Development of the Patient Education Materials Assessment Tool (PEMAT): A new measure of understandability and actionability for print and audiovisual patient information

Patient Education and Counseling

Volumn 96, Issue 3, 2014, Pages 395-403

  Shoemaker, Sarah J ^a   Wolf, Michael S ^b   Brach, Cindy ^c  

^a ABT ASSOCIATES   (United States)

^b NORTHWESTERN UNIVERSITY   (United States)

^c AGENCY FOR HEALTHCARE RESEARCH AND QUALITY   (United States)

Author keywords

Assessment; Audiovisual materials; Clear communication; Educational materials; Health literacy; Instrument development; Measurement; Patient education; Plain language; Readability

Indexed keywords

ADULT; AGED; ARTICLE; AUDIOVISUAL EQUIPMENT; CLINICAL ASSESSMENT TOOL; CONSUMER; CONTENT VALIDITY; CONTROLLED STUDY; EDUCATION; FEMALE; HEALTH LITERACY; HISPANIC; HUMAN; INTERNAL CONSISTENCY; INTERRATER RELIABILITY; MALE; PATIENT EDUCATION; PATIENT EDUCATION MATERIALS ASSESSMENT TOOL; PATIENT INFORMATION; PRINTING; PRIORITY JOURNAL; QUALITATIVE ANALYSIS; READING; RELIABILITY; SCORING SYSTEM; AUDIOVISUAL AID; COMPREHENSION; INTERPERSONAL COMMUNICATION; MASS MEDIUM; REPRODUCIBILITY; STANDARDS; TEACHING;

AUDIOVISUAL AIDS; COMMUNICATION; COMPREHENSION; CONSUMER PARTICIPATION; HEALTH LITERACY; HUMANS; MASS MEDIA; PATIENT EDUCATION AS TOPIC; REPRODUCIBILITY OF RESULTS; TEACHING MATERIALS;

EID: 84906790020     PISSN: 07383991     EISSN: 18735134     Source Type: Journal    
DOI: 10.1016/j.pec.2014.05.027     Document Type: Article

References (37)

