Integrating QVoC (QR Code with Voice Content) to Enhance Medication Adherence for Geriatric Diabetic Patients

Authors

Samantha Desiree N. Delima

Faculty of the Pharmacy Department St. Alexius College, City of Koronadal (Philippines)

Vanessa Joy B. Felizardo

Faculty of the Pharmacy Department St. Alexius College, City of Koronadal (Philippines)

Moh’d Yusoph M. Kusain Jr.

Faculty of the Pharmacy Department St. Alexius College, City of Koronadal (Philippines)

Jazel Q. Racoma

Faculty of the Pharmacy Department St. Alexius College, City of Koronadal (Philippines)

Article Information

DOI: 10.51244/IJRSI.2025.1210000049

Subject Category: Computer Science and Smart Tourism

Volume/Issue: 12/10 | Page No: 545-572

Publication Timeline

Submitted: 2025-10-02

Accepted: 2025-10-08

Published: 2025-11-01

Abstract

Medication compliance is a top-of-mind factor for effective diabetes care, particularly in elderly groups that typically suffer from cognitive, social, and technological barriers. This research sought to establish the impact of incorporating QR Code with Voice Content (QVoC) technology on medication compliance among geriatric diabetic patients in Barangay Morales, Koronadal City. Using a quasi-experimental design, the researchers recruited 20 older diabetic patients through purposive sampling. The intervention was a QVoC device that provided audio cues linked to QR codes for targeted drugs, which were designed to address forgetfulness and complexity in medication regimens. Medication adherence data were collected using a validated questionnaire derived from the Morisky Medication Adherence Scale (MMAS) pre- and post-intervention. The adherence mean score increased from 2.95 (SD = 0.18) before intervention to 3.70 (SD = 0.09) after intervention. Participants reported better comprehension, increased regularity in drug taking, and reduced omitted doses errors. The conclusion drawn by the study was that QVoC is helpful, easy, and very effective technology-based treatment for improving medication adherence among elderly diabetic patients. Future research can explore the long-term outcomes and scalability of such interventions across different populations.

Keywords

medication adherence, geriatric diabetes, QVoC, QR code intervention, digital health, elderly care, chronic disease management

Downloads

References

1. Abas, J., Capricho, Z. A., Golpeo, B., Idong, C. B., Macantan, J., Miranda, M. D., & Faller, E. (2022). POLPHARMACY AMONG GERIATRIC PATIENTS IN ASEAN COUNTRIES: A COMPARATIVE REVIEW. Retrieved in December 2024 from Journal of Health Promotion and Service Management, 1(2), 94-113 on [Google Scholar] [Crossref]

2. Afaya, R. A., Bam, V., Azongo, T. B., Afaya, A., Kusi-Amponsah, A., Ajusiyine, J. M., & Abdul Hamid, T. (2020). Medication adherence and self-care behaviours among patients with type 2 diabetes mellitus in Ghana. Retrieved in December 2024 from PloS one, 15(8), e0237710. [Google Scholar] [Crossref]

3. Anderson, L. J., Nuckols, T. K., Coles, C., Le, M. M., Schnipper, J. L., Shane, R., ... & PHARM-DC Group Choudhry Niteesh K MD, Ph. D O’Mahony Denis MD Sarkisian Catherine MD. (2020). A systematic overview of systematic reviews evaluating medication adherence interventions. Retrieved in December 2024 from American Journal of Health-System Pharmacy, 77(2), 138-147. [Google Scholar] [Crossref]

4. Allemann, S. S., Nieuwlaat, R., Navarro, T., Haynes, B., Hersberger, K. E., & Arnet, I. (2017). Congruence between patient characteristics and interventions may partly explain medication adherence intervention effectiveness: an analysis of 190 randomized controlled trials from a Cochrane systematic review. Retrieved in December 2024 from Journal of clinical epidemiology, 91, 70-79. [Google Scholar] [Crossref]

