Influencing factors and individualized intervention strategies for inadequate bowel preparation before colonoscopy in high-risk populations: a review based on the clinical practice of painless colonoscopy in China

Inadequate bowel preparation (IBP) significantly reduces the diagnostic accuracy of painless colonoscopy and increases complication risks. High-risk populations account for 28% of painless colonoscopy cases in China, with IBP rates ranging from 42% to 62%, but targeted nursing interventions remain underdeveloped. To systematically analyze IBP-related influencing factors and evaluate the effectiveness of individualized nursing interventions for high-risk populations undergoing painless colonoscopy in China. Literature searches were conducted across the MEDLINE (via the PubMed interface, Cochrane Library, Embase, CNKI, Wanfang Data, and VIP from January 2020 to April 2024 using keywords related to bowel preparation, high-risk populations, and nursing intervention. Studies on Chinese high-risk populations undergoing painless colonoscopy were eligible if they reported IBP rate, bowel preparation score, or intervention adherence. RCTs, systematic reviews, and clinical guidelines were included. Two reviewers independently screened records, extracted data, and assessed methodological quality using the Cochrane Risk of Bias Tool, JBI Critical Appraisal Checklist, and AGREE II Instrument. Data synthesis involved descriptive analysis and random-effects meta-analysis. A total of 43 studies (32 RCTs, 7 systematic reviews, 4 guidelines) were included. Six high-risk populations were identified: obese patients (BMI ≥ 28 kg/m²), patients with abdominal/pelvic surgery history, neurological disease patients, long-term medication users, children, and diabetic patients. Key influencing factors included gastrointestinal motility disorders, psychological anxiety, and medication interactions. Individualized interventions (e.g., dose-adjusted laxatives, nurse-led psychological counseling) reduced IBP rates by 23%–48% (pooled OR = 0.36, 95%CI:0.29–0.45, I²=45%). IBP in high-risk populations is driven by multi-dimensional factors. Context-adapted nursing interventions (e.g., WeChat-guided education, parental participation training) significantly improve preparation quality. Standardized protocols for primary hospitals and child-specific regimens are urgently needed. These findings translate into a risk-stratified, nurse-pharmacist-led preparation pathway that can be implemented immediately—especially in primary hospitals—to reduce IBP and improve safety. And these findings pertain to six high-risk populations—obese, post-surgical, neurological disease, long-term medication users, children, and diabetics—as predefined in the Introduction.