Evaluating the Understandability and Actionability of Web-Based Education Materials for Patients Taking Non-vitamin K Oral Anticoagulants

Assessing a Virtual Education Intervention for Patients With Atrial Fibrillation: A Qualitative Study of Patient Perceptions

BACKGROUND

Authors of studies of patients with atrial fibrillation (AF) have identified several knowledge gaps and misconceptions regarding the condition and its management. The COVID-19 pandemic heightened isolation of patients and underscored the need for education and knowledge building in order for patients to effectively manage AF during times of increased health risk.

OBJECTIVE

The aim of this study was to assess, using a qualitative approach, the experiences and perceived benefits of patients with AF regarding an 8-session virtual education intervention (AF-at-Home) during the early months of the COVID-19 pandemic.

METHODS

A qualitative study with 3 focus groups using a semistructured focus group guide was conducted and recorded online with the same trained moderator.

RESULTS

We identified 7 primary themes emerging from patients' experiences: (1) building knowledge beyond information available in clinic visits, (2) managing anxiety, (3) generating self-efficacy, (4) providing social comparison, (5) perceived benefits of both experiential and informational content, (6) facilitating self-management behaviors, and (7) facilitating communication with providers.

CONCLUSIONS

The analysis of the focus groups shows the benefits of a virtual education program in building knowledge, skills, and self-efficacy as well as reducing anxiety and normalizing one's experience by attending a program alongside other patients with AF.

Appraising publicly available online resources to support patients considering decisions about medical assistance in dying in Canada: an environmental scan

BACKGROUND

Medical assistance in dying (MAiD) was legalized in Canada in 2016, with legislation updated in 2021. It is unclear whether resources are available to help patients make this difficult decision; therefore, we sought to identify and quality appraise Canadian MAiD resources for supporting patients making this decision.

METHODS

We conducted an environmental scan by searching Canadian websites for online MAiD resources that were published after the 2016 MAiD legislation, patient targeted, publicly accessible and able to inform decisions about MAiD in Canada. We excluded resources that targeted health care professionals or policy-makers, service protocols and personal narratives. Two authors appraised resources using the International Patient Decision Aids Standards (IPDAS) criteria and the Patient Education Materials Assessment Tool (PEMAT) for health literacy. Descriptive analysis was conducted. We defined resources as patient decision aids if 7 IPDAS defining criteria were met, and we rated resources as adequate for understandability or actionability if the PEMAT score was 70% or greater.

RESULTS

We identified 80 MAiD resources. As of March 2023, 62 resources (90%) provided eligibility according to the 2021 legislation and 11 did not discuss any eligibility criteria. The median IPDAS score was 3 out of 7; 52% discussed alternative options and none provided benefits or harms. Of 80 resources, 59% were adequate for understandability and 29% were adequate for actionability.

INTERPRETATION

Although many resources on MAiD were updated with 2021 legislation, few were adequate to support patients with lower health literacy. There is a need to determine whether a patient decision aid would be appropriate for people in Canada considering MAiD.

Quality of patient decision aids to support the public making COVID-19 decisions: An online environmental scan

OBJECTIVE

To identify and appraise the quality of COVID-19 patient decision aids (PtDAs).

METHODS

We conducted an environmental scan of online publicly available COVID-19 PtDAs. Two reviewers independently searched and extracted data. We calculated median International Patient Decision Aid Standards (IPDAS) scores and proportion scoring > 70% on Patient Education Materials Information Tool (PEMAT) adequate for understandability and actionability.

RESULTS

Of 876 resources identified, 12 were PtDAs. Decisions focused on initial COVID-19 vaccination series (n = 9), location of care for elderly (n = 2), and social distancing (n = 1). All 12 PtDAs were written materials and two had accompanying videos. The median IPDAS score minimizing risk of biased decisions was 4 of 6 items (IQR 1, range 2-4). For PEMAT, 92% had adequate for understandability and none for actionability.

CONCLUSIONS

We identified few online publicly available COVID-19 PtDAs and none were about COVID-19 vaccination boosters or treatment. PtDAs scored poorly on actionability and none met all IPDAS criteria for minimizing risk of biased decisions.

PRACTICE IMPLICATIONS

PtDA developers for COVID-19 and future pandemics should ensure their PtDAs meet all IPDAS criteria for minimizing risk of bias, have adequate scores for actionability, and are disseminated in the A to Z inventory.

The Chinese Version of the Patient Education Materials Assessment Tool for Printable Materials: Translation, Adaptation, and Validation Study

BACKGROUND

Providing people with understandable and actionable health information can considerably promote healthy behaviors and outcomes. To this end, some valid and reliable scales assessing the patient-friendliness of health education materials, like the PEMAT-P (Patient Education Materials Assessment Tool for printable materials), have been well developed in English-speaking countries. However, the English version of the PEMAT-P has not been translated and adapted into simplified Chinese and validated in mainland China.

OBJECTIVE

This study sought to translate the PEMAT-P tool into a simplified Chinese (Mandarin) version (C-PEMAT-P, a Chinese version of the Patient Education Materials Assessment Tool for printable materials) and verify its validity and reliability for assessing the comprehensibility and actionability of health education resources written in simplified Chinese. As a result, the validated C-PEMAT-P could be used to guide health researchers and educators to design more comprehensible and actionable materials for more tailored and targeted health education and interventions.

