Improving Electronic Health Records Patient Education Materials

Health literacy refers to an individual’s ability to read, understand, and use health care information to make decisions about treatment. An estimated 90 million people in the United States have limited health literacy. A low level of patient health literacy can undermine communication between physician and patient, resulting in substandard care. Therefore, health literacy must be a factor in the design of health information and patient educational materials to help patients receive better care.

Abt Associates, in partnership with the Mongan Institute for Health Policy at Massachusetts General Hospital (MGH), and Northwestern University’s Health Literacy and Learning Program (HeLP), developed the Patient Education Materials Assessment Tool (PEMAT). The Patient PEMAT is a systematic method to evaluate and compare the understandability and actionability of patient education materials. It is designed as a guide to help determine whether patients will be able to understand and act on information. Patient education materials are understandable when consumers of diverse backgrounds and varying levels of health literacy can process and explain key messages. 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. Using an inventory of both desirable and undesirable characteristics of patient education materials, the PEMAT produces separate numeric scores for understandability and actionability.

The PEMAT was developed by the research team working with a panel of experts in health literacy, content creation, patient education, and communication. PEMAT items were based on items from existing instruments and concepts in guides to assess and develop patient education materials. Four rounds of reliability testing and refinement were conducted using raters who were not trained in the use of the PEMAT. Consumer testing and comparisons with readability assessments were used to determine construct validity, that is, whether the PEMAT was in fact measuring understandability and actionability. The PEMAT demonstrated strong internal consistency, reliability among raters, and evidence of construct validity.

The tool and user guide is available at: http://www.ahrq.gov/pemat.