5. AlQarni, K., AlQarni, E. A., Naqvi, A. A., AlShayban, D. M., Ghori, S. A., Haseeb, A., ... & Jamshed, S. (2019). Assessment of medication adherence in Saudi patients with Type II diabetes mellitus in Khobar City, Saudi Arabia. Retrieved in December 2024 from Frontiers in pharmacology, 10, 1306. [Google Scholar] [Crossref]

6. Ahmad, A., Rasul, T., Yousaf, A., & Zaman, U. (2020). Understanding factors influencing elderly diabetic patients’ continuance intention to use digital health wearables: extending the technology acceptance model (TAM). Retrieved in December 2024 from Journal of Open Innovation: Technology, Market, and Complexity, 6(3), 81. [Google Scholar] [Crossref]

7. Al Mansour, M. A. (2020). The prevalence and risk factors of type 2 diabetes mellitus (DMT2) in a semi-urban Saudi population. Retrieved in December 2024 from International journal of environmental research and public health, 17(1), 7. [Google Scholar] [Crossref]

8. Brodie, K., Madden, L. L., & Rosen, C. A. (2020). Applications of quick response (QR) codes in medical education. Retrieved in December 2024 from Journal of Graduate Medical Education, 12(2), 138- 140. [Google Scholar] [Crossref]

9. Boonyapalanant, A., Ketcham, M., & Piyaneeranart, M. (2020). Hiding patient injury information in medical images with QR code. In Recent Advances in Information and Communication Technology 2019: Proceedings of the 15th International Conference on Computing and Information Technology (IC2IT 2019) 15 (pp. 258-267). Retrieved in December 2024 from Springer International Publishing. [Google Scholar] [Crossref]

10. Bea, S., Lee, H., Kim, J. H., Jang, S. H., Son, H., Kwon, J. W., & Shin, J. Y. (2021). Adherence and associated factors of treatment regimen in drug-susceptible tuberculosis patients. Retrieved in December 2024 from Frontiers in pharmacology, 12, 625078 [Google Scholar] [Crossref]

11. Babel, A., Taneja, R., Mondello Malvestiti, F., Monaco, A., & Donde, S. (2021). Artificial intelligence solutions to increase medication adherence in patients with non- communicable diseases. Frontiers in Digital Health, 3, 669869 [Google Scholar] [Crossref]

12. Cross, A. J., Elliott, R. A., Petrie, K., Kuruvilla, L., & George, J. (2020). Interventions for improving medication‐taking ability and adherence in older adults prescribed multiple medications. Retrieved in December 2024 from Cochrane Database of Systematic Reviews, (5). [Google Scholar] [Crossref]

13. Carandang, R. A. M. L., Ong, M. T., & Malenab, R. A. J. (2024). Predictors of Cognitive Impairment among Filipino Patients with Type 2 Diabetes Mellitus in a Tertiary Government Hospital. Retrieved in December 2024 from Acta Medica Philippina, 58(14), 6. [Google Scholar] [Crossref]

14. Calano, M. (2019). Factors affecting medication adherence among elderly people with chronic illness in Surigao City, Philippines. International Journal of Current Science Research. Retrieved in December 2024 from https://ijcsrr.org/factors-affecting-medication- adherence-among-elderly-people-with-chronic-illness-in-surigao-city/ [Google Scholar] [Crossref]

15. Demoz, G. T., Berha, A. B., Alebachew Woldu, M., Yifter, H., Shibeshi, W., & Engidawork, E. (2019). Drug therapy problems, medication adherence and treatment satisfaction among diabetic patients on follow-up care at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Retrieved in December 2024 from PloS one, 14(10), e0222985. [Google Scholar] [Crossref]

16. Dimaporo, J., Pizarras, S. J., Yorobe, M. A., Rollorazo, A. R., Tan, M. A., Go, C. J., & Banez, V. Prevalence of exocrine pancreatic insufficiency (epi) in filipino adult patients who are diabetic for a minimum of five years using the fecal elastase test in manila doctors hospital: a prospective cross-sectional study. [Google Scholar] [Crossref]

