The gastrointestinal (GI) disease accounts for many deaths in several parts of the world. Globally 1.9 million new cases were identified and among 0.94 million deaths were occurred. By 2040, 3.2 million cases will be identified and among 1.6 million deaths will be estimated per year [1]. Both Western and Asian populations have increasing risk of CRC as they reach older ages [2]. World cancer research fund reports that there were 1.8 million new cases of colorectal cancer (CRC) and it was the third most common cancer, in 2018. In which 1,006,019 (11.4%) new cases were identified in men and 794,958 (9.7%) new cases were identified in women [3]. American Cancer Society (2024) reports that fourth leading cause of death among younger age (<55yers) is due to colorectal cancer and increasing the incidence by 1-2% annually in both men and women [4-6]. Overall, there was a rise in colon cancer trends in China, the US and India between 2018 and 2027 [7].   CRC screening has significantly contributed to the alleviation of its disease burden. The prevalence and burden of GI diseases mandate appropriate screening measures and diagnostic modalities to prevent and manage the diseases effectively. Cancer that is limited to the mucosa or submucosa and does not spread to the muscularis propria is referred to as early-stage colorectal cancer [8-12].   People at the age of 50 to 75 should be screened for CRC and colonoscopy should be done once in every 10 years. However, a patient may refuse to have a colonoscopy due to a lack of knowledge or a fear of pain, which could have negative effects on both the diagnosis and course of therapy. The inadequate information will lead to inadequate bowel preparation and poor compliance and which further affects the diagnosis process and may require repetition of procedure [13-16]. Provision of information with the help of the technology such as video assisted teaching helped to reduces the fear among the patients and they expressed readiness to undergo the procedure. In patients having screening colonoscopies, a patient-centered instructional video enhances the quality of bowel preparation and may reduce the need for an earlier repetition of procedure [17].   Preparing a patient for an invasive procedure is an important responsibility to the health professionals [7]. Enhanced instructions provided to the patients before the colonoscopy procedure considerably increased the quality of bowel preparation and willingness among patients undergoing colonoscopy, according to the recent meta-analysis of randomized controlled studies.   Hence, the researcher has decided to carry out the study to evaluate the video-assisted strategic instruction on knowledge, preprocedural anxiety and compliance among patients undergoing to colonoscopy procedure [18-21].   Aim of the Study The study aimed to assess the effects of video-assisted strategic instruction on knowledge, anxiety and compliance among patients undergoing to colonoscopy.

Study Design and Participants The one group pre and post-test research design adopted for this study. The patients subjected to colonoscopy procedure with confirmation of appointment and undergoes the procedure at the endoscopy department of a tertiary care hospital. The minimum sample size needed for the study is 60 and the sample size is determined using a comparable study with 80% power and 5% error. The non-probability purposive sampling technique was adopted. The inclusion criteria were such as patients subjected to colonoscopy with confirmation of appointment, both genders, aged between 21 and 70 years, who were undergoing colonoscopy procedure for the first time. Patients who were critically ill and who were subjected to colonoscopy as an emergency were the exclusion criteria.   Data Collection Tools A self-reported questionnaire was used to collect demographic and clinical data. The assessment of anxiety was carried out on a 10-point numerical rating scale. Anxiety was assessed using a Numerical Rating Scale (reliability r = 0.88) and compliance was assessed using a 9-item five-point Likert scale (Cronbach's α = 0.79). The instruments were validated by experts in nursing and gastroenterology.   Data Collection Procedure Written informed consent was obtained from all participants before data collection. Sixty patients were recruited through purposive sampling and underwent baseline assessment of demographic characteristics, knowledge and anxiety. Subsequently, each participant received an individual video-assisted teaching session on colonoscopy and an educational pamphlet. Follow-up assessment of knowledge and anxiety was carried out on the day of the procedure, while compliance was evaluated before, during and after colonoscopy. All data were collected by the investigator and complete responses were obtained from all participants.   Ethical Considerations Institutional Review and Ethics Committee reviewed and approved the study. The study purpose was clarified clearly to the participants. Before conducting the study, a written informed consent was obtained from all the participants. All study participants received assurances that their privacy would be protected during the investigation.   Data Analysis The data analysis plan was established in collaboration with the biostatistician. The gathered data were scrutinized using both description statistics (frequency, percentage, mean and standard deviation) and inferential statistics (paired‘t’ test and Chi square). There were no missing data in the statistical analysis and the results were presented with narrative descriptions and summarized using the tables.

