Development and validity of a method for the evaluation of printed education material

  • Mauro S. Castro
  • Diogo Pilger
  • Flavio D. Fuchs
  • Maria B. Ferreira
Keywords: Patient Education, Comprehension, Validation studies, Brazil


Objectives: To develop and study the validity of an instrument for evaluation of Printed Education Materials (PEM); to evaluate the use of acceptability indices; to identify possible influences of professional aspects.

Methods: An instrument for PEM evaluation was developed which included tree steps: domain identification, item generation and instrument design. A reading to easy PEM was developed for education of patient with systemic hypertension and its treatment with hydrochlorothiazide. Construct validity was measured based on previously established errors purposively introduced into the PEM, which served as extreme groups. An acceptability index was applied taking into account the rate of professionals who should approve each item. Participants were 10 physicians (9 men) and 5 nurses (all women).

Results: Many professionals identified intentional errors of crude character. Few participants identified errors that needed more careful evaluation, and no one detected the intentional error that required literature analysis. Physicians considered as acceptable 95.8% of the items of the PEM, and nurses 29.2%. The differences between the scoring were statistically significant in 27% of the items. In the overall evaluation, 66.6% were considered as acceptable. The analysis of each item revealed a behavioral pattern for each professional group.

Conclusions: The use of instruments for evaluation of printed education materials is required and may improve the quality of the PEM available for the patients. Not always are the acceptability indices totally correct or represent high quality of information. The professional experience, the practice pattern, and perhaps the gendre of the reviewers may influence their evaluation. An analysis of the PEM by professionals in communication, in drug information, and patients should be carried out to improve the quality of the proposed material.


Download data is not yet available.


1. McCabe BJ, Tysinger JW, Kreger M, Currwin AC. A strategy for designing effective patient education materials. J Am Diet Assoc 1989; 89:1290-1292.

2. Lynn MR. Determination and qualification of content validity. Nurs Res 1986; 35:382-385.

3. Bernier MJ. Establishing the psychometric properties of a scale for evaluating quality in printed education materials. Patient Educ Couns 1996; 29:283-299.

4. Bernier MJ. Developing and evaluating printed education materials: a prescriptive model for quality. Orthop Nurs 1993; 12: 39-46.

5. Brockett RG. Developing written learning materials: a proactive approach. Lifelong Learn Adult Years 1984; 7:16-18.

6. Blacklay A, Eiser C, Ellis A. Development and evaluation of an information booklet for adult survivors of childhood cancer. Arch Dis Child 1998; 78:340-347.

7. Moore MB, Sorensen M, Adebajo CF. Materiales impresos ilustrados para la educación en salud y planificación familiar. Foro Mund Salud 1990; 304-310.

8. Rice M, Valdivia L. A simple guide for design, use, and evaluation of educational materials. Health Educ Q 1991; 18:79-85.

9. Bernier MJ, Yasko J. Designing and evaluating printed education materials: model and instrument development. Patient Educ Couns 1991; 18:253-263.

10. Mathis DB. Writing patient education materials. Orthop Nurs 1989; 8:39-42.

11. Smith H, Gooding S, Brown R, Frew A. Evaluation of readability and accuracy of information leaflets in general practice for patients with asthma. BMJ 1998; 317:264-265.

12. Slaytor EK, Ward JE. How risks of breast cancer and benefits of screening are communicated to women: analysis of 58 pamphlets. BMJ 1998; 317: 263-264.

13. Doak LG, Doak CC, Meade CD. Strategies to improve cancer education materials. Patient Educ Couns 1996; 23:1305-1312.

14. Wells JA. Readability of HIV/AIDS educational materials: the role of the medium of communication, target audience, and producer characteristics. Patient Educ Couns 1994; 24:249-259.

15. Shepperd S, Charnock D, Gann B. Helping patients access high quality health information. BMJ 1999; 319:764-766.

16. Svarstad BL, Mount JK. Evaluation of Written Prescription Information Provided in Community Pharmacy, 2001 - Final Report to the U.S. Department of Health and Human Services and the Food and Drug Administration. Available at: URL:, accessed on 25/08/2005.

17. Coulter A, Entwistle V, Gilbert D. Informing Patients: an assessment of the quality of patient information materials. London (UK): King's Fund, 1998. ISBN:1857172140.

18. Cooper C, Booth K, Fear S, Gill G. Chronic disease patient education: lessons from meta-analyses. Patient Educ Couns 2001; 44:107-117.

19. Coulter A. Evidence based patient information. BMJ 1998; 317:225-226.

20. Meade CD, Byrd JC. Patient literacy and the readability of smoking education literature. AJPH 1989; 79:204-206.

21. Dickinson D, Raynor DK, Duman M. Patient information leaflets for medicines: using consumer testing to determine the most effective design. Patient Educ Couns 2001; 43:147-159.