METHODS

We translated the PEMAT-P into simplified Chinese in the following three steps: (1) forward-translating the PEMAT-P into simplified Chinese, (2) back-translating the simplified Chinese version into English, and (3) testing translation equivalence linguistically and culturally by examining the original English version of the PEMAT-P and the back-translated English version of the tool. Any discrepancies between the original English tool and the back-translated English tool were resolved through a panel discussion among the research team of all authors to produce a revised forward-translated Chinese version (C-PEMAT-P). We then evaluated the clarity of construction and wording as well as the content relevance of the C-PEMAT-P using a 4-point ordinal scale to determine its content validity. After that, 2 native Chinese speakers (health educators) used the C-PEMAT-P to rate 15 health education handouts concerning air pollution and health to validate their reliability. We calculated the Cohen coefficient and Cronbach α to determine the interrater agreement and internal consistency of the C-PEMAT-P, respectively.

RESULTS

We finalized the translated Chinese tool after discussing the differences between the 2 English versions (original and back-translated) of the PEMAT-P, producing the final Chinese version of the PEMAT-P (C-PEMAT-P). The content validity index of the C-PEMAT-P version was 0.969, the Cohen coefficient for the interrater scoring agreement was 0.928, and the Cronbach α for internal consistency was .897. These values indicated the high validity and reliability of the C-PEMAT-P.

CONCLUSIONS

The C-PEMAT-P has been proven valid and reliable. It is the first Chinese scale for assessing the comprehensibility and actionability of Chinese health education materials. It can be used as an assessment tool to evaluate health education materials currently available and a guide to help health researchers and educators design more comprehensible and actionable materials for more tailored and targeted health education and interventions.

Translation, Cross-Cultural Adaptation, and Validation of the Japanese Version of the Patient Education Materials Assessment Tool (PEMAT)

BACKGROUND

The Patient Education Materials Assessment Tool (PEMAT) systematically evaluates the understandability and actionability of patient education materials. This study aimed to develop a Japanese version of PEMAT and verify its reliability and validity.

METHODS

After assessing content validation, experts scored healthcare-related leaflets and videos according to PEMAT to verify inter-rater reliability. In validation testing with laypeople, the high-scoring material group (n = 800) was presented with materials that received high ratings on PEMAT, and the low-scoring material group (n = 799) with materials that received low ratings. Both groups responded to the understandability and actionability of the materials and perceived self-efficacy for the recommended actions.

RESULTS

The Japanese version of PEMAT showed strong inter-rater reliability (PEMAT-P: % agreement = 87.3, Gwet's AC1 = 0.83. PEMAT-A/V: % agreement = 85.7, Gwet's AC1 = 0.80). The high-scoring material group had significantly higher scores for understandability and actionability than the low-scoring material group (PEMAT-P: understandability 6.53 vs. 5.96, p < 0.001; actionability 6.04 vs. 5.49, p < 0.001; PEMAT-A/V: understandability 7.65 vs. 6.76, p < 0.001; actionability 7.40 vs. 6.36, p < 0.001). Perceived self-efficacy increased more in the high-scoring material group than in the low-scoring material group.

CONCLUSIONS

Our study showed that materials rated highly on Japanese version of PEMAT were also easy for laypeople to understand and action.

A health literacy analysis of the consumer-oriented COVID-19 information produced by ten state health departments

Objective:

The COVID-19 pandemic highlights the public's need for quality health information that is understandable. This study aimed to identify (1) the extent to which COVID-19 messaging by state public health departments is understandable, actionable, and clear; (2) whether materials produced by public health departments are easily readable; (3) relationships between material type and understandability, actionability, clarity, and reading grade level; and (4) potential strategies to improve public health messaging around COVID-19.

Methods:

Based on US Centers for Disease Control and Prevention statistics from June 30, 2020, we identified the ten states with the most COVID-19 cases and selected forty-two materials (i.e., webpages, infographics, and videos) related to COVID-19 prevention according to predefined eligibility criteria. We applied three validated health literacy tools (i.e., Patient Education Materials Assessment Tool, CDC Clear Communication Index, and Flesch-Kincaid Grade Level) to assess material understandability, actionability, clarity, and readability. We also analyzed correlations between scores on the three health literacy tools and material types.

Results:

Overall, COVID-19 materials had high understandability and actionability but could be improved in terms of clarity and readability. Material type was significantly correlated with understandability, actionability, and clarity. Infographics and videos received higher scores on all tools.

Conclusions:

Based on our findings, we recommend public health entities apply a combination of these tools when developing health information materials to improve their understandability, actionability, and clarity. We also recommend using infographics and videos when possible, taking a human-centered approach to information design, and providing multiple modes and platforms for information delivery.

Evaluation of online Spanish and English health materials for preventive mastectomy. are we providing adequate information?

PURPOSE

Breast cancer remains the leading cause of cancer-related death in US Hispanic women. When present, lower health literacy levels potentially within this patient population require tailored materials to address health disparities. We aim to evaluate and compare Spanish and English online health care informative resources on preventive mastectomy.

METHODS

A Google web search using "preventive mastectomy" and "mastectomía preventiva" was conducted. The first ten institutional/organizational websites in each language were selected. Assessment of mean reading grade level, cultural sensitivity, understandability, and actionability was carried out utilizing validated tools.

RESULTS

The mean reading grade level for English materials was 14.69 compared with 11.3 for Spanish, both exceeding the recommended grade level established by the AMA and NIH. The mean cultural sensitivity score for English information was 2.20 compared with 1.88 for Spanish information, both below the acceptability benchmark of 2.5. English webpages scored 65% and 35% for understandability and actionability, respectively, while Spanish webpages scored 47% and 18%.

CONCLUSIONS

Online English and Spanish preventive mastectomy materials were written at an elevated reading level and lacked cultural sensitivity. Spanish language information demonstrated inferior understandability, actionability, and cultural sensitivity. Addressing these issues provides an opportunity to help resolve health literature disparities regarding preventive mastectomy for US Hispanic women.