17. De la Vega, Shelley Ann F., Nimfa B. Ogena, Maria Stella T. Giron, Angely P. Garcia, Hannah M. Pellejo, Sarah Jane S. Fabito, and Vicente O. Medina III. "Active Aging Health Determinants among Working and Retired Filipino Older Persons Living in an Urban Academic Campus." Retrieved in December 2024 from Acta Medica Philippina 55, no. 4 (2021). [Google Scholar] [Crossref]

18. De Guzman, A. B., & Encabo, R. S. (2021). Factors associated with medication adherence of diabetic patients in the Philippines. Philippine Journal of Health Research and Development, 25(1), 1-10. Retrieved in December 2024 from https://www.philippinejournalofhealthresearchanddevelopment.com/ [Google Scholar] [Crossref]

19. Delavar, F., Pashaeypoor, S., & Negarandeh, R. (2020). The effects of self-management education tailored to health literacy on medication adherence and blood pressure control among elderly people with primary hypertension: A randomized controlled trial. Patient education and counseling, 103(2), 336-342. [Google Scholar] [Crossref]

20. Eriksson, T. (2019). Medication adherence interventions and outcomes: an overview of systematic reviews. Retrieved in December 2024 from European Journal of Hospital Pharmacy, 26(4), 187- 192. [Google Scholar] [Crossref]

21. Gast, A., & Mathes, T. (2019). Medication adherence influencing factors—an (updated) overview of systematic reviews. Retrieved in December 2024 from Systematic reviews, 8, 1-17. [Google Scholar] [Crossref]

22. Giron, M. S., & de la Vega, S. A. (2022). Prevalence of diabetes among community-living older persons in the Philippines: the FITforFrail Study. Retrieved in December 2024 from Journal of the ASEAN Federation of Endocrine Societies, 37(2), 23. [Google Scholar] [Crossref]

23. Garcia, A. P., de la Vega, S. A. F., Giron, M. S. T., & Fabito, S. J. S. (2022). Visual and Hearing Impairments among Working and Retired Employees with Type 2 Diabetes Mellitus in Two Academic Communities in the Philippines. Retrieved in December 2024 from Acta Medica Philippina, 56(3). [Google Scholar] [Crossref]

24. Giron, M. S., & de la Vega, S. A. (2022). Prevalence of diabetes among community-living older persons in the Philippines: the FITforFrail Study. Retrieved in December 2024 from Journal of the ASEAN Federation of Endocrine Societies, 37(2), 23. [Google Scholar] [Crossref]

25. Garcia, A. P., de la Vega, S. A. F., Giron, M. S. T., & Fabito, S. J. S. (2022). Visual and Hearing Impairments among Working and Retired Employees with Type 2 Diabetes Mellitus in Two Academic Communities in the Philippines. Retrieved in December 2024 from Acta Medica Philippina, 56(3) [Google Scholar] [Crossref]

26. Hasanpour, F., Mehravar, F., Badeleh-Shamushaki, M. T., & Mancheri, H. (2024). The association of health literacy and medication adherence in type 2 diabetic’s patients referring to comprehensive health centers in Gorgan city. Retrieved in December 2024 from Scientific Journal of Nursing, Midwifery and Paramedical Faculty, 9(4), 321-333. [Google Scholar] [Crossref]

27. Hashimoto, K., Urata, K., Yoshida, A., Horiuchi, R., Yamaaki, N., Yagi, K., & Arai, K. (2019). The relationship between patients’ perception of type 2 diabetes and medication adherence: a cross-sectional study in Japan. Retrieved in December 2024 from Journal of pharmaceutical health care and sciences, 5, 1-10. [Google Scholar] [Crossref]

28. Jannoo, Z., & Khan, N. M. (2019). Medication adherence and diabetes self-care activities among patients with type 2 diabetes mellitus. Retrieved in December 2024 from Value in health regional issues, 18, 30-35 [Google Scholar] [Crossref]

29. Karia, C. T., Hughes, A., & Carr, S. (2019). Uses of quick response codes in healthcare education: a scoping review. Retrieved in December 2024 from BMC Medical Education, 19, 1-14. [Google Scholar] [Crossref]

