Volume 25, Issue 2
  • ISSN 0142-5471
  • E-ISSN: 1569-979X
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Colorectal cancer is one of the most commonly occurring cancers in the world, and colonoscopy is the most sensitive procedure to detect it. Colonoscopy success depends on the quality of bowel preparation, yet the way information is designed and communicated to patients does not meet their needs. By considering how information is conveyed through three different outputs (booklet, motion graphics and app), this study investigates the advantages of using visualised information when communicating bowel preparation instructions for colonoscopy screening. A user-centered multiple-methods approach was followed and results show how user performance benefits from the use of information visualisation. A set of guidelines is given to inform the development of bowel preparation instructions and other similar health related communications.


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  1. Cancer Research UK.
    Cancer Research UK. (2014) Bowel cancer survival statistics. [Online]. Retrieved fromhttps://www.cancer-researchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/bowel-cancer#heading-Two
  2. Cohen, L. B.
    (2014) Maximizing bowel preparation for colonoscopy: The patient component. Gastroenterology & Endoscopy News, April: 16–17.
    [Google Scholar]
  3. Harewood, G. C., Sharma, V. K., & de Garmo, P.
    (2003) Impact of colonoscopy preparation quality on detection of suspected colonic neoplasia. Gastrointest Endosc, 58(1), 76–79. doi:  10.1067/mge.2003.294
    https://doi.org/10.1067/mge.2003.294 [Google Scholar]
  4. Haute Autorité de Santé
    Haute Autorité de Santé (2008) How to produce an information brochure for patients and users of the healthcare system[Online]. Retrieved fromhttps://www.has-sante.fr/jcms/c_430286/en/how-to-produce-an-information-brochure-for-patients-and-healthcare-system-users
  5. Heynsbergh, N., Heckel, L., Botti, M., Chul, S., & Livingston, P. M.
    (2019) Development of a smartphone app for informal carers of people with cancer: Processes and learnings. JMIR Form Res, 3(2). doi:  10.2196/10990
    https://doi.org/10.2196/10990 [Google Scholar]
  6. Höffler, T. N., & Leutner, D.
    (2007) Instructional animation versus static pictures: A meta-analysis. Learning and Instruction, 17(6), 722–738. doi:  10.1016/j.learninstruc.2007.09.013
    https://doi.org/10.1016/j.learninstruc.2007.09.013 [Google Scholar]
  7. Honka, A., Kaipainen, K., Hietala, H., & Saranummi, N.
    (2011) Rethinking health: ICT-enabled services to empower people to manage their health. IEEE Rev Biomed Eng, 4, 119–139. doi:  10.1109/RBME.2011.2174217
    https://doi.org/10.1109/RBME.2011.2174217 [Google Scholar]
  8. Houts, P. S., Doak, C. C., Doak, L. G., & Loscalzo, M. J.
    (2006) The role of pictures in improving health communication: A review of research on attention, comprehension, recall, and adherence. Patient Educ Couns, 61(2), 173–190. doi:  10.1016/j.pec.2005.05.004
    https://doi.org/10.1016/j.pec.2005.05.004 [Google Scholar]
  9. Johnson, D. A., Barkun, A. N., Cohen, L. B., Dominitz, J. A., Kaltenbach, T., Martel, M., … Rex, D. K.
    (2014) Optimizing adequacy of bowel cleansing for colonoscopy: Recommendations from the U.S. multi-society task force on colorectal cancer. Gastrointest Endosc, 80(4), 543–562. doi:  10.1016/j.gie.2014.08.002
    https://doi.org/10.1016/j.gie.2014.08.002 [Google Scholar]
  10. Leaper, M., Johnston, M. J., Barclay, M., Dobbs, B. R., & Frizelle, F. A.
    (2004) Reasons for failure to diagnose colorectal carcinoma at colonoscopy. Endoscopy, 36(6), 499–503. doi:  10.1055/s‑2004‑814399
    https://doi.org/10.1055/s-2004-814399 [Google Scholar]
  11. Lonsdale, M. dos S.
    (2007) Does typographic design of examination materials affect performance?Information Design Journal, 15(2), 114–139. doi:  10.1075/idj.15.2.04lon
    https://doi.org/10.1075/idj.15.2.04lon [Google Scholar]
  12. (2014) The effect of text layout on performance: A comparison between types of question that require different reading processes. Information Design Journal, 21(3), 279–299. doi:  10.1075/idj.21.3.09san
    https://doi.org/10.1075/idj.21.3.09san [Google Scholar]
  13. (2016) The typographic features of text and how they contribute to the legibility of academic reading materials: An empirical study. Visible Language, 50(1), 79–111.
