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

Patient Educ Couns. 2014 Sep;96(3):395-403. doi: 10.1016/j.pec.2014.05.027. Epub 2014 Jun 12.


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:

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

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Audiovisual Aids
  • Communication
  • Community Participation
  • Comprehension*
  • Health Literacy / standards*
  • Humans
  • Mass Media
  • Patient Education as Topic / standards*
  • Reproducibility of Results
  • Teaching Materials / standards*