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

An Instrument To Assess the Understandability and Actionability of Print and Audiovisual Patient Education Materials

Version 1.0

The Patient Education Materials Assessment Tool (PEMAT) is a systematic method to evaluate and compare the understandability and actionability of patient education materials. It is designed as a guide to help determine whether patients will be able to understand and act on information. Separate tools are available for use with print and audiovisual materials.

Prepared for:

Agency for Healthcare Research and Quality
U.S. Department of Health and Human Services
5600 Fishers Lane
Rockville, MD 20857

Contract No: HHSA290200900012I, TO 4


Sarah J. Shoemaker, Pharm.D., Ph.D., Abt Associates, Inc.
Michael S. Wolf, Ph.D., M.P.H., Northwestern University
Cindy Brach, M.P.P., Agency for Healthcare Research and Quality


An Introduction to the Patient Education Materials Assessment Tool (PEMAT) and User’s Guide
How To Use the PEMAT To Assess a Material
Domain: Understandability
Topic: Content
   Item 1: The material makes its purpose completely evident (P and A/V)
   Item 2: The material does not include information or content that distracts from its purpose (P)
Topic: Word Choice & Style
   Item 3: The material uses common, everyday language (P and A/V)
   Item 4: Medical terms are used only to familiarize audience with the terms. When used, medical terms are defined (P and A/V)
   Item 5: The material uses the active voice (P and A/V)
Topic: Use of Numbers
   Item 6: Numbers appearing in the material are clear and easy to understand (P)
   Item 7: The material does not expect the user to perform calculations (P)
Topic: Organization
   Item 8: The material breaks or “chunks” information into short sections (P and A/V)
   Item 9: The material’s sections have informative headers (P and A/V)
   Item 10: The material presents information in a logical sequence (P and A/V)
   Item 11: The material provides a summary (P and A/V)
Topic: Layout & 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)
   Item 13: Text on the screen is easy to read (A/V)
   Item 14: The material allows the user to hear the words clearly (e.g., not too fast, not garbled) (A/V)
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)
   Item 16: The material’s visual aids reinforce rather than distract from the content (P)
   Item 17: The material’s visual aids have clear titles or captions (P)
   Item 18: The material uses illustrations and photographs that are clear and uncluttered (P and A/V)
   Item 19: The material uses simple tables with short and clear row and column headings (P and A/V)
Domain: Actionability
   Item 20: The material clearly identifies at least one action the user can take (P and A/V)
   Item 21: The material addresses the user directly when describing actions (P and A/V)
   Item 22: The material breaks down any action into manageable, explicit steps (P and A/V)
   Item 23: The material provides a tangible tool (e.g., menu planners, checklists) whenever it could help the user take action (P)
   Item 24: The material provides simple instructions or examples of how to perform calculations (P)
   Item 25: The material explains how to use the charts, graphs, tables, or diagrams to take actions (P and A/V)
   Item 26: The material uses visual aids whenever they could make it easier to act on the instructions (P)
Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P)
Patient Education Materials Assessment Tool for Audiovisual Materials (PEMAT-A/V)


This document was produced under contract to the Agency for Healthcare Research and Quality (AHRQ) under Contract No. HHSA290200900012I, TO 4, “Improving EHRs Patient Education Materials.” The AHRQ Task Order Officer for this project was Cindy Brach, M.P.P.

The content of this document does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does the mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. The authors assume full responsibility for the accuracy and completeness of the ideas presented.


We would like to acknowledge the raters from Abt Associates, AHRQ, Massachusetts General Hospital, and Northwestern University who helped to establish the reliability of the PEMAT; Allyson Ross Davies for her guidance on instrument development; and Ken Carlson and Mark Spranca from Abt Associates for their valuable engagement with the reliability and validity testing of the PEMAT.

We would like to thank the technical expert panel who helped to shape this instrument by providing guidance and feedback at critical points in the development process: Geri Lynn Baumblatt, M.S.; Cynthia Baur, Ph.D.; Patricia Brennan, RN, Ph.D.; Darren DeWalt, M.D., M.P.H.; Robert Mayes, M.S., RN; Michael Paasche-Orlow, M.D., M.P.H.; Eva Powell, M.S.W., CPHQ; Dean Schillinger, M.D.; Josh Seidman, Ph.D., M.H.S.; and Paul Smith, M.D.

Related Impact Case Studies and Articles

University of Texas Health at San Antonio, University Health System Used AHRQ Tools 

AHRQ Tool Helps Memorial Sloan Kettering Cancer Center Improve Patient Education Materials

Center for Health Literacy Promotion Uses AHRQ Tool to Assess Patient Education Materials

Novant Health Uses AHRQ Tool to Assess and Improve Patient Communications

Shoemaker SJ, Wolf MS, Brach C. 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;96(3):395-403. DOI: 10.1016/j.pec.2014.05.027

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