Govert Veldhuijzen

86 Chapter 5 INTRODUCTION Colonoscopy is the gold standard to detect and remove precancerous colonic lesions, such as adenomas. Colonoscopy, performed under proper conditions, reduces cancer morbidity and mortality. 1 Optimal bowel preparation is a key prerequisite to achieve high adenoma detection rate. Inappropriately cleaned colons result in suboptimal detection of relevant lesions and lead to repeated colonoscopies and shorter surveillance intervals. 2,3 There are a number of patient related factors associated with poorly prepared colons such as acceptance of the volume of bowel preparation, inability in following instructions, reduced awareness of health behaviour and health illiteracy. 4,5 Several strategies have been used to improve the bowel preparation through optimizing patient education. This can be achieved by use of simple instruction tools. 6 Efforts that involve direct patient contact such as patient navigators or nurses with face-to-face counselling are the most effective. 7 This is also paramount for increasing adherence to colonoscopy screening programs. 8 Face to face patient counselling is resource-rich and time consuming. The high demand for colonoscopy services, as a result of colorectal screening programs, have surged an interest for more efficient strategies with less personnel while maintaining quality. There is evidence to suggest that eHealth interventions are effective in improving information transfer to patients. 9 Internet based education offers a number of advantages: it visualizes information in a comprehensible format, it is consistent and accessible at any desired moment, and provides the option to remind patients in a timely fashion. 6 We have developed a website based platform consisting of 3D animations, video and voiceover text to inform patients on colonoscopy procedure and preparations needed. 10 This programme mimics the patient journey from pre-colonoscopy consultation in the outpatient clinic to discharge after the procedure. A single center observational study compared this platform to nurse counselling. Patients who followed this programme had adequate bowel preparation. 11 Subsequent efforts helped to evolve this programme into an interactive computer based education (CBE). The main improvement consist of the addition of two-way communication to make home-based use feasible, with substitution of all elements of nurse counselling. 12 The effects of home-based CBE performs in terms of quality of bowel preparation or number of repeated procedures because of inadequately prepared colons are unknown. We hypothesize that CBE as modality for patient education is equally effective to nurse counselling for optimal bowel preparation. We report here on our multicenter