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

Domain: Actionability

Item 20: The material clearly identifies at least one action the user can take (P and A/V)

Ratings: Disagree = 0       Agree = 1

Explanation

For the user to take action, the material needs to clearly identify at least one action.

Examples

Choose "Agree"—Clearly identified actions: Make sure your children wear helmets every time they ride a bike.
Choose "Disagree"—No action identified: Ninety-one percent of bicyclists killed in 2009 weren't wearing helmets.

Choose "Agree"—Clearly identified actions: Be active longer each time. If you are walking 3 days a week for 30 minutes, try walking for an additional 10 minutes or more each day.
Choose "Disagree"—No action identified: Physical activity increases your chances of living a longer, healthier life.

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Item 21: The material addresses the user directly when describing actions (P and A/V)

Ratings: Disagree = 0       Agree = 1

Explanation

To help the user know what actions he or she should take, the material should address the user directly. Choose "Disagree" if no actions are described.

Examples

Choose "Agree"—Direct: You can find it at your drugstore.
Choose "Disagree"—Indirect: Patients can find it at their drugstore.

Choose "Agree"—Direct: Arrange a ride home after the procedure.
Choose "Disagree"—Indirect: Patients should arrange a ride home after the procedure.

Choose "Agree"—Direct: You can find common cold medicines at the pharmacy.
Choose "Disagree"—Indirect: Medicines for the common cold are at the pharmacy.

Choose "Agree"—Direct: Take your medicine when you eat your meals.
Choose "Disagree"—Indirect: Medicine should be taken at mealtimes.

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Item 22: The material breaks down any action into manageable, explicit steps (P and A/V)

Ratings: Disagree = 0       Agree = 1

Explanation

For any actions in a material, the action should be broken down into manageable, explicit steps. The material should tell the user how to take the action, especially if the action is big or broad, such as increase exercise or lose weight. The material should not use terms that can be left to interpretation (e.g., frequently, regularly, deeply, strong, weak). If a material uses ambiguous terms, or suggests health goals without advice on how to achieve them, choose "Disagree."

Examples

Choose "Agree"—Manageable, explicit steps:

  • Exercise regularly:
    • Start by doing at least 10 minutes of physical activity at least 3 times a week. For example, you could walk the dog, take a walk at lunch, get off the bus one stop early and walk, or use the stairs instead of taking the elevator.
    • Increase the number of minutes and the number of times you do your physical activity. Gradually work your way up to getting 2½ hours of exercise over the course of a week.
    • While you are increasing the amount of time you spend exercising, start making some of your activities more demanding, such as aerobic dancing, bicycling, or jogging.

Choose "Disagree"—No manageable steps, ambiguous:

  • Engage in moderate exercise regularly.

Choose "Agree"—Manageable, explicit steps: Eat less salt, which is also called sodium. Don't eat more than 1 teaspoon of salt a day (2,300 mg of sodium). Prepared foods often have a lot of salt, so check nutrition labels at the grocery store and ask at restaurants for low-salt options.

Choose "Disagree"—No manageable steps, ambiguous:

  • Eat less salt.

Choose "Agree"—Manageable, explicit steps:

  • Check your blood sugar level:
    • Insert a new test strip into the meter.
    • Wash your hands.
    • Gently prick the side of your finger with the lancet to draw out a drop of blood.
    • Touch the test strip to the drop of blood.

Choose "Disagree"—No manageable steps:

  • Check your blood sugar level.

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Item 23: The material provides a tangible tool (e.g., menu planners, checklists) whenever it could help the user take action (P)

Ratings: Disagree = 0       Agree = 1

Explanation

Whenever a tool could make it easier for the user to take action, a tool is provided. If you can think of a tool that would help users take action and the material does not provide that tool, you should choose "Disagree."

Examples

The following is an example of a tool that could help a user take action.

Choose "Agree"—Eat Healthy, Move More Chart (material provides a blank chart to fill in as well)

Instructions of how to use the Eat Healthy Move More chart with bullets on filling out the chart ands an example of a completed chart that shows date, eat healthy tip, move more tip, and my successes.

Taken from NIH, We Can! Campaign, Eat Healthy, Move More Chart.
http://www.nhlbi.nih.gov/health/public/heart/obesity/wecan/downloads/tip-eat-healthy-chart.pdf

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Item 24: The material provides simple instructions or examples of how to perform calculations (P)

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

Not Applicable

Choose N/A if the material has no calculations.

Explanation

A calculation is when a material asks the user to add, subtract, multiply or divide, or perform some other mathematical operation. Ideally, materials do not expect users to perform calculations (Item 7). When they do, they should provide simple instructions or examples of how to perform the calculation in order to be actionable.

Examples

Choose "Agree": Simple instructions with an example

How long will your inhaler last?

