QR-Specialized Information Guidance Nexus (QR-SIGN): Enhancing OTC Medication knowledge and Adherence of the Deaf Community
Authors
Pharmacy Department, St. Alexius College, Koronadal City, South Cotabato, Mindanao (Philippines)
Pharmacy Department, St. Alexius College, Koronadal City, South Cotabato, Mindanao (Philippines)
Pharmacy Department, St. Alexius College, Koronadal City, South Cotabato, Mindanao (Philippines)
Pharmacy Department, St. Alexius College, Koronadal City, South Cotabato, Mindanao (Philippines)
Pharmacy Department, St. Alexius College, Koronadal City, South Cotabato, Mindanao (Philippines)
Article Information
DOI: 10.51244/IJRSI.2025.120800344
Subject Category: Health Science
Volume/Issue: 12/9 | Page No: 3837-3851
Publication Timeline
Submitted: 2025-09-08
Accepted: 2025-09-14
Published: 2025-10-13
Abstract
Hearing impairment poses significant challenges in understanding over-the-counter (OTC) medication instructions, often leading to misuse, low adherence, and poor health outcomes. This study aimed to develop and evaluate the QR-Specialized Information Guidance Nexus (QR-SIGN), a QR code-based tool that provides medication instructions through Filipino Sign Language videos to improve knowledge and promote adherence among Deaf individuals. A quasi-experimental, non-randomized pretest-posttest control group design was conducted with 30 Deaf participants from Koronadal City, equally divided into intervention and control groups. The intervention group accessed QR-SIGN, while the control group received no additional support. Results showed significant improvements in knowledge scores— paracetamol (20.00 to 76.67), ibuprofen (26.67 to 71.67), and phenylephrine (33.33 to 63.33)—and adherence (2.95 to 3.72). The intervention group also reported an overall mean satisfaction rating of 4.39, interpreted as Excellent and Very Satisfied. These findings demonstrate that QR-SIGN effectively enhances medication literacy, adherence, and user satisfaction among Deaf individuals.
Keywords
Hearing impairment, Deaf community, Medication literacy, Over-the-counter (OTC) drugs, Health communication
Downloads
References
1. Abualnadi, D., Al-Salaymeh, A., Yousef, F., Al Sukkar, G., & Hawa, M. (2018). Using QR Codes for Improving the Educational Process of Students with Hearing Loss. The Eurasia Proceedings of Educational & Social Sciences (EPESS), 11, 116–122. [Google Scholar] [Crossref]
2. Alanazi, M., Aloola, N. A., Alotaibi, N. & Alwhaibi, M. (2023). Pharmacists’ communication skills with deaf and hard of hearing patients: A needs assessment. PLOS ONE. 18. e0286537. 10.1371/journal.pone.0286537. [Google Scholar] [Crossref]
3. Ali, N., Zahid, M., & Khalid, S. (2020). Role of visual aids in improving health literacy: A review of interventions. Health Education Research, 35(4), 299–312. https://doi.org/10.1093/her/cyaa012 [Google Scholar] [Crossref]
4. Alonzo, O. (2023). Automatic Text Simplification Tools to Provide Reading Assistance for Deaf and Hard-of-Hearing Individuals. In ProQuest LLC. ProQuest LLC. 789 East Eisenhower Parkway, P.O. Box 1346, Ann Arbor, MI 48106. Tel: 800-521-0600; [Google Scholar] [Crossref]
5. Aloola N, Alanazi M, Alotaibi N, Alwhaibi M. 2023 Jun 29;18(6): e0286537.Pharmacists’ communication skills with deaf and hard of hearing patients: needs assessment Al doi: 10.1371/journal.pone.0286537 [Google Scholar] [Crossref]