30. Kvarnström, K., Westerholm, A., Airaksinen, M., & Liira, H. (2021). Factors contributing to medication adherence in patients with a chronic condition: a scoping review of qualitative research. Retrieved in December 2024 from Pharmaceutics, 13(7), 1100 [Google Scholar] [Crossref]

31. Kim, J., Lee, H., & Park, S. (2020). Factors affecting medication adherence in elderly patients with chronic diseases: A systematic review. Retrieved in December 2024 from Journal of Geriatric Medicine, 8(4), 123-130. [Google Scholar] [Crossref]

32. Longo, M., Bellastella, G., Maiorino, M. I., Meier, J. J., Esposito, K., & Giugliano, D. (2019). Diabetes and aging: from treatment goals to pharmacologic therapy. Frontiers in Endocrinology, 10, 45 [Google Scholar] [Crossref]

33. LeRoith, D., Biessels, G. J., Braithwaite, S. S., Casanueva, F. F., Draznin, B., Halter, J. B., ... & Sinclair, A. J. (2019). Treatment of diabetes in older adults: an Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 104(5), 1520-1574. [Google Scholar] [Crossref]

34. Lohrasbi, F., Ilali, E. S., Mousavinasab, S. N., & Yaghoubi, T. (2021). Factors associated with health literacy and medication adherence in the elderly patients with chronic kidney diseases. Journal of Nursing and Midwifery Sciences, 8(2), 106-113. [Google Scholar] [Crossref]

35. Maciejewski, M. L. (2020). Quasi-experimental design. Biostatistics & Epidemiology, 4(1), 38-47. [Google Scholar] [Crossref]

36. Mendes, R., Martins, S., & Fernandes, L. (2019). Adherence to medication, physical activity and diet in older adults with diabetes: its association with cognition, anxiety and depression. Journal of clinical medicine research, 11(8), 583. [Google Scholar] [Crossref]

37. Monterona, D. P., Matinong, R. A., & De Silos, J. (2021). The Effectiveness of Telephone Intervention for Improving Patient Adherence to Medication among Diabetic Patients: A Systematic Review and Meta-analysis of Randomized Trials. medRxiv, 2021-06. [Google Scholar] [Crossref]

38. Mannan, A., Hasan, M. M., Akter, F., Rana, M. M., Chowdhury, N. A., Rawal, L. B., & Biswas, T. (2021). Factors associated with low adherence to medication among patients with type 2 diabetes at different healthcare facilities in southern Bangladesh. Global health action, 14(1), 1872895. [Google Scholar] [Crossref]

39. Murali, K. M., Mullan, J., Roodenrys, S., Hassan, H. C., Lambert, K., & Lonergan, M. (2019). Strategies to improve dietary, fluid, dialysis or medication adherence in patients with end stage kidney disease on dialysis: A systematic review and meta- analysis of randomized intervention trials. PloS one, 14(1), e0211479. [Google Scholar] [Crossref]

40. Musavi Ghahfarokhi, M., Tartifizadeh, H., Tartifizadeh, H., Asakereh, S., Eskandari, N., & Kogani, M. (2024). Relationship between the Level of Health Literacy, Diet Adherence and Dialysis Adequacy in Patients Undergoing Dialysis. Journal of Health Literacy, 9(2), 106-118. [Google Scholar] [Crossref]

41. Mendes, R., Martins, S., & Fernandes, L. (2019). Adherence to medication, physical activity and diet in older adults with diabetes: its association with cognition, anxiety and depression. Journal of clinical medicine research, 11(8), 583. [Google Scholar] [Crossref]

42. McElnay, J. C., & McCallion, C. R. (2020). Adherence and the elderly. In Adherance to Treatment in Medical Conditions (pp. 223-253). CRC Press. [Google Scholar] [Crossref]

43. Milky, G., & Thomas III, J. (2020). Shared decision making, satisfaction with care and medication adherence among patients with diabetes. Patient education and counseling, 103(3), 661-669. [Google Scholar] [Crossref]

44. Ngamdee, N., Chumfang, N., Chiangkhong, A., Satasuwan, A., & Sukdee, S. (2024). Behavioral Patterns and Barriers to Medication Adherence in Older Adults with Diabetes. International Journal of Geoinformatics, 20(3), 64-73. [Google Scholar] [Crossref]

