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

Topic: Layout & Design

Topic: Layout and Design

Item 12: The material uses visual cues (e.g., arrows, boxes, bullets, bold, larger font, highlighting) to draw attention to key points (P and A/V)

Ratings: Disagree = 0       Agree = 1    Video = N/A

Not Applicable

Choose N/A if the material is a video. Rate other audiovisual materials.


Visual cues (e.g., arrows, boxes, bullets, bold, larger font, highlighting) help draw the user’s attention to key points in a material. Visual cues should only be used for key points. If a material overuses visual cues (i.e., uses them indiscriminately), choose "Disagree."


The following are examples of visual cues.


Photo of landscape worker with caption, 'Always wear a hard hat at the job site.' For emphasis, a large arrow is pointing to the hard hat.

Taken from CDC, Simply Put: A Guide for Creating Easy-To-Understand Materials.


Text box that says 'Remember--only a healthcare provide can read your TB skin test results the right way.'

Taken from CDC, What You Need To Know About the TB Skin Test, 2005.

Text box that says: 'Minutes Matter. Call 9-1-1. Lists 3 bullets: 1. If you think you might be having a heart attack (even if you're not sure), call 9-1-1 immediately. Don't wait. 2. Quick treatment can save your life--when in doubt, check it out. 3. Remember, the first minutes matter when you are having a heart attack.'

From NIH, Heart Attack. Know the Symptoms. Take Action. Call 911. December 2011.

Bullets With Bold Type

Bullet list with bold text about healthy eating.

From 4 Steps to Control Your Diabetes for Life. National Diabetes Education Plan. 

Item 13: Text on the screen is easy to read (A/V)

Ratings: Disagree = 0       Agree = 1    No text or all text is narrated = N/A

Not Applicable

Choose N/A if the material has no text or all of the text is narrated.


Audiovisual materials that are overcrowded with words or have text that flashes briefly on the screen are difficult to read and understand. You should choose "Agree" if the text that appears on the screen is sparse and the words stay on the screen long enough for a slow reader to read them.

This item is not applicable (N/A) if no text appears in the material or a narrator reads all of the text out loud, because the material is not relying on the viewer to read the text.

Item 14: The material allows the user to hear the words clearly (e.g., not too fast, not garbled) (A/V)

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

Not Applicable

Choose N/A if the material has no narration.


An audiovisual material, whether a video or a multimedia material with narration, should allow the viewer to hear the words clearly. The narrator or voiceover should not be speaking too fast nor should it be garbled or hard to understand in any other way.

Note: Be sure this item is not assessed based on poor Internet connection or speed.

Page last reviewed October 2013
Page originally created October 2013
Internet Citation: Topic: Layout & Design. Content last reviewed October 2013. Agency for Healthcare Research and Quality, Rockville, MD.
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