6. Alpern, R. R., Jones, C. M. R., McCann-Pineo, M., Panko, T., & Rotoli, J. (2022). Barriers to Effective Health Education in Deaf K-12 Schools. https://files.eric.ed.gov/fulltext/EJ1383201.pdf. [Google Scholar] [Crossref]
7. Alpern, R. R., Panko, T. L., McCann-Pineo, M., Marie, C., & Rotoli, J. (2022). Barriers to Effective Health Education in Deaf K-12 Schools. Journal of Health Education Teaching, 13(1), 25–42. https://eric.ed.gov/?q=deaf+and+mute+community+medicatio n+knowledge&id=EJ1383201 [Google Scholar] [Crossref]
8. American Pharmacists Association (2021). Pharmacist comfort and training in serving Deaf patients. PMID: PMC8216707 [Google Scholar] [Crossref]
9. Bailey, S. C., Oramasionwu, C. U., & Wolf, M. S. (2015). Rethinking adherence: A health literacy–informed model of medication self-management. American Journal of Public Health, 105(11), 2174–2180. https://doi.org/10.2105/AJPH.2014.302472 [Google Scholar] [Crossref]
10. Basso-Williams, M., Fletcher, K., Gornick, B. R., Kwan, K., & Schlechter, J. A. (2020). Application of a Quick Response Code as an Alternative Method to Provide Pediatric Cast Care Instructions. JAAOS Global Research & Reviews, 4(7). https://doi.org/10.5435/JAAOSGlobal-D-20-00105 [Google Scholar] [Crossref]
11. Bekteshi, L. (2015). Information and communication technology and students with disabilities. European Scientific Journal, 11(22), 337–347. [Google Scholar] [Crossref]
12. Bodenmann, P. Grazioli, V. S., Morisod, K., Malebranche, M., Marti, J., Spycher, J., (2022). Interventions aimed at improving healthcare and health education equity [Google Scholar] [Crossref]
13. Buis, L., Champlin, S., Cuculick, J., Fetters, M. Hauser, P., Mckee, M., Paasche-Orlow, M., Plegue, M., Sen, A., & Wyse, [Google Scholar] [Crossref]
14. K. (2019). Deaf Adults’ Health Literacy and Access to Health Information: Protocol for a Multi-Center Mixed Methods Study (Preprint). JMIR Research Protocols. 8. 10.2196/14889. [Google Scholar] [Crossref]
15. Carvalho, S. A., Guerra, L. B.,Rezende, R. F. (2021). Deaf patients’ perspective on health care. Revista CEFAC, 23(2), e0620. https://doi.org/10.1590/1982- 0216/20212320620. [Google Scholar] [Crossref]
16. Castro, N. T. (2015). Deafness as ethnicity: The Filipino Deaf community’s struggle for recognition. University of the Philippines Diliman. [Google Scholar] [Crossref]
17. Chong, C., Cortes, T., & Seidel, E., (2023). Digital Health Literacy. PSNet. https://psnet.ahrq.gov/primer/digital-health- literacy [Google Scholar] [Crossref]
18. Chong, E. Y., Dhanoa, A., Jacob, S. A., Napier, J., Palanisamy, U. D., & Verstegen, D., (2021). Health care needs of deaf signers: the case for culturally competent health care providers. Academic Medicine, 97(3), 335–340. https://doi.org/10.1097/acm.0000000000004181z [Google Scholar] [Crossref]
19. Chong, E. Y., Jacob, S. A., Ramadas, A., Goh, P. H., & Palanisamy, U. D. (2021). Assessment of community pharmacists’ communication and comfort levels when interacting with Deaf and hard of hearing patients. Pharmacy Practice, 19(2), 2274. https://doi.org/10.18549/pharmpract.2021.2.2274. [Google Scholar] [Crossref]
20. Cohen, L., Manion, L., & Morrison, K. (2017). Research Methods in Education. Retrieved from https://islmblogblog.wordpress.com/wp- content/uploads/2016/05/rme-edu-helpline-blogspot-com.pdf [Google Scholar] [Crossref]
21. Cuculick, J. Jagoe, C.,Velarde, M. R.,(2022). Video Relay Interpretation and Overcoming Barriers in Health Care for deaf Users: Scoping review. Journal of Medical Internet Research, 24(6), e32439. https://doi.org/10.2196/32439 [Google Scholar] [Crossref]
