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| ORIGINAL ARTICLE |
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| Year : 2023 | Volume
: 2
| Issue : 1 | Page : 21-26 |
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Patient education frequency and methods during COVID-19 pandemic and the use of technology as an alternative to conventional methods
Aisha F Badr, Dana Barboud, Yousra Al-Rifae, Alanoud Alzubidi, Lujain Alghamdi
Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| Date of Submission | 01-Mar-2022 |
| Date of Acceptance | 05-Oct-2022 |
| Date of Web Publication | 30-Mar-2023 |
Correspondence Address:
Dr. Aisha F Badr
Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, P.O. Box: 80200, Jeddah
Saudi Arabia
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/sjcp.sjcp_5_22
Background: Patient education (PE) during the coronavirus disease-2019 (COVID-19) pandemic faced various challenges because of social distancing that was implemented to limit the transmission of COVID-19. As a result, traditional, face-to-face PE may have been jeopardized. Objectives: The aim of this study was to therefore compare PE frequency and methods used before and after the pandemic as well as assess the use of technology in this practice. Materials and Methods: A cross-sectional observational study conducted in Jeddah, Saudi Arabia targeted the public of different age groups. An electronic link was shared with questionnaire items that included: (1) respondent’s demographics, (2) PE frequency and methods used before and during the pandemic, (3) familiarity with QR code use, and (4) reasons and deterrents for its use in PE. Results: Our results showed that majority of respondents before COVID-19 pandemic (60.4%) relied on face-to-face method for PE; however, a switch to technology-based methods, such as phone calls 44.8% (n = 86), telehealth 29% (n = 56), and QR code 15.6% (n = 30), was perceived during COVID-19 pandemic. Most respondents (70.3%) support QR code technology for PE particularly due to ease of use (70.8%), followed by accuracy of information 65% (n = 125) and reduce medication errors 57.8% (n = 111). Conclusion: QR code technology suggests a futuristic way that can allow pharmacists to keep a 2-m social distance from patients to reduce the risk of human-to-human transmission of COVID-19 infection. This is an innovative way that uses technology in pharmacy and can be used even after the pandemic. Keywords: COVID-19, innovation, patient education, QR-code, technology
How to cite this article:
Badr AF, Barboud D, Al-Rifae Y, Alzubidi A, Alghamdi L. Patient education frequency and methods during COVID-19 pandemic and the use of technology as an alternative to conventional methods. Saudi J Clin Pharm 2023;2:21-6 |
How to cite this URL:
Badr AF, Barboud D, Al-Rifae Y, Alzubidi A, Alghamdi L. Patient education frequency and methods during COVID-19 pandemic and the use of technology as an alternative to conventional methods. Saudi J Clin Pharm [serial online] 2023 [cited 2023 Jun 10];2:21-6. Available from: http://www.sjcp.org/text.asp?2023/2/1/21/372931 |
| Introduction | |  |
The World Health Organization (WHO) announced the outbreak of coronavirus disease-2019 (COVID-19) pandemic on December 31, 2019. This ongoing pandemic has affected millions globally in both direct and indirect ways.[1]
Due to implemented restrictions amid the spread of the disease, direct patient care is warned by Centers for Disease Control and Prevention (CDC) recommendations of keeping a safe distance (no less than 2 m) and wearing a mask at all times.[2] Social distancing, periodic quarantine, and hospital restrictions caused challenges to healthcare providers regarding patient education (PE) through the traditional face-to-face interaction to limit disease transmission.[3]
One of the most important tasks of a pharmacist is educating patients on their proper use of medications. This task is considered a vital role as it assures patient understanding of what is expected of their medication, and improves both medication and disease knowledge, attitude, practice, and treatment outcome.[4]
Moreover, in one study conducted in the USA, educated patients were found to have better compliance with 85% of medication regimens as compared with noneducated patients (55%). On the contrary, insufficient PE was linked to poor health outcomes, increase hospitalization rates, worsen quality of life, and increased healthcare costs.[5]
During the pandemic, a lot of patients––particularly the elderly––feared going to the pharmacy, because they are at high risk of developing complications from COVID-19. They would also limit their face-to-face interaction for fear of contracting the virus.[6] Furthermore, wearing the mask can also lead to inaudible or misunderstood direction of use, especially for people with hearing impairment.[7] All these may suggest the need for a different way to educate the public on their medications, in an accurate, efficient, and safe method during a pandemic.
