This increases the risk of poor health outcomes and mortality, especially in people with pre-existing health conditions.

Poor health literacy is associated with reduced access to healthcare services and negatively affects patient self-management and empowerment (Protheroe et al, 2009).

Digital health can improve patient understanding, but effort is needed to ensure information and services are accessible and digitally inclusive to give equity of care.

This is extremely relevant for respiratory patients as people with chronic obstructive lung disease have an increased risk of poor health literacy, leading to poor health outcomes (Azkan Ture et al, 2022).

Evaluating the effective delivery of inhaled medical treatment is particularly important for respiratory patients as a systemic review of inhaler technique shows only 31% of inhaler users have correct technique (Sanchis et al, 2015).

When taking inhaled medication, it is important the molecules reach the lungs to ensure therapeutic effect. This depends on good inhaler technique.

If inhaler technique is poor, medication is not as effective, which can lead to lack of bronchodilation and symptom control.

Ensuring inhaler technique is correct reduces the risk of poor health outcomes, ensures patients are prescribed the correct device and reduces NHS costs.

“Ensuring inhaler technique is correct reduces the risk of poor health outcomes and ensures patients are prescribed the correct device”

As a respiratory nurse specialist, I spend a lot of time educating patients on how to use their inhalers correctly.

In my former role at the East and North Hertfordshire NHS Trust, I was contemplating how we could ensure equal, accessible health literature for patients with poor health literacy when I stumbled upon a QR poster in the surgical department.

Scanning the QR code provided information on surgical procedures and aftercare.

It seemed such a simple and sustainable way of sharing information, I was keen to adapt this idea to meet the needs of our respiratory patients.

To make it accessible to all patients, the QR would need to link to a video whereas the QR poster on the surgical ward only directed patients to written information.

As part of the Plan, Do, Study, Act cycle, we planned to place the QR inhaler poster on the respiratory ward.

It would generate a learning experience and could be a welcome activity patients could do when waiting on the wards.

It could also be used as part of everyday medication review and optimisation by different health professionals.

After discussion with the wider team, the QR inhaler poster began to take shape.  The QR codes were generated to link to an NHS website video of the inhaler technique the patient wished to view.

The health liaison team were contacted to ensure input from healthcare professionals working with adults with learning disabilities, alongside the expert by experience panel, for service user review.

This feedback highlighted the need for an alternative resource for adults with learning disabilities, which is currently being developed.

On completion, we uploaded the poster onto the trust’s respiratory team Twitter page.  Feedback from the respiratory community was positive, with many NHS and non-NHS organisations requesting that the resource was shared.

The team is now being supported by the Association of Respiratory Specialist Nurses (ARNS) to develop the poster, so it is sustainable and robust enough to be shared nationally.

This has connected us with other services wishing to support the project, such as Respiratory Futures. Asthma and Lung UK have also granted permission for the QR codes to link to the videos on their website. I am now continuing this work with another trust.

The QR inhaler poster is a modern way of reducing health literacy inequalities and will hopefully be a catalyst for more conversations about inhaler technique education. I hope it encourages nurses to review and educate patients using inhaled therapy on correct technique.

I also hope it inspires you to review health literature within your service and think of creative ways to break down barriers to ensure people with poor health literacy can access suitable and alternative health literature and resources.

Sarah Lewis is physical health nurse at Hertfordshire Partnership University NHS Foundation Trust

References

Azkan Ture D et al (2022) Health literacy and health outcomes in chronic obstructive pulmonary disease patients: an explorative study. Front Public Health 10:846768.

Protheroe J et al (2009) Health literacy: a necessity for increasing participation in health care. The British Journal of General Practice; 59: 567, 721–723.

Public Health England (2015) Local Action on Health Inequalities: Improving Health Literacy. PHE

Sanchis J et al (2016) Aerosol drug management improvement team (ADMIT). Systematic review of errors in inhaler use: has patient technique improved over time? Chest; 150:2, 394-406.