Multidimensional Characteristics and Needs of Intestinal Preparation Prior to Colonoscopy in middle-aged and older adults with diabetes : a qualitative user persona study

Before a doctor can look inside the colon to check for cancer or other problems, the patient must clear out the bowel completely. This process, known as bowel preparation, involves drinking large amounts of a special liquid and following a strict diet. For most people, this is difficult but manageable. However, for adults with diabetes, the task becomes a complex balancing act. They must follow the cleaning instructions while simultaneously managing their blood sugar levels, which can drop dangerously low if they eat less or take their usual medication. If the preparation is not done correctly, the doctor might miss a problem, or the patient could face serious health risks like fainting or dehydration.

For years, medical teams have tried to help these patients by giving everyone the same set of instructions. The assumption was that if the information was clear, everyone would follow it. Yet, many patients still struggle, and their experiences vary wildly. Some follow every rule perfectly, while others ignore parts of the plan because they feel they know better, or because they simply cannot understand the complex steps. This gap between a standard instruction sheet and the reality of a patient's life is what a new study from Qinghai University in China set out to understand. Instead of asking why patients failed, the researchers asked who these patients are, how they think, and what kind of help they actually need.

The researchers spent time listening to twenty-two adults with diabetes, aged forty-five to seventy-three, who were preparing for a colonoscopy. They did not just ask if the patients followed the rules; they asked how they felt, what they worried about, and how they made decisions. The team listened for patterns in how these people handled the challenge. They found that there is no single "diabetic patient" when it comes to bowel preparation. Instead, the group naturally split into five distinct types, each with its own way of thinking and its own specific needs.

The first group, which the researchers call the "Active Management" type, consists of people who treat the preparation like a serious project. These individuals usually have higher education and a strong understanding of their health. They read the instructions carefully, plan their meals, and monitor their blood sugar with precision. They are confident and capable, but their strength can sometimes become a weakness. Because they want to do everything perfectly, they often worry too much, checking their blood sugar constantly and feeling anxious about every small change. They do not need basic instructions; they need a clear timeline that helps them coordinate their diet, their laxatives, and their medication without overwhelming themselves.

Then there is the "Experience Replacement" type. These patients are also educated and capable, but they rely heavily on their own past experiences with diabetes rather than strictly following the new instructions. They understand the goal of the procedure but may skip steps or change the plan based on how their body feels at the moment. For example, they might decide to drink less of the cleansing liquid if they feel full, trusting their own judgment over the doctor's order. They are not ignoring the advice out of laziness; they are filtering it through their own history. The challenge for this group is not a lack of knowledge, but a need to understand exactly where they can be flexible and where they must be rigid. They need guidance that respects their experience while clearly defining the safety boundaries they cannot cross.

A third group faces a different hurdle: the "Cognitive Limitation" type. These patients are willing to cooperate, but they struggle to process complex information. They might have trouble reading, poor eyesight, or memory issues that make it hard to remember a multi-step plan. They cannot hold a long list of instructions in their head. Instead of a written sheet, they need simple, visual cues and direct help. For them, the preparation process often depends on a family member who acts as a substitute, reading the instructions aloud and managing the timing. Without this hands-on support, they are likely to miss a dose of medicine or forget a step, not because they do not want to succeed, but because the information is too difficult to hold onto.

The fourth group is the "Risk-Sensitive" type. These individuals are terrified of the process. They understand the steps, but their minds are consumed by fear of the worst-case scenarios: a sudden drop in blood sugar, a fall, or a bad test result. This anxiety makes them hesitate. They might drink the liquid but then stop if they feel even slightly dizzy, or they might call the doctor repeatedly for reassurance. Their high awareness of risk does not make them safer; it makes them paralyzed. They do not need more information about what to do; they need constant reassurance that they are safe and clear, simple rules that tell them exactly what to do if something goes wrong.

Finally, there is the "Support-Imbalance" type. These patients are caught in a gap between what they need and what they have. They might speak a different language, such as Tibetan, or come from a cultural background where the standard diet instructions do not make sense. They have family members who want to help, but those family members do not know enough about diabetes or the medical procedure to give the right advice. The support is there, but it is the wrong kind of support. The family might translate the words but miss the meaning, or they might try to manage the medical risks without the proper training. These patients need education that is translated into their native language and tailored to their specific cultural foods, along with training for their family members so they can help effectively.

The study suggests that the old way of treating all patients the same is not working. A single instruction sheet cannot fit five different ways of thinking and living. The researchers found that the difficulties these patients face are not just about a lack of knowledge or a failure to follow orders. The problems are deeply rooted in how each person processes information, handles fear, and relies on their support network. By recognizing these five distinct types, doctors and nurses can stop guessing what a patient needs. They can match the right kind of help to the right person: giving the confident planner a detailed schedule, the experienced self-manager clear safety limits, the overwhelmed learner a visual guide, the anxious patient constant reassurance, and the culturally isolated patient a translator and a culturally appropriate diet plan.

This approach does not require new technology or expensive equipment. It requires a shift in how medical teams see the patient. Instead of seeing a list of symptoms or a diagnosis, they can see a person with a specific way of navigating the world. When the support matches the person, the preparation becomes less of a struggle and more of a manageable part of their healthcare journey. The study confirms that understanding the human side of medical procedures is just as important as the medical procedure itself.