In order to simplify, provide adequate knowledge, improve treatment, and reduce patient wait time, advancement in technology has been used in PE process.[8],[9] The advancements in technology have allowed pharmacists to develop a new method for reducing drug adverse events related to medication use, by printing drug information (the correct drug, dose, time, route, patient, and education material) on the medication bottle.[10]
A study conducted in Spain that was held at two health centers and associations of diabetic patients used QR code in the elderly population to educate them on their complex drug regimen.[11] Those patients had a 90% satisfaction rate with using this method, and 95% of patients found the information to be clear.[11]
The technology recommended in both studies; in the form of a Quick Response QR code allows storing large information on medication’s proper use in a small area, which could be placed anywhere on the medication bottle/vial. The method suggests ease of use and access by simply scanning the QR code using a smartphone camera.[12]
Another use was explained in a study conducted in the USA that provided healthcare information in a dermatology clinic, in the form of QR code that was laminated over the clinic’s room. The QR code showed benefits in increasing patient's access to online educational materials by 77.8% for an English version, 66.7% for a Spanish version, and 77.8% for the visually impaired patients.[13]
The aim of this study was to, therefore, compare PE frequency and methods used before and after the pandemic as well as assess the use of technology in this practice.
| Materials and Methods | | |
Study design
Following ethical approval from the Research Ethics Committee of the Faculty of Pharmacy at King Abdul-Aziz University, a cross-sectional observational study was conducted in Jeddah, Saudi Arabia and was distributed from March 15 to 30, 2021. An electronic Google Form survey and a link were shared via social media. Adults over 18 years of age were included. Research collaborators also helped document the responses of 40 patients who were randomly selected at the hospital affiliated by the university.
Before answering the electronic survey, respondents were explained the study aim followed by a consent question that is required to access questionnaire items. Respondents were assured their identity will be anonymous. The survey items included (1) respondent’s sociodemographic, (2) PE method used before and during the pandemic, (3) familiarity with QR code use, and (4) reasons and/or deterrents for its use in PE. Data was gathered and analyzed using Microsoft excel 2019.
Respondent’s questionnaire items
Respondents were encouraged to answer the survey either by themselves or by their caregivers. The survey included 15 questions written in Arabic. Questionnaire items were divided into four sections: the first section was on sociodemographics (gender, place of residence, nationality, age, level of education, and spoken language(s)); second and third were on PE method(s) and frequency conducted by the pharmacist before and during the COVID-19 pandemic, including changes adopted by the pharmacy or hospital they get their medications refilled at (if any). Finally, the fourth section explored the use of QR code technology for PE and whether they support its use for PE or not. Questions asked included: availability of smartphone, familiarity with scanning a QR code, support of QR code use in providing PE, and challenges of using this method as well as any other recommendations or comments. Detailed questionnaire items are listed in [Table 1].
| Results | | |
Respondent’s sociodemographics
A total of 192 respondents consented to participate in the research. Majority were female (n = 109; 56.7%) and between the age of 18 and 24 years old (n = 68; 35.4%). Majority were also Saudis (n = 154; 80.2%), residing in the western region (n = 145; 75.5%) and held a bachelor degree (n = 127; 66.1%). All respondents spoke Arabic (n = 192; 100%) and over half spoke English too (n = 117; 60.9%) [Table 2].