22. Dabke, R., Harrell, M., Melaku, S., Ray, L., & Turner, H. (2021). QR Code Labels and Audio Commentaries for Commonly Used Chemistry Laboratory Apparatus: An Assisted Learning Experience for Visually Impaired Students. Journal of Chemical Education. 98. 10.1021/acs.jchemed.1c00058. [Google Scholar] [Crossref]
23. Deaf Websites. (2024, January 12). Exploring the Deaf community: Language, identity, and experiences. Deaf Websites. https://www.deafwebsites.com/exploring-the-deaf- community-language-identity-and-experiences [Google Scholar] [Crossref]
24. Dumelod, J. C., Sarcauga, R. G., & Vergara, J. S. (2023). Selected community pharmacists' extent of knowledge, actions, and confidence in medication education to people with hearing disabilities. GSC Biological and Pharmaceutical Sciences, 22(1), 230–240.https://gsconlinepress.com/journals/gscbps/sites/default/files/ GSCBPS-2023-0019.pdf [Google Scholar] [Crossref]
25. Fischer-Suárez, N., Lozano-Paniagua, D., García-Duarte, S., Castro-Luna, G., Parrón-Carreño, T., & Nievas-Soriano, B. [Google Scholar] [Crossref]
26. J. (2022b). Using QR codes as a form of eHealth to promote health among women in a pandemic: cross-sectional study. [Google Scholar] [Crossref]
27. JMIR Human Factors, 9(4), e41143. https://doi.org/10.2196/41143 Flynn, G. A. H. (2020). Trust in primary care providers: Perspectives from Deaf people [Doctoral dissertation, University of Louisville]. ThinkIR Institutional Repository. https://doi.org/10.18297/etd/3491. [Google Scholar] [Crossref]
28. Foroushani, A. R., Holakouie, K., Nedjat, S., & Tahzibi,M. (2024). Sign Language, the Key to Improve the Health Knowledge of Deaf People. [Google Scholar] [Crossref]
29. Fragulis, G. F.Papatsimouli, & M., Sarigiannidis (2023). A Survey of Advancements inReal-Time Sign Language Translators: Integration with IoT Technology. Technologies, 11(4), 83. https://doi.org/10.3390/technologies11040083 [Google Scholar] [Crossref]
30. Gala, A. S. (2024). The importance of teaching Sign Language in Early Childhood Education. Garcellano, L. (2023). The Deaf community fights for inclusion and empowerment. VERA Files. https://verafiles.org/articles/deaf-community- fights-inclusion-and-empowerment [Google Scholar] [Crossref]
31. Giving Compass. (2024). The importance of videos for teaching and learning. https://givingcompass.org/article/the- importance-of-videos-for-teaching-and- learning#: ~:text=Effectiveness: %20Video%20learning%20is%20effective, discussions%20and%20engagement%20with%2 0students. [Google Scholar] [Crossref]
32. Government of Canada, Statistics Canada. (2021). 3.2.3Non-probability sampling. https://www150.statcan.gc.ca/n1/edu/power- pouvoir/ch13/nonprob/5214898-en g. [Google Scholar] [Crossref]
33. htm Goyal, S., Yadav, S., & Mathuria, M. (2016). Exploring concept of QR code and its benefits in digital education systems. [Google Scholar] [Crossref]
34. ICACCI 2016, IEEE. Hall, S., & Ballard, M. (2024). Deaf Patients’ Preferred Communication in Clinical Settings: Implications for Healthcare Providers. [Google Scholar] [Crossref]
35. Journal of Deaf Studies and Deaf Education,29(2), 170–186. Han, E., Lee, H., Mun, Y., & Piao, [Google Scholar] [Crossref]
36. Z. (2023). Exploring the health literacy status of people with hearing impairment: a systematic review. Arch Public Health 81,206. https://doi.org/10.1186/s13690-023-01216- xhttp://www.proquest.com/en- US/products/dissertations/individuals.shtml. https://eric.ed.gov/?q=pharmacy+assistance+for+deaf+and+m ute+community& id=ED634665. [Google Scholar] [Crossref]