    [Google Scholar]
  14. Lonsdale, M. dos S., Dyson, M. C., & Reynolds, L.
    (2006) Reading in examination-type situations: The effects of text layout on performance. Journal of Research in Reading, 29(4), 433–453. doi:  10.1111/j.1467‑9817.2006.00317.x
    https://doi.org/10.1111/j.1467-9817.2006.00317.x [Google Scholar]
  15. McLachlan, S. A., Clements, A., Austoker, J.
    (2012) Patients – experiences and reported barriers to colonoscopy in the screening context: A systematic review of the literature. Patient Educ Couns, 86(2), 137–146. doi:  10.1016/j.pec.2011.04.010
    https://doi.org/10.1016/j.pec.2011.04.010 [Google Scholar]
  16. MDedge
    MDedge (2013) DDW13: App helps patients prepare for colonoscopy[Online]. Retrieved fromhttps://www.youtube.com/watch?v=oRApCs7mrDE
  17. Moran, K.
    (2016) Using the Microsoft desirability toolkit to test visual appeal[Online]. Retrieved fromhttps://www.nngroup.com/articles/microsoft-desirability-toolkit/
  18. nhs.uk.
    nhs.uk. (2018) Bowel cancer[Online]. Retrieved fromhttps://www.nhs.uk/conditions/bowel-cancer/
  19. Pak, R., & McLaughlin, A.
    (2011) Designing displays for older adults. London: Taylor & Francis (CRC Press).
    [Google Scholar]
  20. Parker, D.
    (1992) Human responses to colonoscopy. Society of Gastroenterologists Nurses and Associates, December, 107–109. 10.1097/00001610‑199212000‑00005
    https://doi.org/10.1097/00001610-199212000-00005 [Google Scholar]
  21. Patrick, K., Griswold, W. G., Raab, F., & Intille, S. S.
    (2008) Health and the mobile phone. American Journal of Preventive Medicine, 35(2), 177–181. doi:  10.1016/j.amepre.2008.05.001
    https://doi.org/10.1016/j.amepre.2008.05.001 [Google Scholar]
  22. Petterson, R.
    (2015) Information design 5: Cognition. Tullinge: Institute for Infology.
    [Google Scholar]
  23. Rex, D. K., Petrini, J. L., Baron, T. H., Chak, A., Cohen, J., Deal, S. E., … Pike, I. M.
    (2006) Quality indicators for colonoscopy. Gastrointest Endosc, 63(4), S16–S28. doi:  10.1016/j.gie.2006.02.021
    https://doi.org/10.1016/j.gie.2006.02.021 [Google Scholar]
  24. Ristvedt, S. L., McFarland, E. G., Weinstock, L. B., & Thyssen, E. P.
    (2003) Patient preferences for CT colonography, conventional colonoscopy, and bowel preparation. Am J Gastroenterol, 98(3), 578–585. doi:  10.1111/j.1572‑0241.2003.07302.x
    https://doi.org/10.1111/j.1572-0241.2003.07302.x [Google Scholar]
  25. Robertson, D. J., Greenberg, E. R., Beach, M., Sandler, R. S., Ahnen, D., Haile, R. W., … Baron, J. A.
    (2005) Colorectal cancer in patients under close colonoscopic surveillance. Gastroenterology, 129(1), 34–41. doi:  10.1053/j.gastro.2005.05.012
    https://doi.org/10.1053/j.gastro.2005.05.012 [Google Scholar]
  26. Romero, R. V., & Mahadeva, S.
    (2013) Factors influencing quality of bowel preparation for colonoscopy. World J Gastrointest Endosc, 5(2), 39–46. doi:  10.4253/wjge.v5.i2.39
    https://doi.org/10.4253/wjge.v5.i2.39 [Google Scholar]
  27. Rosenfeld, G., Krygier, D., Enns, R. A., Singham, J., Wiesinger, H., & Bressler, B.
    (2010) The impact of patient education on the quality of inpatient bowel preparation for colonoscopy. Can J Gastroenterol, 24(9), 543–546. doi:  10.1155/2010/718628
    https://doi.org/10.1155/2010/718628 [Google Scholar]