The data regarding background variables of the patients, 83.3% were male and 40.0% of the participants were between the ages of 31 and 40. According to the patients' educational records, 45% of them had completed school and regarding occupation 46.7% of them were business people. Regarding type of family, 68.3% of the patients belonged to nuclear family. The data regarding place of residence showed that 70% of them were from urban area (Table 1).   Table 1: Distribution of the Patients Subjected to Colonoscopy According to Their Demographic Variables Demographic Variables N Percentage Age (Years) 21-30 07 11.7 31-40 24 40.0 41-50 19 31.6 51-60 7 11.7 61-70 3 05.0 Gender Male 50 83.3 Female 10 16.7 Education No formal education 3 5.0 Primary 12 20.0 Higher secondary 27 45.0 Graduate 18 30.0 Occupation Daily wages 8 13.3 Business 28 46.7 Professional 14 23.3 Home maker 10 16.7 Marital Status Single 5 8.3 Married 54 90.0 Widow/divorce 1 1.7 Type of Family Joint 19 31.7 Nuclear 41 68.3 Place of Residence Urban 42 70.0 Rural 18 30.0 Monthly Income(in Rupees) <10,000 3 5.0 10,000-20,000 29 48.3 >20,000 28 46.7 The data on indication for colonoscopy as 26.7% had complaints of constipation, 28.3 % had complaints of bleeding per rectum, 20.0% had complaints of diarrhea, 11.7 had complaints of anemia and 13.3% had complaints of abdomen pain. About co-morbid illness, 73.3% of the patients did not have any co-morbid illness. The data on alcohol consumption and smoking habits reveal that 76.7% and 80% of them, respectively, did not have these habits. With respect to family history of gastric problem, 96.7% of the patients did not have family history of gastric problem (Table 2).   Table 2: Distribution of the Patients Subjected to Colonoscopy According to Their Clinical Variables Clinical variables n Percentage Indication for Colonoscopy Constipation 16 26.7 Bleeding per rectum 17 28.3 Diarrhoea 12 20.0 Anemia 7 11.7 Abdomen pain 8 13.3 Comorbid Illness Hypertension 3 5.0 Diabetes mellitus 11 18.3 Cardiac diseases 1 1.7 Respiratory diseases 1 1.7 Nil 44 73.3   Knowledge and Anxiety According to the results, 3.3% of patients had a moderate level of knowledge during the pretest, whereas 96.7% of patients had an inadequate level. Of them, 23.3% had a moderate level of knowledge and 76.7% had an adequate level during the posttest.   With related to anxiety, the findings reveal that during pretest, 41.7% of the patients had mild level of anxiety, 53.3% of them had moderate level of anxiety and 5% had severe level of anxiety. During posttest, 50% of the patients had mild level of anxiety, 48.3% of them had moderate level of anxiety and 1.7% had severe level of anxiety.   The second goal of the study was to assess the compliance after video-assisted strategic instruction among patients subjected to colonoscopy. The study Finding reveals that during posttest, 21.7% of the patients showed moderate level of compliance and 78.3% of them showed good level of compliance. The mean score of the compliance was 26.57 with the standard deviation of 3.12 (Table 3).   Table 3: Comparison of Knowledge Before and After Video-Assisted Strategic Teaching Among Patients Subjected to Colonoscopy Knowledge Mean SD Difference Paired t-value p-value Mean SD Pretest 1.68 0.833 -5.817 1.049 -42.931*** 0.000 Posttest 7.50 1.359 ***p<0.05   The mean knowledge scores of the patients undergoing colonoscopy before and after video-assisted strategic instruction showed a statistically significant change (p<0.05) (Table 3). The mean anxiety scores of the patients undergoing colonoscopy before and after video-assisted strategic instruction showed a statistically significant change (p<0.05). During posttest, the mean score of the compliance was 26.57 with standard deviation of 3.12 (Table 4).   Table 4: Comparison of Anxiety Before and After Video-Assisted Strategic Teaching Among Patients Subjected to Colonoscopy Anxiety Mean SD Difference Paired t-value p-value Mean SD Pretest 4.12 1.342 0.417 0.591 5.464*** 0.000 Posttest 3.70 1.212 ***p<0.05

The present study found that video-assisted strategic teaching significantly improved the knowledge of patients undergoing colonoscopy. The marked increase in posttest knowledge scores indicates that the intervention was effective in enhancing patients’ understanding of the procedure. These findings are consistent with previous studies that reported improved patient knowledge following educational interventions [19-21].   The study also demonstrated a significant reduction in anxiety levels after the intervention. Adequate information regarding the procedure may help patients feel more prepared and confident, thereby reducing anxiety. Hence, the hypothesis stating that video-assisted strategic teaching would improve knowledge and reduce anxiety among patients undergoing colonoscopy was supported [22].   Most participants showed good compliance with colonoscopy-related instructions following the intervention. The use of visual and structured educational materials may have enhanced understanding and recall, leading to better adherence. Similar findings have been reported in studies that identified video-assisted education as an effective strategy for improving bowel preparation, patient satisfaction and procedural outcomes among individuals undergoing colonoscopy [23].   The effectiveness of video-assisted strategic teaching may be attributed to its ability to provide clear and comprehensive information in an easily understandable format. Improved knowledge can reduce uncertainty and fear associated with the procedure, thereby promoting positive behavioral responses. These findings are supported by previous research demonstrating that educational videos enhance bowel preparation quality and reduce the need for repeat colonoscopies [24].   The study further revealed that patients with no family history of gastric problems tended to have lower levels of knowledge. In addition, higher compliance levels were observed among educated participants, whereas poor compliance was more common among those with no formal education. These findings suggest that previous exposure to health information and educational status play an important role in influencing patient awareness and adherence to healthcare recommendations. Similar observations have been reported in earlier studies evaluating educational interventions among colonoscopy patients [25].   Strength and Limitations This study has evaluated effects of video assisted strategic instruction on knowledge, anxiety and compliance among patients undergoing to colonoscopy. Samples recruitment was successful and none of the patients resisted to participate in the study and also there were no missing information. This study had insisted the needs of prior instruction before colonoscopy procedure and thus subsequently reduces anxiety and thereby it improves compliance among patients throughout the procedure. The use of non-probability sampling techniques and one-group pre-test and post-test designs may limit the generalizability of study results.

The study concluded that video-assisted strategic instruction is an essential intervention to increase knowledge about colonoscopy procedure, reduce anxiety level and improve compliance among patients subjected to colonoscopy. The decreased anxiety and improved compliance will lead to good patient outcomes during the colonoscopy procedure.