45. Othman, G., Ali, F., Ibrahim, M. I. M., Al-Worafi, Y. M., Ansari, M., & Halboup, A. M. (2020). Assessment of anti-diabetic medications adherence among diabetic patients in Sana’a City, Yemen: A cross sectional study. Journal of Pharmaceutical Research International, 32(21), 114-122. [Google Scholar] [Crossref]

46. Onyishi, C. N., Eseadi, C., Ilechukwu, L. C., Okoro, K. N., Okolie, C. N., Egbule, E., & Asogwa, E. (2022). Potential influences of religiosity and religious coping strategies on people with diabetes. World Journal of Clinical Cases, 10(25), 8816. [Google Scholar] [Crossref]

47. Presley, B., Groot, W., & Pavlova, M. (2019). Pharmacy-led interventions to improve medication adherence among adults with diabetes: a systematic review and meta-analysis. Research in Social and Administrative Pharmacy, 15(9), 1057-1067. [Google Scholar] [Crossref]

48. Pouls, B. P., Vriezekolk, J. E., Bekker, C. L., Linn, A. J., van Onzenoort, H. A., Vervloet, M., ... & van den Bemt, B. J. (2021). Effect of interactive eHealth interventions on improving medication adherence in adults with long-term medication: systematic review. Journal of medical Internet research, 23(1), e18901. [Google Scholar] [Crossref]

49. Papus, M., Dima, A. L., Viprey, M., Schott, A. M., Schneider, M. P., & Novais, T. (2022). Motivational interviewing to support medication adherence in adults with chronic conditions: systematic review of randomized controlled trials. Patient Education and Counseling, 105(11), 3186-3203. [Google Scholar] [Crossref]

50. Poulter, N. R., Borghi, C., Parati, G., Pathak, A., Toli, D., Williams, B., & Schmieder, R. E. (2020). Medication adherence in hypertension. Journal of hypertension, 38(4), 579-587. [Google Scholar] [Crossref]

51. Punnapurath, S., Vijayakumar, P., Platty, P. L., Krishna, S., & Thomas, T. (2021). A study of medication compliance in geriatric patients with chronic illness. Journal of Family Medicine and Primary Care, 10(4), 1644-1648. [Google Scholar] [Crossref]

52. Robinson, R. S. (2024). Purposive sampling. In Encyclopedia of quality of life and well-being research (pp. 5645-5647). Cham: Springer International Publishing. [Google Scholar] [Crossref]

53. Saqlain, M., Riaz, A., Malik, M. N., Khan, S., Ahmed, A., Kamran, S., & Ali, H. (2019). Medication adherence and its association with health literacy and performance in activities of daily livings among elderly hypertensive patients in Islamabad, Pakistan. Medicina, 55(5), 163 [Google Scholar] [Crossref]

54. Svensk, J., & McIntyre, S. E. (2021). Using QR code technology to reduce self- administered medication errors. Journal of pharmacy practice, 34(4), 587-591. [Google Scholar] [Crossref]

55. Saffari, Mohsen, et al. "The role of religious coping and social support on medication adherence and quality of life among the elderly with type 2 diabetes." Quality of Life Research 28 (2019): 2183-2193. [Google Scholar] [Crossref]

56. Sahoo, J., Mohanty, S., Kundu, A., & Epari, V. (2022). Medication adherence among patients of type II diabetes mellitus and its associated risk factors: a cross- sectional study in a tertiary care hospital of eastern India. Cureus, 14(12). [Google Scholar] [Crossref]

57. Stewart, S. J. F., Moon, Z., & Horne, R. (2023). Medication nonadherence: health impact, prevalence, correlates and interventions. Psychology & health, 38(6), 726-765. [Google Scholar] [Crossref]

58. Sendekie, A. K., Netere, A. K., Kasahun, A. E., & Belachew, E. A. (2022). Medication adherence and its impact on glycemic control in type 2 diabetes mellitus patients with comorbidity: A multicenter cross-sectional study in Northwest Ethiopia. PLoS One, 17(9), e0274971. [Google Scholar] [Crossref]

