Introduction of Quick Response Coded Digital Allergy Patient Information Leaflets: Patient Perspectives and Key Digital Inclusion Considerations

With demand far surpassing the availability of allergy services, there is a growing unmet need for allergy care [1, 2]. Self-management, a patient's ability to care for their health, can improve clinical outcomes and reduce healthcare utilisation [3]. Providing accessible and reliable patient information and educational resources is essential for empowering patients to effectively self-care [3]. Quick Response (QR) codes are two-dimensional barcodes that encode text, often a web address. When scanned by cameras of personal devices, QR codes direct the device's web browser to the intended web page or document [4]. QR codes are widely used in healthcare as an alternative to paper-based documents, from accessing patient surveys to encoding patient identity on wristbands and test tubes and linking to patient resources. No prior work has explored allergy patient views of QR-coded information leaflets. This service improvement project aimed to provide patients with expanded options for receiving information about their allergy diagnoses. A total of 10 unique QR codes were generated and linked to digital PDF versions of each paper patient leaflet currently offered in the Adult Allergy Service. Between 3rd November 2023 and 10th January 2024 all patients attending general allergy and specialist food clinics delivered by the authors, 127 patients, were offered options for receiving information about their diagnoses—either paper and/or the newly introduced QR-coded digital patient leaflets. Through patient surveys, we determined attitudes and acceptability among adult patients (> 16 years) diagnosed with one or more allergy conditions. Patient ages ranged from 16 to 70 (median 30) years, with a male-to-female ratio of 1:2. The allergy action plan was the most frequently provided topic (n = 53), followed by Pollen Food Syndrome (PFS/OAS) (n = 42), Chronic Spontaneous Urticaria and Angioedema (CSUA) (n = 31), Nut allergy (n = 25) and House Dust Mite (HDM) (n = 21). The remaining topics were provided between 2 and 7 times (fish/shellfish (n = 7), sesame (n = 4), Lipid Transfer Protein (LTP) (n = 6), milk (n = 3) and egg (n = 2)). Of the 127 patients surveyed, 57% (72) opted for QR-coded digital leaflets, while 31% (40) chose paper leaflets. A further 12% (15) accepted both formats. Between the QR code and paper choice groups, there were no significant differences in age (p = 0.7801, unpaired t-test) or gender (p = 0.8611, chi-squared test). Patients who chose both QR and paper leaflets were excluded from these comparisons. A statistically significant difference was observed between any prior QR code experience and no prior QR code experience (p = 0.0027, Fisher's exact). Similarly, logistic regression analysis confirmed that prior QR code experience was strongly associated with choosing QR-coded digital leaflets (Odds Ratio was 22–25), with other independent variables (gender, age as a continuous variable and age as a categorical generation variable) showing no association with this preference, Table 1. The displayed QR codes and additional information about study results are available in the online repository (https://doi.org/10.5281/zenodo.14290973). Free text reasons for paper choice were perceived better readability (n = 13), storage convenience (n = 12), unfamiliarity with QR codes (n = 5), device storage, data and download issues (n = 4), hardware issues/lack of QR camera (n = 2) and a desire to write on the information provided (n = 2). Among the patients preferring QR-coded digital leaflets, perceived better storage/access (n = 38) and environmental or cost considerations (n = 23) were the top reasons provided. One patient preferred QR-coded digital leaflets to perform online translations. Two other patients wanted to take the opportunity to use QR codes within a healthcare setting for the first time. Only two patients required assistance to scan the QR codes. Of these, one patient had no prior experience with QR code usage and declared a learning disability. Over the 10 weeks, analytics logged 217 unique scans and 296 total scans. QR code usage among our Adult Allergy Service patients remains robust, with 1657 total QR codes scanned as of 29th November 2024. To mitigate the risks of digital exclusion, paper leaflets continue to be offered as a non-digital alternative and assistance with QR code device scanning is provided. Over the 10 weeks, 57% of sample patients opted for QR-coded patient leaflets, resulting in a printing cost saving of £70.40 (A4 and colour-print). During this same period, if 57% of all (1169) patients seen in either specialist food or general allergy clinics in our Service also opted for digital leaflets, there is a potential annual cost savings of approximately £3506.79 (£674.38 per 10 weeks). Groups at risk of digital exclusion include older age, lower-income, unemployed, homeless, rural residents, fewer educational qualifications, those less fluent in the English language and those with disabilities [5]. We did not actively survey disability status. However, one patient did describe their disabilities as the reason for not opting for a QR-coded digital leaflet. It is important to take steps to mitigate against digital exclusion in healthcare as it can overlap with other forms of social exclusion and disadvantage and compound health inequalities. Our allergy patients disclosed barriers to QR code use (disability, lack of hardware, data and download issues and no prior QR experience) that align with the three fundamentals of digital inclusion: digital connectivity, accessibility and digital skills/capability [6]. Allergists can address accessibility through inclusive design and implementation aiming to be accessible to and usable by as many individuals as possible. This can be achieved by accommodating variations in physical and cognitive ability, language skills and other human differences [7]. Examples include the implementation of screen readers and text magnification for those visually impaired, captions for those hearing impaired and non-digital alternatives [8, 9]. In conclusion, our findings indicate that the substantial majority (69% of our cohort) are receptive to QR codes as a method of receiving patient information, which we envisage will improve the self-management of their diagnosed allergy condition. O.S.K., C.A., O.T., S.T. and L.Q.C.S. collected the data. O.S.K., L.Q.C.S., A.W. and S.T. analysed and interpreted the data. O.S.K., C.A., O.T., S.T., A.W., L.Q.C.S. drafted and reviewed the manuscript. All authors participated in the conceptualisation and design of this work and contributed to the drafting and review of the manuscript. The authors declare no conflicts of interest. The data that support the findings of this work are available from the corresponding authors upon reasonable request.