You can figure out how many days your inhaler will last with regular use.

  • First, estimate how many times a day you take your medicine and multiply that number by how many puffs you take each time. This is the number of puffs you take each day.
  • Second, look on the inhaler to see how many puffs of medicine are in it.
  • Finally, divide the number of puffs in the inhaler by the number of puffs you use each day. This will give you the number of days your inhaler should last to help you know when to refill it.

For example, if you use 2 puffs each time you use your inhaler and use it 4 times a day, and your inhaler has 200 puffs in it, then your inhaler should last 25 days. Here's the math:

2 puffs × 4 times per day = 8 puffs per day

200 puffs in inhaler ÷ 8 puffs per day = 25 days

Choose "Disagree": Vague instructions without an example

How long will your inhaler last?

You can figure out how many days your inhaler will last with regular use by determining the number of puffs in your inhaler (e.g., 200 puffs) divided by how many puffs you use per day. This will give you the number of days your inhaler should last to help you know when to refill it.

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Item 25: The material explains how to use the charts, graphs, tables, or diagrams to take actions (P and A/V)

Ratings: Disagree = 0       Agree = 1    No charts, graphs, tables, diagrams = N/A

Not Applicable

Choose N/A if the material has no charts, graphs, tables, or diagrams.

Explanation

If the user needs to use a chart, graph, table, or diagram to take an action, the material should explain how to use the chart, graph, table, or diagram.

Examples

Choose "Agree"—The material explains how to use the chart

Picture of a Nutrition Facts label with explanation of serving size and  sodium content.

Taken from National Kidney Disease Education Program, NIH, How To Read a Food Label: Tips for People With Chronic Kidney Disease.
http://nkdep.nih.gov/resources/nutrition-food-label-508.pdf

Choose "Disagree"—The material does not explain how to use the chart

Picture of a Nutrition Facts label.

Modified from National Kidney Disease Education Program, NIH, How To Read a Food Label: Tips for People With Chronic Kidney Disease.
http://nkdep.nih.gov/resources/nutrition-food-label-508.pdf

Choose "Agree"—The material explains how to use the table

A larger number of stars is a better rating. For example, if you want to know which facility has the best health inspection rating, look across the Health Inspection row to see which facility has the most stars.

Screenshot of Web page with table showing overall ratings for three facilities, as well as health inspection, staffing, and quality measure ratings.

Modified from Centers for Medicare & Medicaid (CMS) Nursing Home Compare tool.
http://www.medicare.gov/NursingHomeCompare/search.aspx?bhcp=1

Choose "Disagree"—The material does not explain how to interpret the table

Screenshot of Web page with table showing overall ratings for three facilities, as well as health inspection, staffing, and quality measure ratings.

Modified from CMS Nursing Home Compare tool.
http://www.medicare.gov/NursingHomeCompare/search.aspx?bhcp=1

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Item 26: The material uses visual aids whenever they could make it easier to act on the instructions (P)

Ratings: Disagree = 0       Agree = 1

Explanation

The material should include a visual aid if one could make it easier to act on the instructions or information presented. If you can think of a meaningful visual aid that could have been added to make instructions easier to follow, you should disagree with this item.

Examples

The following are examples of visual aids that make the instructions easier to act on.

How to check your blood sugar

Drawing of hand holding blood sugar meter, along with written instructions on how to use it.

Image taken from NIH MedlinePlus Interactive Tutorials, X-Plain Series, Diabetes - Introduction.
http://www.nlm.nih.gov/medlineplus/tutorials/diabetesintroduction/htm/_no_50_no_0.htm

Pictures of Foods To Choose and Foods To Avoid

Drawing of sweets and snacks in three categories: go, slow, and whoa.

Taken from NIH We Can! Campaign, "U R What U Eat."
http://www.nhlbi.nih.gov/health/public/heart/obesity/wecan/downloads/urwhateat.pdf

Picture Showing How To Use a Metered Dose Inhaler

Drawing of steps involved in using a metered dose inhaler.

Taken from Asthma Society of Canada, How To Use Your Inhaler.
http://www.asthma.ca/adults/treatment/meteredDoseInhaler.php

Photo Showing Insulin Injection

A photo showing patient injecting herself in the abdomen with insulin.

Taken from AHRQ, EHC Program, Methods for Delivering Insulin and Monitoring Blood Sugar.
http://www.effectivehealthcare.ahrq.gov/ehc/products/242/1240/glu_mon_cons_fin_to_post.pdf

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Current as of October 2013
Internet Citation: The Patient Education Materials Assessment Tool (PEMAT) and User’s Guide: Domain: Actionability. October 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/prevention-chronic-care/improve/self-mgmt/pemat/pemat9.html