Patient Education Through Mobile Messaging Improves Bowel Preparation for Colonoscopy 

Researchers explored the efficacy of nurse-led, reinforced education regarding bowel preparation delivered via WhatsApp Messenger on patients undergoing colonoscopy.

Patients receiving nurse-led, WhatsApp Reinforced Education (WRE) prior to colonoscopy for colorectal cancer (CRC) screening demonstrated significantly improved bowel preparation adequacy rates compared with patients receiving No Reinforced Education (NRE), according to study findings published in the International Journal of Nursing Studies.

Researchers conducted a randomized controlled trial in Hong Kong, China, from July 2017 to April 2019, in which 685 eligible patients undergoing colonoscopies for CRC screening following positive immunochemical tests, were divided into 2 groups — one receiving WRE (n=343)  and the other receiving NRE (n=342). Nine patients in each group did not undergo the scheduled colonoscopies.

WRE included text and video formatted messages providing bowel preparation education by trained nurses 4 days prior to colonoscopy, while NRE included standard-of-care treatment.

Patients receiving WRE demonstrated significantly improved bowel preparation adequacy rates according to intention-to-treat (ITT) and per-protocol (PP) analyses using the Aronchik Scale (ITT: 83.4% vs. 75.4%; P =.010 and PP: 85.6% vs. 77.5%; P =.007) and the Boston Bowel Preparation Scale (ITT: 94.2% vs. 88.9%; P =.013 and PP: 96.7% vs. 91.3%; P =.003).

While the WRE cohort had a higher detection rate of adenomas than the NRE group, it was not statistically significant (71.4% vs. 67.5%; P =.27). Nurse-led reinforced education did not impact mean intubation time (P =.503); mean withdrawal time (P =.958); cecal intubation rate (P =.505); incomplete colonoscopies secondary to incomplete bowel preparation (P =1.000); technical difficulties or strictures (P =.451); or mean number of detected adenomas (P =.934).

In addition to lack of reinforced education (adjusted odds ratio [aOR], 0.564; 95% CI, 0.371-0.856; P=.007), the researchers observed higher risk for inadequate bowel preparation among male patients (64% increase; aOR, 1.638; 95% CI, 1.054-2.546; P =.028) and patients with diabetes (2-fold increase; aOR, 2.062; 95% CI, 1.215-3.497; P =.007).

Study limitations included lack of assessment of patient behavior following reinforced education, lack of identification of factors influencing patient behavior, and the understanding that not all patients have access to or are technologically savvy enough to use mobile messengers such as WhatsApp.

“Nurse-led reinforced education delivered via mobile messenger can improve pre- and post-irrigation bowel preparation quality in colonoscopy following positive fecal immunochemical test in an organized population-based colorectal cancer screening program,” the authors stated. “Future studies are required to develop proper intervention to improve adequacy rate of patients at risk [for] inadequate bowel preparation and investigate the relationship between adenoma detection rate and reinforced education.”


Lam TYT, Wu PI, Tang RSY, et al. Nurse-led reinforced education by mobile messenger improves the quality of bowel preparation of colonoscopy in a population-based colorectal cancer screening program: A randomized controlled trial. Int J Nurs Stud. Published online May 30, 2022. doi:10.1016/j.ijnurstu.2022.104301