  28. Sidhu, S., Geraghty, J., Karpha, I., Wark, L., Logan, C., & Sarkar, S.
    (2011) Outcomes following an initial unsuccessful colonoscopy: A 5-year complete audit of teaching hospital colonoscopy practice. Presented at2011 British Society of Gastroenterology Annual General Meeting; March 14–17, 2011; Birmingham, United Kingdom. 10.1136/gut.2011.239301.423
    https://doi.org/10.1136/gut.2011.239301.423 [Google Scholar]
  29. Smith, S. G., von Wagner, C., McGregor, L. M., Curtis, L. M., Wilson, E. A., Serper, M., & Wolf, M. S.
    (2012) The Influence of health literacy on comprehension of a colonoscopy preparation information leaflet. Dis Colon Rectum, 55(10), 1074–1080. doi:  10.1097/DCR.0b013e31826359ac
    https://doi.org/10.1097/DCR.0b013e31826359ac [Google Scholar]
  30. Spiegel, B. M., Talley, J., Shekelle, P., Agarwal, N., Snyder, B., Bolus, R., … Cohen, H.
    (2011) Development and validation of a novel patient educational booklet to enhance colonoscopy preparation. Am J Gastroenterol, 106(5), 875–883. doi:  10.1038/ajg.2011.75
    https://doi.org/10.1038/ajg.2011.75 [Google Scholar]
  31. Strizver, I.
    (2014) Type rules! The designer’s guide to professional typography (4th ed.). New York: John Wiley and Sons Inc.
    [Google Scholar]
  32. Tae, J. W., Lee, J. C., Hong, S. J., Han, J. P., Lee, Y. H., Chung, J. H., …Lee, M. S.
    (2012) Impact of patient education with cartoon visual aids on the quality of bowel preparation for colonoscopy. Gastrointest Endosc, 76(4), 804–811. doi:  10.1016/j.gie.2012.05.026
    https://doi.org/10.1016/j.gie.2012.05.026 [Google Scholar]
  33. Tractinsky, N., Katz, A. S., Ikar, D.
    (2000) What is beautiful is usable. Interacting with Computers, 13(2), 127–145. doi:  10.1016/S0953‑5438(00)00031‑X
    https://doi.org/10.1016/S0953-5438(00)00031-X [Google Scholar]
  34. Um, E. R., Plass, J. L., Hayward, E. O., & Homer, B. D.
    (2012) Emotional design in multimedia learning. Journal of Educational Psychology, 104(2), 485–498. doi: 10.1037/a0026609.
    https://doi.org/10.1037/a0026609. [Google Scholar]
  35. Voiosu, A., Tanţău, A., Garbulet, C., Tanţău, M., Mateescu, B., Băicuş, C., … Voiosu, T.
    (2013) Factors affecting colonoscopy comfort and compliance: A questionnaire based multicenter study. Romanian Journal of Internal Medicine, 52(3), 151–157.
    [Google Scholar]
  36. Wiana, W., Barliana, M., & Riyanto, A.
    (2018) The effectiveness of using interactive multimedia based on motion graphic in concept mastering enhancement and fashion designing skill in digital format. International Journal of Emerging Technologies in Learning, 13(2), 4–20. 10.3991/ijet.v13i02.7830
    https://doi.org/10.3991/ijet.v13i02.7830 [Google Scholar]
  37. Wolf, M. S., Curtis, L. M., Waite, K., Bailey, S. C., Hedlund, L. A., Davis, T. C., … Wood, A. J. J.
    (2011) Helping patients simplify and safely use complex prescription regimens. Arch Intern Med, 171(4), 300–305. doi:  10.1001/archinternmed.2011.39
    https://doi.org/10.1001/archinternmed.2011.39 [Google Scholar]
  38. Wolfson, S., & Case, G.
    (2000) The effects of sound and color on responses to a computer game. Interacting with Computers, 13(2), 183–192. doi:  10.1016/S0953‑5438(00)00037‑0
    https://doi.org/10.1016/S0953-5438(00)00037-0 [Google Scholar]
  39. World Cancer Research Fund
    World Cancer Research Fund (2019) Colorectal cancer statistics. Colorectal cancer is the third most common cancer worldwide[Online]. Retrieved fromhttps://www.wcrf.org/dietandcancer/cancer-trends/colorectal-cancer-statistics

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