procedure.
Tri-lingual Educational Pamphlet
BehavioralStructured written educational material in Malay, English, and Chinese languages detailing complete bowel preparation instructions, timing, dietary guidance, what to expect, and troubleshooting tips. Provided to participant with brief verbal explanation.
QR-Linked Instructional Videos
BehavioralShort, professionally produced instructional videos accessible via smartphone QR code link. Videos present step-by-step bowel preparation instructions, timing, dietary guidance, common concerns, and what to expect during procedure. Participant scans QR code to access video(s) on their smartphone.
Adequate Bowel Preparation on Boston Bowel Preparation Scale (BBPS)
Primary outcome dichotomized as adequate versus inadequate bowel preparation. Adequate = total BBPS score ≥6 with all three colon segments (left, transverse, right) scoring ≥2 each (scale 0-3 per segment; range 0-9). Inadequate = total \<6 or any segment \<2. Assessment performed before any bowel cleansing/lavage.
Polyp Detection Rate
Proportion of participants with at least one polyp detected during colonoscopy. Documented as yes/no and number of polyps.
Cecal Intubation Time
Time in minutes from colonoscope insertion to identification of cecal landmarks.
Colonoscopy Withdrawal Time
Time in minutes from initiation of scope withdrawal to scope exit at rectum, excluding biopsy/therapeutic time.
Procedure Cancellation Rate
Proportion of participants whose colonoscopy was cancelled and reason for cancellation.
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