If patients and consumers don’t understand patient education materials — or don't know what action to take after reading or viewing them — those materials aren’t doing their job.
The result could be confusion, disengagement, or poor health outcomes.
But how do we know whether health education materials are effective? One important health literacy tool that is used to assess patient education materials is the Patient Education Materials Assessment Tool (PEMAT).
Why is the PEMAT important, and how can medical communicators use it to get better results?
What Is the PEMAT?
The PEMAT was developed under contract by the Agency for Healthcare Research and Quality (AHRQ). Medical communicators can use this simple scoring tool to determine if audiences, especially patients, will be able to understand materials and take the recommended actions.
What It Does
The AHRQ describes PEMAT as “a systematic method to evaluate and compare the understandability and actionability of patient education materials.” Here’s how the PEMAT User’s Guide defines these two measures.
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“Understandability: Patient education materials are understandable when consumers of diverse backgrounds and varying levels of health literacy can process and explain key messages.”
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“Actionability: Patient education materials are actionable when consumers of diverse backgrounds and varying levels of health literacy can identify what they can do based on the information presented.”
There are two versions of the PEMAT. The PEMAT-P is for printable materials such as brochures, pamphlets, and PDFs. The PEMAT-A/V is for audiovisual materials such as videos and multimedia products.
The PEMAT does not check for accuracy. So a material could be quite understandable but contain inaccurate information.
Medical communicators can add the PEMAT to their toolkits as a way to evaluate printed materials, including anything that can be printed or viewed on a website. Note: It isn’t designed to determine the user-friendliness of a website.
PEMAT Terms and Examples
The Patient Education Materials Assessment Tool (PEMAT) and User’s Guide provides a useful list of terms and examples of the types of health education materials that the PEMAT can be used to assess. The following are the PEMAT’s definitions of materials.
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Printed or printable materials are “booklets, brochures, and materials that can be printed from a Website (e.g., PDFs of html text).”
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Audiovisual (A/V) materials “include a visual component that may be accompanied by a sound component, such as a video or a multimedia material but not a podcast.” The following are examples of audiovisual materials:
- Video
- An interactive tutorial with narration
- A multimedia material that combines text, audio, still images, animation, video, or interactive content
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Very Short Material is
- Printable (P): “a material with two or fewer paragraphs and no more than 1 page in length.”
- Audiovisual (A/V): “A video or multimedia presentation that is under 1 minute, or a multimedia material that has 6 or fewer slides or screenshots.”
Using PEMAT To Assess a Material
The PEMAT User’s Guide recommends reading through the guide and the material you are rating before completing the assessment. You’ll need to decide whether you are rating printable materials (PEMAT-P) or audiovisual works (PEMAT-A/V). For printable materials, there are 24 questions; for A/V materials there are 17.
Each item has an option to Agree or Disagree, and some have a Not Applicable (NA) option.
When you calculate the material’s scores, the PEMAT has two different scores. The first is for the material’s understandability. The second rates its actionability.
Scoring Understandability
What types of questions are on the PEMAT to determine how understandable a material is?
The person evaluating the material is asked to Disagree or Agree with statements that assess how the average reader would respond to key elements of materials: Content, Word Choice & Style, Organization, and Layout & Design. The PEMAT User’s Guide provides examples. For example, the following are the PEMAT’s Content questions:
Content
Item 1: The material makes its purpose completely evident.
“The material uses a title or upfront text that clearly tells you at a glance what the material is about.” Example: Choose AGREE for the title “What will happen during your mammogram,” but Choose DISAGREE for the title “Mammograms and You.”
Item 2: The material does not include information or content that distracts from its purpose (P).
“The material’s content is focused and relevant to its purpose, and no information distracts or detracts from the material’s purpose.” Examples are excessive details about equipment, procedures, or background of a disease or condition that distract the audience from the message.
Scoring Actionability
Patient education materials need to be understandable and must also convey to audiences what they need to do. The Actionability section of the PEMAT includes the following statements:
- “The material clearly identifies at least one action the user can take.
- “The material addresses the user directly when describing actions.”
- “The material breaks down any action into manageable, explicit steps.”
- “The material explains how to use the charts, graphs, tables, or diagrams to take actions.”
Everyday Language for Clear Health Communication
The PEMAT items 3 and 4 under the topic “Word Choice & Style” may be especially important for medical writers who create health literacy materials.
Item 3 reads, “The material uses common, everyday language.” In short, cut the jargon.
AHRQ’s website provides the following explanation:
“The material should use common, everyday language that would be easy to understand for most consumers or patients nearly all of the time. Jargon (i.e., technical language) should not be used.”
Acronyms should be spelled out or defined the first time they are used. The use of acronyms should be limited, unless they are well known, such as CT or CAT scan. The following are some other examples of everyday terms:
- Doctor, not physician
- Runny nose, not excess mucus
- Pain killer, not analgesic
- Swelling, not inflammation
- Helpful, not beneficial
- Feverish, not febrile
Using Medical Terms
Item 4 of the PEMAT reads, “Medical terms are used only to familiarize audience with the terms. When used, medical terms are defined.”
Medical terms can make patient education materials difficult to understand. That’s why medical procedures, medical devices, drug classes, and conditions need to be explained in terms that the patient can understand.
Here are a couple of examples of how to use medical terms from the AHRQ’s explanation:
- You can have high blood pressure (hypertension) for years without any symptoms. Uncontrolled high blood pressure increases your chances of serious health problems, including heart attack and stroke.
- A heart attack occurs when blood flow to a part of your heart is blocked for a long time and part of the heart muscle is damaged or dies. The medical term for this is myocardial infarction.
Better Communication = Better Health
Medical writers, health communicators, and health care providers are all responsible for creating effective patient education materials that are easy to understand and act on.
No evaluation tool can replace the human brain when it comes to determining accuracy or common sense, but the PEMAT is a reliable tool that can make patient education materials better.
Internet Citation: Topic: Word Choice & Style. Content last reviewed November 2020. Agency for Healthcare Research and Quality, Rockville, MD.
https://www.ahrq.gov/health-literacy/patient-education/pemat4.html
