Does a Non-English-Speaking Background Affect the Quality of Bowel Preparation for Colonoscopy?

Background Bowel preparation quality is critical for colonoscopy diagnostic yield. Whether a non-English-speaking background (NESB) adversely affects preparation quality in Australia is unknown. We aimed to determine whether NESB status is associated with inadequate bowel preparation compared to English-speaking background (ESB) patients, and to identify other clinical predictors. Methods A retrospective audit of consecutive patients undergoing elective colonoscopy at the Northern Hospital, Epping, Victoria (September-November 2017). NESB was defined as a primary language other than English. Preparation quality was assessed using the Aronchick scale, dichotomised as adequate (excellent/good/fair) or inadequate. Multivariable logistic regression was performed to identify independent predictors of inadequate preparation. Results  Of 1,385 patients, 1,129 (81.5%) were ESB and 256 (18.5%) NESB. Professional interpreters were used by 73.0% of NESB patients. Inadequate preparation occurred in 8.9% of ESB and 6.2% of NESB patients; no significant difference was found on univariable (p=0.16) or age-adjusted multivariable analysis (adjusted odds ratio (OR) 0.73, 95% confidence interval (CI) 0.42-1.27; p=0.26). No factor reached statistical significance at the 5% level, although extended bowel preparation (adjusted OR 1.83, p=0.06), morning-list colonoscopy (adjusted OR 1.45, p=0.06), Moviprep (adjusted OR 1.47, p=0.09) and age (adjusted OR 0.88 per 10-year increment, in the direction of lower rather than higher risk with increasing age; p=0.06) approached it; male sex was not associated with inadequate preparation (adjusted OR 1.27, p=0.23). Conclusions We found no evidence of an association between NESB status and inadequate bowel preparation at a culturally diverse Australian institution, although the confidence interval remains compatible with both a modest protective and a modest harmful association. High utilisation of professional interpreter services may mitigate language barriers in preparation adherence. In contrast to previous reports, male sex, extended preparation and morning-list timing were not statistically significant independent predictors of inadequate preparation in this cohort, although extended preparation and morning-list timing showed trends consistent with the published literature that this study was underpowered to resolve.