Colonoscopy is essential for the early detection of colorectal cancer. However, inadequate bowel preparation remains a common challenge, associated with reduced adenoma detection rates, prolonged procedure time, and increased healthcare costs. Current individualized regimens rely largely on higher laxative dosages-an approach with limited clinical utility. Non-pharmacological interventions, including dietary modification, physical activity, and health education, are safe and tend to have better patient adherence. The effectiveness of health education depends largely on message framing. Guided by information-framing theory, we developed an individualized non-pharmacological regimen. This randomized controlled trial aims to evaluate the efficacy of this regimen in improving bowel preparation quality.
age ≥ 18 years;
outpatient scheduled for colonoscopy using oral laxatives for bowel preparation;
able to understand the study and provide written informed consent.
undergoing emergency colonoscopy;
suspected intestinal obstruction, stricture, or perforation;
severe cardiac, cerebral, hepatic, or renal disease;
severe psychiatric disorder;
Parallel
Individualized bowel preparation regimen
Other interventionPatients receive verbal instructions and printed illustrated bowel preparation educational material. Patients with a risk score ≥ 3.25 are instructed to take low-residue diet 3 days before colonoscopy and walk for 30 minutes after each meal, with a target of approximately 6,000 steps per day. After consuming each 500 mL of polyethylene glycol electrolyte solution, and finishing the entire solution, patients are asked to chew one piece of sugar-free gum for 10 minutes. Patients with a score \< 3.25 received the standard bowel preparation regimen.
Information-framing guidance
Other interventionFor those with an inadequate bowel preparation risk score ≥ 3.25, negatively-framed materials emphasizing the harms of non-adherence are provided; for those with a score \< 3.25, positively-framed materials emphasizing the benefits of adherence are provided.
Standard bowel preparation guidance
Other interventionPatients receive verbal bowel preparation instruction and printed text-based bowel preparation education materials.
Bowel preparation quality
Bowel preparation quality is assessed using the Boston Bowel Preparation Scale (BBPS). Bowel preparation was considered adequate when the total BBPS score was ≥ 6, with each colonic segment score ≥ 2.
Incidence of bowel preparation-related adverse events
Incidence of nausea, vomiting, abdominal distension, abdominal pain
Polyp/adenoma detection rate
Compliance of bowel preparation
Compliance of bowel preparation is assessed by Bowel Preparation Adherence Behavior Assessment Scale. The Bowel Preparation Adherence Behavior Assessment Scale has a total score ranging from 12 to 60, with higher scores indicating better adherence.
Willingness to undergo colonoscopy again (yes/no)
Patients are asked whether they are willing to undergo a repeat colonoscopy.
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