59. Spinelli, M. A., Haberer, J. E., Chai, P. R., Castillo-Mancilla, J., Anderson, P. L., & Gandhi, M. (2020). Approaches to objectively measure antiretroviral medication adherence and drive adherence interventions. Current Hiv/Aids Reports, 17, 301-314. [Google Scholar] [Crossref]

60. Świątoniowska-Lonc, N., Tański, W., Polański, J., Jankowska-Polańska, B., & Mazur, G. (2021). Psychosocial determinants of treatment adherence in patients with type 2 diabetes–a review. Diabetes, Metabolic Syndrome and Obesity, 2701-2715. [Google Scholar] [Crossref]

61. Sanati, T., Vaezi, A., & Jambarsang, S. (2020). Medication adherence status and its related factors among older adults in Yazd, Iran. Elderly Health Journal, 6(2), 85-90. [Google Scholar] [Crossref]

62. Sato, Y., et al. (2022). Factors associated with medication compliance in elderly patients with type 2 diabetes: A cross-sectional study in Japan. Diabetes Research and Clinical Practice, 183, 109149. https://doi.org/10.1016/j.diabres.2021.109149 [Google Scholar] [Crossref]

63. Świątoniowska-Lonc, N., Tański, W., Polański, J., Jankowska-Polańska, B., & Mazur, G. (2021). Psychosocial determinants of treatment adherence in patients with type 2 diabetes–a review. Diabetes, Metabolic Syndrome and Obesity, 2701-2715. [Google Scholar] [Crossref]

64. Ti, Y. W., Chen, S. K., & Wu, W. C. (2020). A New Visual Cryptography‐Based QR Code System for Medication Administration. Mobile Information Systems, 2020(1), 8885242. [Google Scholar] [Crossref]

65. Wahsheh, H. A., & Al-Zahrani, M. S. (2021, May). Secure and usable QR codes for healthcare systems: the case of covid-19 pandemic. In 2021 12th international conference on information and communication systems (ICICS) (pp. 324-329). IEEE. [Google Scholar] [Crossref]

66. Wilhelmsen, N. C., & Eriksson, T. (2019). Medication adherence interventions and outcomes: an overview of systematic reviews. European Journal of Hospital Pharmacy, 26(4), 187-192. [Google Scholar] [Crossref]

67. Wiecek, E., Tonin, F. S., Torres-Robles, A., Benrimoj, S. I., Fernandez-Llimos, F., & Garcia-Cardenas, V. (2019). Temporal effectiveness of interventions to improve medication adherence: A network meta-analysis. PloS one, 14(3), e0213432. [Google Scholar] [Crossref]

68. Xu, N., Xie, S., Chen, Y., Li, J., & Sun, L. (2020). Factors influencing medication non-adherence among Chinese older adults with diabetes mellitus. International Journal of Environmental Research and Public Health, 17(17), 6012. [Google Scholar] [Crossref]

69. Yazdanpanah, Y., Saleh Moghadam, A. R., Mazlom, S. R., Haji Ali Beigloo, R., & Mohajer, S. (2019). Effect of an educational program based on health belief model on medication adherence in elderly patients with hypertension. Evidence Based Care, 9(1), 52-62. [Google Scholar] [Crossref]

70. Ydirin, C. S. B. (2020). Health literacy and health-promoting behaviors among adults at risk for diabetes in a rural setting. Health Literacy Research, 5(2), 45-56. [Google Scholar] [Crossref]

71. Ydirin, C. S. B. (2021). Health literacy and health-promoting behaviors among adults at risk for diabetes in a remote Filipino community. Belitung Nursing Journal, 7(2), 88. [Google Scholar] [Crossref]

72. Yan, Y., Wu, T., Zhang, M., Li, C., Liu, Q., & Li, F. (2022). Prevalence, awareness and control of type 2 diabetes mellitus and risk factors in Chinese elderly population. BMC Public Health, 22(1), 1382. [Google Scholar] [Crossref]

Metrics

Views & Downloads

Similar Articles