Tools for Clear Communication: PEMAT and the Clear Communication Index

Cynthia Baur, PhD

Cynthia Baur, PhD

Cynthia Baur presented two tools to evaluate patient education materials — the Patient Education Materials Assessment Tool (PEMAT) and the CDC’s Clear Communication Index (Index), both of which are free. The goals of the tools are to help users ensure their materials are understandable and drive the patient to action.

The PEMAT helps untrained lay and health professionals assess the understandability and actionability of print and audiovisual health information materials. The PEMAT does not assess accuracy, comprehensiveness or cultural appropriateness, or perform readability tests; it is a standardized approach to clarity.

There are two PEMATs:  PEMAT-P for printable materials, with 17 items that address understandability — including content, word choice, visuals and design; and 7 items for actionability — how to use the information and take action. PEMAT-A/V is for audiovisual materials (understandability:  13 items, actionability:  4 items).  Downloadable at , the PEMAT consists of a user guide and a fillable score sheet, where you rate the material:  Disagree, Agree, N/A, enter the ratings and interpret the scores.

The Clear Communication Index consists of four questions and 20 items based in communication and related sciences that staff can use to develop, assess, and score the clarity of communication materials. With this tool, staff can develop new material or assess an existing one. Materials are scored in seven areas: main message and call to action, language, information design, state of the science, behavioral recommendations, numbers and risk. The CCI can be downloaded at

Baur led the audience in learning about Index items, what they mean, and how to apply them. The items incorporate plain language, numeracy, and risk communication principles, as well as core communication concepts such as main message and primary audience. She then applied the Index to some sample materials.

The Power of Field Testing

From left to right: Ryan Miller, MA, Christina Powell, MA

From left to right: Ryan Miller, MA, Christina Powell, MA

Powell and Miller talked about qualitative field testing of materials. This type of field testing focuses on quality and has few participants. The data collected is subjective, personal, and in-depth, they said. They offered tips for conducting qualitative field testing. When choosing a test site, we should think about the ideal type of site and site features. “The test site can be just about anywhere. But make sure it creates an environment of free expression so participants will tell you their opinions. Think about audience, budget, and time frame,” said Powell.

The presenters offered tips for recruiting participants, like asking the site for help, provide incentives, screen people for desired demographics, recruit extra participants, in case of no-shows, get the first names of participants and send reminders. They also offered tips for making a detailed schedule, such as limiting each session to about one hour, and allow extra time for notes, bathroom breaks, snacks, and late arrivals. If you have more than one researcher, hold concurrent sessions to save time. “Have the researchers observe each other so they can align their styles,” said Powell.

The presenters offered guidelines for two types of qualitative field testing: cognitive interviews and focus groups.  Cognitive interviews are conducted one-on-one. The interviewer acts as an observer. Her job is to ask follow-up questions and note nonverbal reactions, the presenters said. “These can help you understand the participants’ perspective and give you thoughtful insights,” Miller said. Focus groups are conducted in a group setting — usually eight to 12 participants. The moderator leads a discussion, rather than just observing. His job is to encourage group interaction, ask follow-up questions, note nonverbal reactions, and make sure no one dominates.

The presenters discussed how to work with interpreters. They talked about how to write field test questions and record answers. They also discussed how to analyze and summarize data and write recommendations. The final report should include participant quotations to illustrate points, they said. “This is often what people look at first or think is most important,” said Miller.

The Power of Digital Storytelling

Robin Smith

Robin Smith

Smith’s session was centered on the power of conveying a story and how we can use these stories to effectively reach and educate our patients.  She believes that while data gathering is important to organizations, it is also important to be able to tell a story because “ultimately you need to put a heart in your data” in order to make an emotional connection to another human being.  She quoted Helen Osborne’s insightful point that “when you tell a good story, you can frame important messages in ways that make them memorable for your listeners.”

Story telling is a “powerful tool to engage, inspire and promote learning”. Smith discussed various ways stories can be gathered and the steps you should take in order to create an effective piece.  She also provided tips on how to identify a good story, how to interview, and how to get the appropriate releases. Furthermore, she outlined the aspects that make up a good story, such as having a Hero, describing their obstacles or why their story is important, and defining a clear beginning, middle and end. One suggestion she provided was to interview your patient or client.  She recommended to audio tape the interview, transcribe the interview and then have it reviewed by a third party.  She also stresses the importance of pictures to capture a visual image of the story.

Smith demystified the process of creating a video story and walked attendees through the steps of creating a powerful video piece. She emphasized how important it is to keep record of the digital stories you collect for purposes such as patient and client education, marketing, training, and advocacy.

From Didactic to Fantastic: Integrating Interactivity into Your Learning Session

Farrah Schwartz, MA

Farrah Schwartz, MA

Consumer health education is often didactic and may not engage participants in learning. Not only can this be boring for learners and for teachers, but this approach has been demonstrated to have poorer learning outcomes than education that uses multiple formats and integrates adult learning strategies.
Interaction in education is easy to do and can help make learning successful. Schwartz provided attendees with simple strategies to integrate interactive activities into their learning to maximize health outcomes, learning retention and engagement.

This interactive session used various engagement strategies starting before attendees walked through the door, and drew on attendees own experiences. Schwartz shared some basic adult learning principles and facilitated discussions to help attendees identify adult learning needs and strategies in a healthcare environment.

Schwartz reviewed some specific interactive techniques that can be used in learning, such as:

  • reflection
  • paired and group discussion
  • audience polling
  • quizzes, games
  • ice breakers
  • the use of multimedia, including digital technology

The session closed with attendees identifying interactive strategies that they will integrate into their teaching over the next 6 months.

Effective Design for Patient Education Materials

From left to right: Stacy Robison, MHEd, MCHES, Xanthi Scrimgeour, MHEd, MCHES

From left to right: Stacy Robison, MHEd, MCHES, Xanthi Scrimgeour, MHEd, MCHES

Scrimgeour and Robison discussed what every health professional needs to know about designing health information. Good design makes materials easier to read and understand, so the materials are “Useful, Usable and Attractive.” They described information design as the “ability to take information and data and communicate it in a way that is clear and facilitates good decision making.” Design is more than aesthetics.  It helps people find what they need, understand what they find and remember what they read.

The presenters emphasized that it’s important to design for your readers: Understand them, think about what you want them to know or do, and organize the content accordingly. Identify the main messages – ideally no more than three. The main messages should come first, followed by the supporting information and then background details.

They listed 10 Tips for Designing Health Information:

  1.  Create a path for the eye to follow. Most readers start at the top left corner. Avoid visual cues at the bottom of the page, e.g., callouts.
  2. Use visual hierarchy. Distinct text size, color and placement help readers focus on the main message.
  3. Use a grid to align content and images for structural balance – similar to magazines and newspapers.
  4. Incorporate white space for a clean look.  Add padding around images.
  5. Use bulleted and numbered lists, which are easy to scan.
  6. Use conceptual cues, e.g., colors can reinforce key messages.
  7. Use images and captions to facilitate understanding.
  8. Use icons or images to call out important content.
  9. Consider sans serif fonts, which are cleaner and easier to read.
  10. Increase font size to 16 pixels or larger for Web and 12 points minimum for print text.

Scrimgeour and Robison urged the group to think outside the box. An example they gave was an information blanket (a blanket with health information on it) that was given to new moms. “It doesn’t have to be a brochure,” said Scrimgeour.