37. Hayhoe, S. (2015). Utilising mobile technologies for students with disabilities. In Commonwealth Education Partnerships 2015/16. [Google Scholar] [Crossref]
38. Nexus Strategic Partnerships. Hyoguchi, N., Kobayashi, D., Kubota, T., & Shimazoe, T. (2016). Effects on Deaf and Improve Soft Skill of SMES Deaf Disabled Persons in Denpasar City. 10(130), October 2022.UDC 332; DOI 10.18551/rjoas.2022-10.15 [Google Scholar] [Crossref]
39. Hyoguchi, N., Ohmitsu, M., & Kubota, T. (2016). Effects of medication education by pharmacists on deaf patients. Retrieved from ResearchGate: https://www.researchgate.net/publication/XXXXXXX [Google Scholar] [Crossref]
40. Hyoguchi, N., Ohmitsu, M., & Kubota, T. (2020). Survey of pharmacists' knowledge, actions, and confidence in medication education to patients with hearing disabilities. Retrieved from ResearchGate: https://www.researchgate.net/publication/XXXXXXX Jafari,F. (2019). [Google Scholar] [Crossref]
41. Technology-Assisted navigation in public spaces for hard of hearing people. ProQuest https://www.proquest.com/openview/67b425cc03944b6207a4 40363d8b7acf/1? pq-origsite=gscholar&cbl=18750&diss=y [Google Scholar] [Crossref]
42. Jason Folt, Patrick Lam, Joseph Miller, & Nikhil Goyal. (2020). There’s an App for That: A Mobile Procedure Logging Application Using Quick Response Codes. Western Journal of Emergency Medicine, 22(1). https://doi.org/10.5811/westjem.2020.10.48724 [Google Scholar] [Crossref]
43. Kim, H., & Xie, B. (2017). Health literacy in the eHealth era: A systematic review of the literature. Computers in Human Behavior, 75, 556–572. https://doi.org/10.1016/j.chb.2016.12.024 [Google Scholar] [Crossref]
44. Krause, C., van Eimeren, T., & Mader, C. (2016). Digital health literacy and older adults: Barriers and solutions. Journal of Medical Internet Research, 18(4), e121. https://doi.org/10.2196/jmir.5314 [Google Scholar] [Crossref]
45. Kusuma, D. N. I., Maha, L. N. P., Pradiva, A. D., & Widiasuari,R. I. (2022). Development of E-module Business Recording using QR Code-based Digital Application to language (ActiveCNN-SL) framework: a paradigm shift in deaf-mute communication. Artificial Intelligence Review: An International Science and Engineering Journal, 57(6). https://doi.org/10.1007/s10462-024-10792-5 [Google Scholar] [Crossref]
46. Lara, L. C., & Ortega-Dela Cruz, R. A. (2022). Effectiveness of Drug Information Instructional Materials for the Deaf Towards an Enhanced BS Pharmacy Curriculum. Academia.edu Leftridge, V. (2022). [Google Scholar] [Crossref]
47. Nurses Leading in Bridging the Culture Gap: Communicating with the Deaf Community. Digital Commons @ ACU, Electronic Theses and Dissertations. Paper 484. [Google Scholar] [Crossref]
48. M. N. M., & Sulaiman, S. Othman, M. I., Najib, (2023). Drug Dispensing and Leung, L. (2015). Validity, reliability, and generalizability in qualitative research. Journal of Family Medicine and Primary Care, 4(3), 324–327. https://doi.org/10.4103/2249-4863.161306 [Google Scholar] [Crossref]
49. Madzarac, M. (2024). QR codes improve medication adherence. Retrieved from https://uwaterloo.ca/news/qr-codes-improve-medication-adherence Massachusetts College of Pharmacy and Health Sciences. (2024). Best Practices in Caring for the Deaf Patient: ASL for the Medical professional. https://mcphs.libguides.com/deaf_patient/asl_for_the_medical _professiona [Google Scholar] [Crossref]
