Context: Voter turnout disparities have been associated with poor self-rated health when controlled for income inequality. This association between health and voting yields an underrepresentation of less healthy populations in our democracy. Studies have shown that the health care system provides an opportunity to promote civic engagement among underrepresented demographics by facilitating access to voter registration. Quick Response (QR) codes have shown promise in patient engagement in health care settings, but have not been explored as a tool for voter registration efforts.

Objective: To assess QR codes as a viable and convenient medium for voter registration in primary care clinics

Study Design: Observational pilot study

Setting: Family medicine residency clinic in a patient-centered medical home in Houston, Texas

Population Studied: Staff and patients of the patient-centered medical home who interacted with the voter registration instrument

Intervention/Instrument: Flyers in English and Spanish were printed with customized QR codes leading to Vote.org with Texas-specific forms. The flyers were posted on bulletin boards in 50 clinic exam rooms, six staff work areas, and three staff break areas. Study partner VoteHealth 2020, LLC collected data from QR code interaction via a vote.org account.

Outcome Measures: Number of unique QR code interactions and online form completion rate, including voter verifications and absentee ballot requests

Results: VoteHealth recorded 20 interactions with the QR code interface. Patient room flyers resulted in two voter verifications, one absentee ballot request, and one incomplete absentee ballot request. Staff work area flyers produced seven voter verifications and three voter registrations. Staff break area flyers produced three voter verifications, two registrations, and one incomplete absentee ballot request. Of these interactions, the online form completion rate was 90 percent.

Conclusions: The pilot revealed limited usage of our QR code voter resources, suggesting that presence of QR codes alone is unlikely to facilitate voter registration or increases in civic participation. Instead, QR codes may necessitate supportive elements, such as in-person cues or more explicit user instructions. Future studies should explore coupling QR code-based materials with in-person prompts and guidance.