22. Williams MV, Baker DW, Parker RM, Nurss JR. Relationship of functional health literacy to patient’s knowledge of their chronic disease: a study of patients with hypertension and diabetes. Arch Intern Med 1998; 158:166-172.

23. Steering Committee for the Collaborative Development of a Long-Range Action Plan for the Provision of Useful Information about Prescription Medicine. Action Plan for the Provision of Useful Information about Prescription Medicine, Unpublished report submitted to The Honorable Donne E. Shalala, Secretary of the U.S. Department of Health and Human Services, December 1996. URL: accessed on 25/08/2005.

24. Luz ZMP, Pimenta DN, Rabello A, Schall V. Evaluation of informative materials on leishmaniasis distributed in Brazil: criteria and basis for the production and improvement of health education materials. Cad Saúde Pública 2003; 19:561-569.

25. Schall VT, Monteiro S, Rebello SM, Torres M. Evaluation of the ZIG-ZAIDS game: an entertaining educational tool for HIV/Aids prevention. Cad Saúde Pública 1999; 15:107-119.

26. Doak CC, Doak LG, Root JH. Teaching Patients with Low Literacy Skills. 2nd ed. Philadelphia (Pen): J.B. Lippincott Company; 1996. ISBN 0397551614.

27. Streiner DL, Norman GR. Health Measurement Scales - a practical guide to their development and use. 2ª ed. New York: Oxford; 1995. ISBN:0192626701.

28. Achutti A, Medeiros AB. Hipertensão Arterial no Rio Grande do Sul. Boletim da Saúde da SSMA-RS. 1985; 12:2-72.

29. Fuchs FD, Moreira LB, Moraes RS, Bredemeier M, Cardozo SC. Prevalência de hipertensão e fatores associados na região urbana de Porto Alegre. Arq Bras Cardiol. 1994; 63:473-79.

30. Chobanian AV, Bakris GL, Cushman WC, Green LA, Izzo JL, Jones DL et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. JAMA 2003; 289:2560-2572.

31. Sociedade Brasileira de Hipertensão, Sociedade Brasileira de Cardiologia, Sociedade Brasileira de Nefrologia. III Consenso Brasileiro de Hipertensão Arterial. 1998.

32. Goldim JR. O consentimento e a adequação de seu uso na pesquisa em seres humanos [dissertation]. Porto Alegre (RS). UFRGS; 1999.

33. Castro MS, Ferreira MBC. Material Educativo Impresso: influência na adesão ao Tratamento. Rev Bras Farm 1998; 79:45-48.

34. Rantucci MJ. Pharmacists Talking with Patients: A guide to patient counseling. Baltimore: Williams & Wilkins, 1997. ISBN:0683071270.

35. Schommer JC, Wiederholt JB. The association of prescription status, patient age, patient gender, and patient question asking about behavior with the content of pharmacist-patient communication. Pharm Res 1997; 14:145-151.

36. Lewis RK, Lasack NL, Lambert BL, Connor SE. Patient counseling - a focus on maintenance therapy. Am J Health-Syst Pharm 1997; 54: 2084-2098.

37. Oliveira VZ. Comunicação Médico-Paciente e adesão ao tratamento em adolescentes portadores de doenças orgânicas crônicas [dissertation]. Porto Alegre (RS): UFRGS; 2000.

38. Claesson S, Morrison A, Wertheimer AI, Berger ML. Compliance with prescribed drugs: challenges for the elderly population. Pharm World Sci 1999; 21:256-259.

39. Mayeaux EJ, Murphy PW, Arnold C, Davis TC, Jackson RH, Sentell T. Improving patient education for patients with low literacy skills. Am Fam Physician 1996; 53:205-211.

40. Visser A. Education and counseling approaches in chronic conditions. Patient Educ Couns 2000; 41:241-242.

41. Webber GC. Patient education. Med Care 1990; 28:1089-1103.

42. Norman SA, Marconi KM, Schelzel GW, Schechter CF, Stolley PD. Beliefs, social normative influences, and compliance with anti-hypertension medication. Am J Prev Med 1985; 1:10-17.

43. Knight MA. The police surgeon’s view: medical paternalism is unacceptable. BMJ 1995; 311:1620-1621.

44. World Health Organization. Resolution on the role of the pharmacist in support of the WHO revised drug strategy. 47ª World Health Assembly; 1994.WHA47.12

45. World Health Organization. The role of the pharmacist in the health care system: Report of a WHO Meeting. 1993. WHO/PHARM/94.596.
Original Research

Most read articles by the same author(s)