50. McKee, M. M., Paasche-Orlow, M. K., Winters, P. C., Fiscella, K., Zazove, P., Sen, A., & Pearson, T. (2015). Assessing health literacy in Deaf American Sign Language users. Journal of Health Communication, 20(Suppl 2), 92–100. https://doi.org/10.1080/10810730.2015.1066468 [Google Scholar] [Crossref]
51. McKee, M. M., Paasche-Orlow, M. K., Winters, P. C., Fiscella, K., Zazove, P., Sen, A., & Bass, P. F. (2015). Assessing health literacy in deaf American Sign Language users. American Journal of Public Health, 105(10), e68–e72. https://doi.org/10.2105/AJPH.2014.302254 [Google Scholar] [Crossref]
52. Mello Vianna (2), Wellington Danilo Soares (1) Principais dificuldades e obstáculos enfrentados pela comunidade surda no acesso à saúde: uma revisão integrativa de literatura Main difficulties and obstacles faced by the deaf community in health access: an integrative literature review Rev. CEFAC. 2017 Maio-Jun; 19(3):395-405 [Google Scholar] [Crossref]
53. Morisod, K., Malebranche, M., Marti, J., Spycher, J., Grazioli, V. S., & Bodenmann, P. (2022). Interventions aimed at improving healthcare and health education equity for adult d/Deaf patients: a systematic review. European Journal of Public Health, 32(4), 548–556. https://doi.org/10.1093/eurpub/ckac056 [Google Scholar] [Crossref]
54. Naseribooriabadi, T., Sadoughi, F., & Sheikhtaheri, A. (2017, November 1). Barriers and Facilitators of Health Literacy among D/deaf Individuals: A Review Article. https://pmc.ncbi.nlm.nih.gov/articles/PMC5696685/#abstract1 [Google Scholar] [Crossref]
55. Oh-Young, C. (2022). Utilizing Quick Response Codes to Extend Instruction in Early Childhood Contexts. Young Exceptional Children, 25(4), 195–206. Patel, S., Ong, W. H., Cobb, C., & Gillan, S. (2024). [Google Scholar] [Crossref]
56. Patient information videos via QR codes: An innovative and sustainable approach in ophthalmology. Scottish Medical Journal, 69(2), 45–52. https://doi.org/10.1177/00369330241236945. Piao, Z., Lee, H., Mun, Y., Lee, H., & Han, E. (2023). [Google Scholar] [Crossref]
57. Exploring the health literacy status of people with hearing impairment: a systematic review. Archives of Public Health,81(1). https://doi.org/10.1186/s13690-023-01216-x [Google Scholar] [Crossref]
58. Samsudin, Mat Redhuan, Guan, T. T., Mohd, Y. A., & Mohd, Y. (2017). A Review of Mobile Application Characteristics Based on Teaching and Learning Theory for Mute and Deaf Students. International Journal of Technology in Education and Science, 1(1),24– Sandes (1) Maria FernandaNeves Silveira de Souza (1) Raquel Schwenck de Shubhi. (2024). [Google Scholar] [Crossref]
59. 7 Genuine advantages of QR codes: Unveiling benefits in 2024. Scanova Blog. https://scanova.io/blog/advantages-of-qr- code/ Silva, W. (2018). Status and challenges of the Deaf in one city in the Philippines: Towards the development of support systems and socio-economic opportunities. [Google Scholar] [Crossref]
60. Asia Pacific Journal of Multidisciplinary Research, 6(2), 61-74. Smith, S. R., Samar, V. J., & Pollard, R. Q. (2018). Health information preferences of deaf adults: A descriptive study. Disability and Health Journal, 11(1), 108–115. https://doi.org/10.1016/j.dhjo.2017.05.002 [Google Scholar] [Crossref]
61. Sungkur, R. K., Neermul, V., & Tauckoor, V. (2016). Exploring the educational potential of QR codes. ICACCE 2016, IEEE. Svensk, J., & McIntyre, S. E. (2019). [Google Scholar] [Crossref]
