Health Literacy Demand of Printed Lifestyle Patient Information Materials Aimed at People With Chronic Kidney Disease: Are Materials Easy to Understand and Act On and Do They Use Meaningful Visual Aids?

Abstract

People with chronic kidney disease (CKD) need usable information on how to live well and slow disease progression. This information is complex, difficult to communicate, and changes during the course of the disease. We examined lifestyle-related printed CKD patient education materials focusing on actionability and visual aids. From a previous systematic review assessing readability of CKD patient information, we identified materials targeting nutrition, exercise, and self-management. We applied the Suitability Assessment of Materials (SAM) and Patient Education Materials Assessment Tool (PEMAT) to evaluate how easy materials were to understand (understandability) and act on (actionability). We created the 5C image checklist and systematically examined all visual aids for clarity, contribution, contradiction, and caption. Of the 26 materials included, one fifth (n = 5, 19%) were rated “not suitable” on SAM and fewer than half (n = 11, 42%) were rated “superior.” PEMAT mean subdomain scores were suboptimal for actionability (52) and visuals (37). Overall, more than half of all 223 graphics (n = 127, 57%) contributed no meaning to the text. Images in three documents (12%) directly contradicted messaging in the text. CKD lifestyle information materials require focused improvements in both actionability of advice given and use of visual aids to support people with CKD to self-manage their condition. The fifth C is culture and is best evaluated by user-testing.

Acknowledgments

The authors would like to thank Michaela Flynn who performed the initial search and categorization of documents included in these analyses, and Danielle Muscat who performed the reliability check. Questions from PEMAT-P are reprinted with permission of the Agency for Healthcare Research and Quality, Rockville, MD, USA.

Funding

Suzanne Kirkendall was supported by a Sydney Medical School Summer Research Scholarship.

Supplemental Material

Three supplemental appendices (Appendix 1: Domains and items for SAM and PEMAT mapped for similarity of intent; Appendix 2: Comparison of SAM and PEMAT scores across subdomains; Appendix 3: Ratings of all materials on all variables) are available on the publisher’s website at http://dx.doi.org/10.1080/10810730.2016.1258744

Additional information

Funding

Suzanne Kirkendall was supported by a Sydney Medical School Summer Research Scholarship.