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

OBJECTIVE: To develop a reliable and valid instrument to assess the understandability and actionability of print and audiovisual materials.
METHODS: We compiled items from existing instruments/guides that the expert panel assessed for face/content validity. We completed four rounds of reliability testing, and produced evidence of construct validity with consumers and readability assessments.
RESULTS: The experts deemed the PEMAT items face/content valid. Four rounds of reliability testing and refinement were conducted using raters untrained on the PEMAT. Agreement improved across rounds. The final PEMAT showed moderate agreement per Kappa (Average K=0.57) and strong agreement per Gwet's AC1 (Average=0.74). Internal consistency was strong (α=0.71; Average Item-Total Correlation=0.62). For construct validation with consumers (n=47), we found significant differences between actionable and poorly-actionable materials in comprehension scores (76% vs. 63%, p<0.05) and ratings (8.9 vs. 7.7, p<0.05). For understandability, there was a significant difference for only one of two topics on consumer numeric scores. For actionability, there were significant positive correlations between PEMAT scores and consumer-testing results, but no relationship for understandability. There were, however, strong, negative correlations between grade-level and both consumer-testing results and PEMAT scores.
CONCLUSIONS: The PEMAT demonstrated strong internal consistency, reliability, and evidence of construct validity. PRACTICE IMPLICATIONS: The PEMAT can help professionals judge the quality of materials (available at: http://www.ahrq.gov/pemat).