Systematic review of studies describing the process of development and validation of instruments designed to assess the quality and suitability of patient education materials produced in printed form.

Introduction

 The following study is continuation of the research that was presented during the EAHIL conference in Lisbon, where it was shown how medical librarian could support the process of patient education by helping physicians in the quality assessment of patient education materials (PEMs) produced in printed form. In her oral presentation the author introduced the results of suitability and readability assessment of written health education materials being used for education of patients in the Division of Pain Research and Treatment of the University Hospital in Cracow (Poland). The quality assessment of the health education materials was performed by using the Suitability Assessment of Materials (SAM) instrument. This tool was invented by Cecily and Leonard Doak [1] in order to help health care professionals and the authors of PEMs to choose/ produce the most suitable health education materials for their patients, in terms of their relevance for low literacy patients. SAM is only one of the few instruments which are commonly used by people involved in patient education to perform the quality assessment of PEMs. Medical librarians, especially these working in hospital libraries and health education centers should be aware of these tools and should be able to apply them in practice in order to support the process of evaluation of PEMs.

Aims

 The first aim of the study was to identify all published instruments, which were designed to help people involved in patient education to evaluate or select the most appropriated PEMs, produced in printed form (leaflets, pamphlets), for their patient population. The second aim of the study was to assess the methodological quality of the studies, where the instruments designed to perform the quality (suitability) of PEMs were described.

 Methods

 Systematic review of the studies published in English from 1995 to 2011 and available through library databases, which purpose was to develop the instrument/ checklist to assess the quality/ suitability of PEMs in printed form. Studies describing the validity and reliability of produced instruments, as well as the process of their development and describing the pilot studies of the produced instruments were included in the review. Studies do not describing how the instrument was develop or not measuring its psychometric properties and the studies describing other types of instruments (for e.g to assess the quality of web information or decision aids) were excluded from the review.

Quality assessment of included studies 

 According to the author best knowledge, there is no special method to perform a critical appraisal of the methodology of the studies describing the development of the instrument to be used to assess the quality of PEMs in printed form.  Therefore the alternative method was used to assess the methodological quality of the included studies.  It was checked if the authors of the studies aiming at the development of such instruments took into account all the necessary stages in the development and validation of criterion-referenced measures. It was performed by comparing the phases of the studies included in the review to the stages in the development and validation of criterion-referenced measures as it was proposed by Waltz by Waltz in the book: Measurement in Nursing and Health Research (2010) [2], especially taking into account the process of validation, reliability testing and pretesting of the developed instrument.

Results

  Nine studies describing the instruments designed to assess the quality of PEMs produced in printed form, met the inclusion criteria and were qualified for further analysis. All of the included studies have a good methodological quality and take into account all the necessary stages in the development and validation of criterion-referenced measures. For one of the tools, SAM, which is introduced in the book “Teaching Patients with low literacy skills” the lack of some procedures necessary in the development of criterion-referenced measures (like how the measure was constructed and field-tested) was noted. Nevertheless the tool was included into the systematic review, as SAM belongs to one of the most widely used tools of its type [3] for assessment of the health education materials produced in printed form. Only four of the identified instruments: SAM, DISCERN, EQIP and TEMPtEd seem to be finished and are ready to be used by the potential users, the other tools seem to be still in the process of development (SAM + CAM, ELF), were never finished (BIDS) or are not considered to be produced for the broader use (Checklist, EVALPEM). The identified instruments were classified according to their purpose (for e.g instruments developed to assess the health literacy demand of PEMs, instruments assessing general quality of PEMs or their presentation quality), population they suppose to serve (authors or producers of health information materials, healthcare providers, representatives of patient population, librarians etc.) or their type (checklists and rating forms) (table 1).
 It is expected, that this research might help medical librarians to choose the most relevant instruments for assessing the quality of materials that are produced or supplied in the hospitals and public health centers they are working in or cooperating with. Medical Librarians of XXI century must redefine their traditional role and expand their activities also to these areas of health care practice, where their support was so far limited and unknown, but might be necessary needed.