While our review suggests that many educational interventions are efficacious in improving bowel preparation prior to colonoscopy, it also highlights important methodological concerns. Several studies had limited external validity (i.e., generalizability). For example, the study by Liu, et al, of telephone re-education before colonoscopy was conducted in China, where roughly 2/5 of the sample had only completed elementary school [36]. Because illiteracy increases the risk of inadequate bowel preparation, this intervention may be less effective in more educated populations [47]. Prakash, et al, examined the use of an online instructional video but reported 100% adherence in the treatment group (it is unclear if this is per-protocol or intention-to-treat analysis) [33], which is unrealistic in practice. Others have reported very low rates of adherence for online instructional videos (6%) [41] and smart phone applications for bowel preparation (10%) [48], again raising questions about external validity of the study by Prakash, et al. (NB: Reference 48 did not meet inclusion criteria for this review.) More research is needed to examine whether the results of the interventions reviewed here can be replicated in other diverse settings before they can be broadly recommended.
How to learn colonoscopy Philip Smart
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