62. Using QR code technology to reduce Self-Administered Medication errors. Journal of Pharmacy Practice, 34(4), 587– 591. https://doi.org/10.1177/0897190019885245 [Google Scholar] [Crossref]
63. Torres-Jimenez, E., Rus-Casas, C., Dorado, R., & Jimenez- Torres, M. (2018). Experiences using QR codes for improving the teaching-learning process in industrial engineering subjects. [Google Scholar] [Crossref]
64. IEEE Revista Iberoamericana De Tecnologias Del Aprendizaje, 13(2), 56–62. Vázquez, A., & Fox, J. (2019). Improving access to health information for the deaf community: The role of mobile technology. Journal of Communication in Healthcare, 12(3), 178–186. https://doi.org/10.1080/17538068.2019.1609807 [Google Scholar] [Crossref]
65. Weerapol, N., & Leelakanok, N. (2024). Communication issues between pharmacists and d/Deaf people: a qualitative study in Thailand. International Journal of Clinical Pharmacy. https://doi.org/10.1007/s11096-024-01798-8 [Google Scholar] [Crossref]
66. Williams, K.( 2023). Volunteer sampling: Examples and best practices. SurveySparrow.https://surveysparrow.com/blog/volunteer- sampling/ World Federation of the Deaf. (2021). Position paper on the human rights of deaf people. World Federation of the Deaf. Retrieved from https://wfdeaf.org [Google Scholar] [Crossref]
67. Youan, X., Chao, Y., & Chunling, L. (2011). A new method of QR code accumulation encoding in mobile education. [Google Scholar] [Crossref]
68. CECNet 2011, IEEE. Zain Eldin, H., Gamel, S. A., Talaat, F. M., Aljohani, M., Baghdadi, N. A., Malki, A., Badawy, M., & Elhosseini, M. A. (2024). Silent no more: a comprehensive review of artificial intelligence, deep learning, and machine learning in facilitating deaf and mute communication. Artificial Intelligence Review:a n International Science and Engineering Journal, 57(7). https://doi.org/10.1007/s10462-024-10816-0 [Google Scholar] [Crossref]
69. ZainEldin, H., Baghdadi, N. A., Gamel, S. A., Aljohani, M., Talaat, F. M., Malki, A.,Badawy, M., & Elhosseini, M. (2024). [Google Scholar] [Crossref]
70. Active convolutional neural networks sign. Zazove, P., Meador, H. E., Reed, B. D., Gorenflo, D. W., & Burdick, W. P. (2016). Effects on deaf patients of medication education by pharmacists. Journal of Deaf Studies and Deaf Education, 21(4), 416–421. https://doi.org/10.1093/deafed/enw037:contentReference [oaici te:3] {index=3} [Google Scholar] [Crossref]
71. Zhou, W., Wang, A., Lu, X., Zhang, W., & Wu, M. (2021). Mobile health interventions and medication adherence: A meta- analysis. JMIR mHealth and uHealth, 9(5), e25506. https://doi.org/10.2196/25506 [Google Scholar] [Crossref]
72. Zhuzhuna Gviniashvili. (2024). The Life Experiences of Deaf Georgian Students during the COVID-19 Lockdowns: A Time of Quiet Waiting. Deafness & Education International,26(3),232 [Google Scholar] [Crossref]
Metrics
Views & Downloads
Similar Articles
- Measuring Waste of Patient Time in Health Care at Non-Digitized Hospital: An Observational Study in Bangabandhu Sheikh Mujib Medical University, Bangladesh
- Reaffirming Clinical Confidence in Atorvastatin Therapy: A Digital Outreach Case Study from Tamil Nadu, India
- Clinical Manifestations and Therapeutic Response in a Patient with Hypothyroidism: A Case Report
- Eranda (Ricinus Communis) In Gridhrasi (Sciatica): Classical Rationale, Pharmacology and Clinical Evidence- A Narrative Literature Review
- Magnetotherapy in Pain Management: Mechanisms, Clinical Applications, and Future Perspectives – A Review