title: Patient factors that affect quality of colonoscopy preparation.
abstract: OBJECTIVE
  Optimal colonoscopy preparation requires patients to adhere to written instructions and be activated to complete the task. Among patients with chronic disease, health literacy and patient activation have been associated with outcome, but these factors have not been studied for colonoscopy. We examined the association between health literacy, patient activation, and quality of bowel preparation.
  
  
  METHODS
  We analyzed outpatient colonoscopy results from 462 adults, 55-74 years old (mean, 62 ± 6 years), who previously completed extensive neurocognitive assessments as part of a prospective study (Health Literacy and Cognitive Function in Older Adults). We collected information on cecal intubation, polyp detection, bowel preparation quality, and histopathology.
  
  
  RESULTS
  One-third of the patients (n = 134) had suboptimal quality of bowel preparation; 15% (n = 62) had fair quality, and 17% (n = 72) had poor quality. Limited health literacy was associated with a lower level of education (P < .001), diabetes (P < .001), and a higher number of chronic conditions (P < .001), but not quality of colonoscopy preparation. No baseline characteristics were associated with patient activation. In multivariable analysis, after adjusting for demographics and clinical characteristics, diabetes (odds ratio [OR], 2.45; 95% confidence interval [CI], 1.14-5.25) and patient activation (OR, 2.12; 95% CI, 1.30-3.45) were independent predictors of suboptimal bowel preparation quality, but limited health literacy was not (OR, 0.76; 95% CI, 0.38-1.52).
  
  
  CONCLUSIONS
  We investigated the relationship between health literacy, patient activation, and colonoscopy preparation quality. Lower patient activation was an independent predictor of suboptimal bowel preparation quality. Interventions to improve colonoscopy preparation quality should consider the importance of patient activation within their design.
authors: Health Literacy and Learning Program, Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois. Electronic address: mserper@gmail.com.
authors: Marina
authors: M
authors: Serper
authors: Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors: Andrew J
authors: AJ
authors: Gawron
authors: Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, United Kingdom.
authors: Samuel G
authors: SG
authors: Smith
authors: Health Literacy and Learning Program, Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors: Anjali A
authors: AA
authors: Pandit
authors: Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors: Allison R
authors: AR
authors: Dahlke
authors: Health Literacy and Learning Program, Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors: Elizabeth A
authors: EA
authors: Bojarski
authors: Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors: Rajesh N
authors: RN
authors: Keswani
authors: Health Literacy and Learning Program, Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Learning Sciences, School of Education and Social Policy, Northwestern University, Evanston, Illinois.
authors: Michael S
authors: MS
authors: Wolf
mesh_terms: D000368:Aged; D003113:Colonoscopy / Q000379:methods*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D016903:Drug Monitoring
keywords: Endoscopy; LitCog; Predictors; Procedure
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