Adequate bowel preparation of patients undergoing screening colonoscopy : Does educational status matter? A retrospective data analysis.

Background: In order to achieve a high-quality screening colonoscopy, a high-quality bowel preparation is essential. To perform an adequate bowel cleansing patients need to understand and act on medical information, also known as health literacy. This study aimed to analyze the relationship between the patients' educational status as a proxy for health literacy and adequate bowel preparation.

Methods: A retrospective analysis of data collected within the Austrian national colorectal cancer screening program from 2012 to 2022 was conducted. The database contains information on the quality of bowel preparation as well as the academic degree of the patients. Variables were used to perform a logistic regression analysis, with bowel preparation quality (based on the Aronchick scale) as the dependent variable and completed tertiary education as independent variable, and sex and age as control variables.

Results: A total of 329,778 patients aged 30-99 years were included in the analysis. Within the group of academics, 88.46% (n = 21,883) were adequately prepared whereas in the group of non-academics, 84.79% (n = 258,641) were found to have a high bowel preparation quality. The odds ratio (OR) for academics to have an adequate bowel preparation quality was 1.37 (95% confidence interval, CI 1.32-1.43; p < 0.001).

Conclusion: Patients with a tertiary education showed better bowel preparation quality than non-academics in Austria. Therefore, it is important to improve strategies on how to inform also less educated persons to facilitate a better screening colonoscopy quality and to optimize the use of resources from a clinical as well as a public health perspective.