ArticleHealth expectations : an international journal of public participation in health care and health policy2026
Development, Suitability and Comprehensibility of a QR Code-Enabled Educational Package to Improve Self-Care Practices Among Patients With Type 2 Diabetes: A Multimethod Study in Iran.
Article in Health expectations : an international journal of public participation in health care and health policy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Not yet cited in PubMed.
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Abstract
backgroundEffective type 2 diabetes (T2DM) education must be culturally relevant and accessible to patients with varying literacy levels. In Iran, most materials lack locally tailored, multimedia-enhanced guidance.
objectiveTo develop a culturally tailored, QR code-enabled educational package for T2DM self-care and perform a preliminary assessment of its suitability, readability, and comprehensibility.
methodsThis multimethod study (February-October 2025) was conducted in two phases. In Phase 1, we developed the package through a focused literature review and semi-structured interviews with 30 patients and 10 healthcare professionals. Content was synthesized via conventional content analysis. In Phase 2, a multidisciplinary panel of 30 experts assessed the package using the Suitability Assessment of Materials (SAM) and Readability Assessment of Materials (RAM) tools. Additionally, 30 patients evaluated comprehensibility using the Cloze readability test. Inter-rater agreement was measured using Fleiss' κ.
resultsThe resulting 20-page A5 booklet, Take Control: Your Guide to Effective Diabetes Self-Care, is supplemented by 12 QR-linked digital resources. Content covers diet/lifestyle, foot care, resource utilization, and medication adherence. The overall SAM score was 78.4% (superior suitability), and RAM scores reached the maximum for all components. The mean Cloze score (72.3%) indicated an independent reading level. Expert agreement was strong (Fleiss' κ = 0.82).
conclusionThis QR-enabled package is culturally appropriate and highly readable for patients with T2DM. While clinical effectiveness was not evaluated, these results support its potential for further testing in routine diabetes care. PATIENT OR PUBLIC CONTRIBUTION: Patients acted as study participants, providing qualitative data for content development and evaluating the final material's readability. They were not involved in study design, data analysis, or manuscript preparation.
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