Patient education frequency before and during COVID-19 pandemic
The prevalence of PE did not differ greatly before and during the pandemic. The majority reported that they sometimes get educated on their medication 32.2% (n = 62) and 26% (n = 50) before and during the pandemic, respectively [Figure 1]. | Figure 1: Patient education frequency before and during COVID-19 pandemic (n = 192)
Click here to view |
Patient education methods used before and during COVID-19 pandemic
As shown in [Figure 2], the majority of patients before the COVID-19 pandemic (60.4%; n = 116) used to get educated on their medications using face-to-face encounters. On the contrary, during COVID-19 pandemic the face-to-face method is almost not used at all and is replaced with other technology-based methods such as phone calls (44.8%; n = 86), telemedicine (29%; n = 56) and QR code (15.6%; n = 30) [Figure 2]. | Figure 2: Patient education method before and during COVID-19 pandemic (n = 192)
Click here to view |
Familiarity with QR code use
Most respondents had smartphones (94.8%; n = 182). Furthermore, 80.20% (n = 154) knew how to scan a QR code and 70.3% (n = 135) supported its use in PE [Figure 3]. As shown in [Table 3], one of the main reasons to support QR code technology in PE is ease of use 70% (n = 136), followed by information accuracy 65% (n = 125), and reduced medication errors 57.8% (n = 111). Other reasons are listed in [Table 3]. | Figure 3: Use of new technology (QR code) in health/medication education (n = 192)
Click here to view |
| Discussion | | |
Although there is a lot of literature suggesting the use of technology-based methods in the healthcare internationally to overcome restraints and challenges that faced the healthcare system as a whole, little is known of their adaptation in PE.[3],[14],[15] Our study is the first to document PE frequency and methods used during COVID-19 pandemic in Jeddah, Saudi Arabia.
Survey was fairly distributed between males and females, with good representation of all age groups including the elderly. A diverse population of different level of education was also captured; including 6.25% illiterate who had a caregiver complete the electronic survey or one of our research collaborators. All surveyed participants spoke Arabic and over half spoke English (60.9%), which is the second language In Saudi Arabia.
PE frequency before and during the COVID-19 pandemic did not defer greatly. Since it was represented as a Likert scale, the majority (median) stated that they sometimes get educated on their medications by a pharmacist (32.3% before and 26.04% during the pandemic) or never (21.9% before and 22.4% during the pandemic). Which was surprising to see and may suggest overall poor PE practice even before the pandemic.
As for PE methods, a drop in face-to-face PE was greatly perceived by our respondents, given the nature of disease transmission (59.9%) and so did handing written patient educational materials which dropped by (26.04%). However, a rise in technology-based methods was greatly perceived during the pandemic. Particularly using phone calls, which increased by (17.2%), telemedicine (11.46%), and QR codes (15.6%). Finally, the number of participants who declined having any PE provided upon receiving their medications increased greatly by (21.88%).
All these numbers portray PE challenges during the pandemic and how many institutions have adopted technology-based methods to compensate for the jeopardized traditional methods that may have held the risk of disease transmission.
Moreover, we wanted to assess the diversity of our sample size to assess for any selection bias. Of all respondents (94.8%) had a smartphone and (80.2%) were familiar with QR code technology, and most respondents (95%) supported the use of QR code technology in PE (70.3% yes, 25% maybe).
The utilization of QR Code technology was mainly supported for ease of use (70.8%) followed by information accuracy (65%) and to decrease medication errors (57.8%). It was also chosen for sustainability reasons (56.8%), reduction of COVID-19 transmission (54.2%), and to a lesser extent, increase medication adherence (32%).
Finally, QR code technology proposes an innovative, easy, and low-cost method for PE. This method also offers a solution for educating the deaf, those who have hearing difficulty, and patients who have memory loss such as dementia.
Future studies should investigate which method is most clinically effective. Also, further research should be done to investigate the possibility of adding braille labeling education information in the form of QR code to serve the blind population as well. QR code can also incorporate an educational video on the proper use of certain devices such as inhalers or high-risk medications such as insulin.
This study is limited to individuals who lack smartphone since the survey was distributed via social media portals and thus the results are only limited to this specific population. In addition, patients who do not own a smartphone, will not be able to benefit from this technology. Furthermore, the use of this technology in elderly, illiterate, low socioeconomic, and low-income areas may still be challenging because digital illiteracy is much more common in this population.
| Conclusion | | |
QR technology suggests a futuristic way that can allow pharmacists to keep a two-meter social distance from patients to reduce the risk of human-to-human transmission of COVID-19 infection. This is an innovative way that uses technology in pharmacy and can code for more than just written educational material. The technology used in pharmacy should be further studied and implemented to provide a better quality of care. The study encourages the use of this technology as an alternative or add-on method to traditional face-to-face PE to optimize therapy and minimize risks.
Ethical policy and institutional review board statement
This study was approved by the research ethics committee in King Abdulaziz University, faculty of pharmacy on March 4, 2021 (reference number 1442–59).
Financial support and sponsorship
Not applicable.
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3]
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