The Patient Education Materials Assessment Tool (PEMAT) and User’s Guide

Domain: Understandability

Topic: Use of Visual Aids

Item 15: The material uses visual aids whenever they could make content more easily understood (e.g., illustration of healthy portion size) (P)

Ratings: Disagree = 0       Agree = 1

Explanation

The material should use a visual aid whenever it would make the content easier to understand. For example, an illustration of a healthy portion size would increase understanding beyond using just text to describe the size of a healthy portion. This also includes using graphic displays to make numeric information easier to understand. If you can think of a meaningful visual aid that could have been added to clarify the meaning of text, you should disagree with this item.

Examples

CHOOSE "AGREE"–Illustration of portion sizes

Picture of a poster showing portion sizes for grains, vegetables and fruit, dairy and cheese, meat, and fats.

From National Heart, Lung, and Blood Institute, Stay Young at Heart
http://hp2010.nhlbihin.net/portion/servingcard7.pdf

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Item 16: The material's visual aids reinforce rather than distract from the content (P)

Ratings: Disagree = 0       Agree = 1    No visual aids = N/A

Not Applicable

Choose N/A if the material has no visual aids.

Explanation

The material should only use visual aids that reinforce or relate to the content being presented, or visual aids can provide examples or clarify information. While some materials may use a lot of visual aids to break-up the text and keep the material visually interesting, this does not necessarily benefit understandability.

Ask yourself whether the visuals largely reinforce and relate to the content. If they do not reinforce content, especially if they distract from the content, then choose "Disagree." Similarly, for a generic picture that neither describes the content nor provides further explanation, choose "Disagree."

Examples

CHOOSE "AGREE"–Visual aid that reinforces

The following visual aid reinforces the content by illustrating levels of activity.

A graphic showing the levels of activitiy from 'not active' to 'very active.'

From NIH We Can! Campaign, Parent Tips: Calories Needed Each Day.
http://www.nhlbi.nih.gov/health/public/heart/obesity/wecan/downloads/calreqtips.pdf

CHOOSE "DISAGREE"–A visual aid that does not reinforce but distracts

The following visual aid does not appear related to the text and is distracting from the material's purpose.

Drawing of two women hugging next to text about needing to repeat a colonoscopy.

From Colonoscopy from MedlinePlus
http://www.nlm.nih.gov/medlineplus/tutorials/colonoscopy/htm/_no_50_no_0.htm

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Item 17: The material's visual aids have clear titles or captions (P)

Ratings: Disagree = 0       Agree = 1    No visual aids = N/A

Not Applicable

Choose N/A if the material has no visual aids.

Explanation
Captions and titles for visual aids are important to help the user know what the graphic is about or what it is showing. Visual aids are meant to support the text and can be a way to explain the material's content. If a material has images that do not have a caption or title, or if the captions or titles are unclear or are unrelated to the visual aid, you should choose "Disagree."
Examples

CHOOSE "AGREE"—Clear caption related to the visual aid

Drawing of an adult cleaning baby's teeth, with caption 'Clean your baby’s teeth with a clean, soft cloth or a baby toothbrush.'

Clean your baby's teeth with a clean, soft cloth or a baby toothbrush.

CHOOSE "DISAGREE"—Unclear caption

Drawing showing an adult cleaning baby's teeth, with caption 'Clean your baby's teeth as soon as they come in.'

Clean your baby's teeth as soon as they come in.

 

CHOOSE "DISAGREE"—Unrelated caption

Drawing of an adult cleaning baby's teeth, with caption 'Keeping teeth healthy.'

Keeping teeth healthy

Image taken from National Institute of Dental and Craniofacial Research, A Healthy Mouth for Your Baby
http://www.nidcr.nih.gov/OralHealth/Topics/ToothDecay/AHealthyMouthforYourBaby.htm

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Item 18: The material uses illustrations and photographs that are clear and uncluttered (P and A/V)

Ratings: Disagree = 0       Agree = 1    No visual aids = N/A

Not Applicable

Choose N/A if the material has no visual aids.

Explanation

For the user to understand the content covered in an illustration or photograph, the image must be clear and uncluttered. If a material is not both clear and uncluttered, then you should choose "Disagree."

Examples

CHOOSE "AGREE"–A clear and uncluttered illustration

Graphic showing simplified diagram of human nervous system highlighting the brain, spinal cord, and nerves.

From Lead Poisoning: Words To Know From A to Z
http://www.cdc.gov/nceh/lead/tools/LeadGlossary_508.pdf

 

CHOOSE "DISAGREE"–A cluttered illustration

Drawing of coronary arteries and what happens to them during a coronary balloon angioplasty.

Taken from NIH, Explore Coronary Angioplasty, February 2012.
http://www.nhlbi.nih.gov/health/health-topics/topics/angioplasty/howdone.html

CHOOSE "DISAGREE"–An unclear photograph

Blurry photo of doctor and patient.

 

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Item 19: The material uses simple tables with short and clear row and column headings (P and A/V)

Ratings: Disagree = 0       Agree = 1    No tables = N/A

Not Applicable

Choose N/A if the material has no tables.

Examples

CHOOSE "AGREE"–Clear row and column headings

Table showing guide to UV index, with sun exposure category, index number, and sun protection messages.

From Environmental Protection Agency. A Guide to the UV Index
http://www.epa.gov/sunwise/doc/uviguide.pdf

CHOOSE "DISAGREE"–Incomplete or unclear row and column headings

Categories for Blood Pressure Levels in Adults
(measured in millimeters of mercury, or mm Hg)

CategorySystolic (top number) Diastolic (bottom number)
NormalLess than 120AndLess than 80
Prehypertension120-139Or80-89
High blood pressure   
Stage 1140-159Or90-99
Stage 2160 or higherOr100 or higher

Taken from NIH, Explore High Blood Pressure, August 2012
http://www.nhlbi.nih.gov/health/health-topics/topics/hbp/

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Page last reviewed October 2013
Internet Citation: The Patient Education Materials Assessment Tool (PEMAT) and User’s Guide: Domain: Understandability. October 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/prevention-chronic-care/improve/self-mgmt/pemat/pemat8.html