Impact of patient education with cartoon visual aids on the quality of bowel preparation for colonoscopy

Gastrointest Endosc. 2012 Oct;76(4):804-11. doi: 10.1016/j.gie.2012.05.026. Epub 2012 Jul 27.


Background: High-quality bowel preparation is a prerequisite for colonoscopy. Few studies have evaluated visual aids as a means of improving the quality of bowel preparation.

Objective: To assess the effect of patient education by using cartoon visual aids on the quality of bowel preparation.

Design: An endoscopist-blinded, randomized, controlled trial.

Setting: Tertiary referral center.

Subjects: Patients scheduled for screening colonoscopy in a health examination center.

Interventions: Patients were assigned to receive the existing verbal and written instructions (group A) or a new cartoon visual educational instruction (group B) for colonoscopy.

Main outcome measurements: The primary endpoint was the quality of bowel preparation, assessed by using the Boston Bowel Preparation Scale (BBPS). Secondary endpoints were the quality of bowel preparation assessed by using the Universal Preparation Assessment Scale; insertion, withdrawal, and workup times; and polyp detection rates in the 2 groups. Logistic regression analysis was performed to determine the factors associated with poor bowel preparation according to a BBPS score less than 5.

Results: Group B exhibited better bowel preparation than group A according to BBPS scores (mean BBPS score, 6.12 ± 2.19 vs 7.44 ± 1.87, P ≤ .01; median BBPS score, 6.00 ± 0.00 vs 9.00 ± 0.00, P ≤ .01; good bowel preparation for colonoscopy, BBPS score ≥5, 81.6% vs 93.1%, P = .02). Multivariate analysis revealed that older age (odds ratio 1.07, P ≤ .01) and no use of visual aids (odds ratio 3.08, P = .02) were independent factors associated with poor bowel preparation.

Limitations: Single-center study.

Conclusions: Patient education with cartoons effectively improved bowel preparation for colonoscopy.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Audiovisual Aids*
  • Cartoons as Topic*
  • Cathartics / administration & dosage*
  • Colonoscopy*
  • Female
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Patient Compliance*
  • Patient Education as Topic / methods*
  • Polyethylene Glycols / administration & dosage*
  • Prospective Studies
  • Single-Blind Method


  • Cathartics
  • Polyethylene Glycols