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