{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T06:15:13Z","timestamp":1783318513082,"version":"3.54.6"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T00:00:00Z","timestamp":1783296000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Recognizing stool forms is essential for improving constipation awareness and promoting bowel health in children. This study aimed to evaluate primary school students\u2019 ability to identify stool forms using the Bristol Stool Form Scale (BSFS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A quasi-experimental study was conducted between June 8 and 12, 2020, in a public primary school in Yunlin County, Taiwan. Students in grades 3 to 6 were enrolled and assigned to either a multimedia or a paper-based instructional condition. The multimedia learning group received pre-recorded audio-visual instruction, whereas those in the paper-based group engaged in self-learning using BSFS cards with textual explanations. All participants subsequently completed a 10-item stool-form identification test, and weighted scoring was applied to account for adjacent-type misclassification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 190 students were included in the final analysis (multimedia:\n                      <jats:italic>n<\/jats:italic>\n                      =\u202f97; paper-based:\n                      <jats:italic>n<\/jats:italic>\n                      =\u202f93). The mean weighted score (out of 10) was 8.64\u202f\u00b1\u202f1.29 in the multimedia group and 8.91\u202f\u00b1\u202f1.43 in the paper-based group, with no statistically significant difference between the groups (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.165). Lower accuracy was observed for constipation-related stool types and mixed forms.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Primary school students in grades 3 to 6 demonstrated high levels of stool-form recognition using the BSFS after brief structured instruction. No significant differences were observed between multimedia and paper-based instructional modalities. These findings suggest that either approach may be feasibly implemented in school-based health education.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1893172","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T05:37:37Z","timestamp":1783316257000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Teaching stool form recognition in primary school: multimedia versus paper-based instruction using the Bristol stool form scale"],"prefix":"10.3389","volume":"14","author":[{"given":"Chia-Jen","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Healthcare Administration, College of Medical and Health Science, Asia University","place":["Taichung, Taiwan"]},{"name":"Shuitsanlin Elementary School","place":["Yunlin County, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yung-Jen","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of General Psychiatry, Tsaotun Psychiatric Center, Ministry of Health and Welfare","place":["Tsaotun Township, Nan-Tou County, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying-Jyun","family":"Shih","sequence":"additional","affiliation":[{"name":"Department of Nursing, Tsaotun Psychiatric Center, Ministry of Health and Welfare","place":["Caotun, Nan-Tou County, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiun-Yi","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Healthcare Administration, College of Medical and Health Science, Asia University","place":["Taichung, Taiwan"]},{"name":"Department of Medical Research, China Medical University Hospital, China Medical University","place":["Taichung, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,6]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e01029","DOI":"10.14309\/ctg.0000000000001029","article-title":"Global prevalence of functional constipation across all age groups according to Rome II-IV criteria, 1999-2025: a systematic review and meta-analysis","volume":"17","author":"Youn","year":"2026","journal-title":"Clin Transl Gastroenterol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e156","DOI":"10.1542\/peds.2009-1009","article-title":"Long-term prognosis for childhood constipation: clinical outcomes in adulthood","volume":"126","author":"Bongers","year":"2010","journal-title":"Pediatrics"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"920","DOI":"10.3109\/00365529709011203","article-title":"Stool form scale as a useful guide to intestinal transit 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