1. U.S.Department of Health and Human Services Healthy people 2010 2000, Washington, DC, U.S. Government Printing Office. 2nd ed.
2. Berkman N.D., Sheridan S.L., Donahue K.E., Halpern D.J., Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med 2011, 155:97-107.
3. Dewalt D.A., Berkman N.D., Sheridan S., Lohr K.N., Pignone M.P. Literacy and health outcomes: a systematic review of the literature. J Gen Intern Med 2004, 19:1228-1239.
4. Keller D.L., Wright J., Pace H.A. Impact of health literacy on health outcomes in ambulatory care patients: a systematic review. Ann Pharmacother 2008, 42:1272-1281.
5. Health literacy: a prescription to end confusion 2004, National Academies Press, Washington, DC. L. Nielsen-Bohlman, A.M. Panzer, D.A. Kindig (Eds.).
6. U.S.Department of Health and Human Services Research-based web design and usability guidelines 2006, U.S. Government Printing Office, Washington, DC, Available from http://www.usability.gov/sites/default/files/documents/guidelines_book.pdf?post=yes [accessed 23.08.13].
7. Brach C., Keller D., Hernandez L.M., Baur C., Parker R., Dreyer B., et al. Ten attributes of a health literate health care organization 2012, Institute of Medicine, Washington, DC.
8. Baker D.W. The meaning and the measure of health literacy. J Gen Intern Med 2006, 21:878-883.
9. Rudd R. Objective 11-2. Improvement of health literacy. Communicating health: priorities and strategies for progress 2003, U.S. Department of Health and Human Services, Washington, DC.
10. U.S.Department of Health and Human Services, Office of Disease Prevention and Health Promotion National action plan to improve health literacy 2010, Available from http://www.health.gov/communication/hlactionplan/pdf/Health_Literacy_Action_Plan.pdf [accessed 23.08.13].
11. Pfizer Clear Health Communication Initiative Pfizer principles for clear health communication 2004, Available from http://www.pfizerhealthliteracy.com/asset/pdf/PfizerPrinciples.pdf [accessed 23.08.13]. 2nd ed.
12. U.S.Department of Health and Human Services, Office of Disease Prevention and Health Promotion Quick guide to health literacy 2010, Available from http://www.health.gov/communication/literacy/quickguide/ [accessed 23.08.13].
13. Centers for Medicare & Medicaid Services The toolkit for making written material clear and effective 2012, Available from http://www.cms.gov/WrittenMaterialsToolkit/ [accessed 23.08.13].
14. National Institutes of Health, National Cancer Institute Clear & simple: developing effective print materials for low-literate readers 2013, Available from http://www.cancer.gov/cancertopics/cancerlibrary/clear-and-simple [accessed 23.08.13].
15. National Institutes of Health, U.S.National Library of Medicine How to write easy-to-read health materials 2013, Available from http://www.nlm.nih.gov/medlineplus/etr.html [accessed 23.08.13].
16. Friedman D.B., Hoffman-Goetz L. A systematic review of readability and comprehension instruments used for print and web-based cancer information. Health Educ Behav 2006, 33:352-373.
17. Doak C.C., Doak L.G., Root J.H. Teaching patients with low literacy skills 1996, Lippincott, Philadelphia. 2nd ed.
18. Helitzer D., Hollis C., Cotner J., Oestreicher N. Health literacy demands of written health information materials: an assessment of cervical cancer prevention materials. Cancer Control 2009, 16:70-78.
19. Clayton L. TEMPtEd: development and psychometric properties of a tool to evaluate material used in patient education. J Adv Nurs 2009, 65:2229-2238.
20. Charnock D., Shepperd S., Needham G., Gann R. DISCERN: an instrument for judging the quality of written consumer health information on treatment choices. J Epidemiol Commun Health 1999, 53:105-111.
21. Northwest Territories Literacy Council. A plain language audit toolkit. 2008. Available from [accessed 23.08.13]. http://www.nald.ca/library/learning/nwt/auditool/audit.pdf.
22. Smith S. Reviewer's guide to evaluating health information materials 2008, Available from http://www.beginningsguides.com/upload/Reviewers-Guide.pdf [accessed 23.08.13].
23. Literacy Partners of Manitoba ClearDoc Index 2004, Available from http://www.nald.ca/library/research/defining/33.htm [accessed 23.08.13].
24. Kaphingst K.A., Kreuter M.W., Casey C., Leme L., Thompson T., Cheng M.-R., et al. Health Literacy INDEX: development, reliability, and validity of a new tool for evaluating the health literacy demands of health information materials. J Health Commun 2012, 17(Suppl. 3):203-221.
25. Centers for Disease Control and Prevention CDC clear communication index 2013, Available from http://www.cdc.gov/healthcommunication/ClearCommunicationIndex/ [accessed 23.08.13].
26. Fleiss J.L. Measuring nominal scale agreement among many raters. Psychol Bull 1971, 76:378-382.
27. Cohen J. A coefficient of agreement for nominal scales. Educ Psychol Meas 1960, 20:37-46.
28. Landis J.R., Koch G.G. The measurement of observer agreement for categorical data. Biometrics 1977, 33:159-174.
29. Gwet K.L. Computing inter-rater reliability and its variance in the presence of high agreement. Br J Math Stat Psychol 2010, 61:29-48.
30. Feinstein A.R., Cicchetti D.V. High agreement but low kappa: I. The problems of two paradoxes. J Clin Epidemiol 1990, 43:543-549.
31. Nurss J.R., Parker R.M., Williams M.V., Baker D.W. Short test of functional health literacy in adults (STOFHLA) 2001, Peppercorn, Hartford, MI.
32. Parker R.M., Baker D.W., Williams M.V., Nurss J.R. The test of functional health literacy in adults: a new instrument for measuring patients' literacy skills. J Gen Intern Med 1995, 10:537-541.
33. Stata 11.2, MP-Parallel ed. [Computer software], College Station, TX: StataCorp; 2011.
34. Davis T.C., Wolf M.S., Bass P.F., Middlebrooks M., Kennen E., Baker D.W., et al. Low literacy impairs comprehension of prescription drug warning labels. J Gen Intern Med 2006, 21:847-851.
35. Stenner A.J., Horabin I., Smith D.R., Smith M. The Lexile Framework 1988, MetaMetrics, Durham, NC.
36. Wolf M.S., Shekelle P., Choudry N.K., Agnew-Blais J., Parker R.M., Shrank W.H. Variability in pharmacy interpretations of physician prescriptions. Med Care 2009, 47:370-373.
37. Finnie R.K.C., Felder T.M., Linder S.K., Mullen P.D. Beyond reading level: a systematic review of the suitability of cancer education print and web-based materials. J Cancer Educ 2010, 25:497-505.