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BACKGROUND: The accuracy of colonoscopy results is significantly affected by the quality of bowel preparation. Identifying and understanding the factors that contribute to effective bowel preparation are crucial for optimizing patient outcomes. PURPOSE: The aim of this meta-analysis was to systematically evaluate the variables influencing bowel preparation efficacy in order to inform the development of improved clinical protocols and patient care strategies. METHODS: We conducted a literature search of several databases to find studies that investigated factors affecting the quality of bowel preparation over a period ranging from the inception of each database to November 5, 2024. Studies were independently screened based on preestablished inclusion and exclusion criteria. The meta-analysis was conducted using RevMan 5.4 software. RESULTS: The meta-analysis included 27 articles containing data from 30,716 patients who underwent bowel preparation for colonoscopy. Eight factors were identified that were significantly associated with suboptimal bowel preparation: older age (odds ratio [OR], 1.28; 95% CI, 1.12-1.68; P = 0.019), male gender (OR, 1.33; 95% CI, 1.16-1.53; P < 0.001), chronic constipation (OR, 3.46; 95% CI, 2.65-4.09; P < 0.001), diabetes (OR, 4.72; 95% CI, 2.18-10.22; P < 0.001), use of opioids (OR, 1.62; 95% CI, 1.24-2.45; P = 0.006), a preprocedure high-fiber diet (OR, 2.94; 95% CI, 1.65-5.22; P < 0.001), an interval exceeding five hours between the final administration of the bowel cleansing agent and the procedure (OR, 2.82; 95% CI, 1.79-4.45; P < 0.001), and a last bowel movement that is not watery (OR, 4.78; 95% CI, 2.35-9.71; P < 0.001). CONCLUSION: Health care providers, including nurses, should consider these determinants of bowel preparation effectiveness and implement appropriate interventions in a timely manner to enhance patient education and care.