Development and Evaluation of Cardiovascular Disease Prevention Education Materials for Middle-aged Korean-Chinese Female Workers: Applying Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P)

Article information

Res Community Public Health Nurs. 2016;27(3):284-298

Publication date (electronic) : 2016 September 30

doi : https://doi.org/10.12799/jkachn.2016.27.3.284

Hyeonkyeong Lee ¹, Junghee Kim ², Ri Yoo ¹, Ja-yin Lee ²

¹College of Nursing · Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Korea.

²Graduate School of Nursing · Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Korea.

Corresponding author: Kim, Junghee. Graduate School of Nursing, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea. Tel: +82-2-2228-3306, Fax: +82-2-392-5440, kjh129@yuhs.ac

Received 2016 June 02; Revised 2016 September 21; Accepted 2016 September 24.

Abstract

Purpose

The purpose of this study was to develop and evaluate the quality (understandability and actionability) of health education materials for Korean-Chinese (KC) female migrant workers, using Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P).

Methods

Educational needs assessment was conducted with 3 focus groups with 20 KC women and a focus group with 4 community stakeholders. The quality of the educational materials was evaluated by 3 experts and a community stakeholder, followed by a survey with 15 KC women using 17 items for understandability and 7 items for actionability by means of a Korean version PEMAT-P.

Results

The health educational calendar consists of 12 subjects out of 9 topics related to healthy lifestyles for preventing cardiovascular diseases. The overall mean understandability score was 98.8% and the overall mean actionability was 100%.

Conclusion

Involvement of KC women and community stakeholders in the development of educational materials was found to be an effective strategy for increasing understandability and actionability of educational materials for KC female migrant workers. This study also demonstrates the PEMAT-P is a useful evaluation tool, emphasizing the actionability of educational materials.

Keywords: Health promotion; Health education; Patient education handout

Notes

This article was funded by a grant from the Mo-Im Kim Nursing Research Institute Yonsei University.

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Article information Continued

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Funded by : Yonsei Universityhttp://dx.doi.org/10.13039/501100002573

Figure 1

Research process.

Figure 2

Examples of education materials.

Table 1

Characteristics of Korean-Chinese Women in the Study

Variables	Characteristics	Categories	n (%) or M±SD
Focus group interviews (N=20)	Age (year)		56.4±6.18
	Marriage	Married	19 (95.0)
	Marriage	Other	1 (5.0)
	Living with family	Yes	8 (40.0)
	Living with family	No	12 (60.0)
	Spouse's nationality^†	China	19 (95.0)
	Education	Elementary school	2 (10.0)
		Middle school	4 (20.0)
		High school	13 (65.0)
		≥College	1 (5.0)
	Job	Restaurant worker	3 (15.0)
		Domestic worker	14 (70.0)
		Office worker	1 (5.0)
		Factory worker	1 (5.0)
		Cleaner	1 (5.0)
	Work duration (month)		82.4±58.00
	Duration of residence in Korea (month)		107.7±67.81
	Religion	Christian	19 (95.0)
	Religion	None	1 (5.0)
Understandability & actionability (N=15)	Age (year)^†		58.3±4.13
	Marriage^†	Married	13 (86.7)
	Marriage^†	Divorced	1 (6.7)
	Living with family^†	Yes	8 (53.3)
	Living with family^†	No	6 (40.0)
	Spouse's nationality^†	China	13 (86.7)
	Spouse's nationality^†	Korea	1 (6.7)
	Education	Middle school	4 (26.7)
		High school	9 (60.0)
		≥College	2 (13.3)
	Job	Domestic worker	12 (80.0)
		Office worker	1 (6.7)
		Cleaner	1 (6.7)
		Service	1 (6.7)
	Work duration (month)		92.1±58.34
	Duration of residence in Korea (month)		140.1±52.67
	Religion	Christian	12 (80.0)
	Religion	None	3 (20.0)

^†Percentages do not add up to 100 because of missing data.

Table 2

Understandability & Actionability of Educational Materials Perceived by Korean-Chinese Women Participants (N=15)

Item#	Item		Agreement (n)
Understandability	Topic: Content
	1	The material makes its purpose completely evident.	15
	2	The material does not include information or content that distracts from its purpose.	14
	Topic: Word choice & style
	3	The material uses common, everyday language.	15
	4	Medical terms are used only to familiarize audience with the terms. When used, medical terms are defined.	14
	5	The material uses the active voice.	15
	Topic: Use of numbers
	6	Numbers appearing in the material are clear and easy to understand.	15
	7	The material does not expect the user to perform calculations.	14
	Topic: Organization
	8	The material breaks or “chunks” information into short sections.	15
	9	The material’s sections have informative headers.	15
	10	The material presents information in a logical sequence.	15
	11	The material provides a summary.	15
	Topic: Layout & design
	12	The material uses visual cues (e.g., arrows, boxes, bullets, bold, larger font, highlighting) to draw attention to key points.	15
	Topic: Use of visual aids
	15	The material uses visual aids whenever they could make content more easily understood	15
	15	(e.g., illustration of healthy portion size).	15
	16	The material’s visual aids reinforce rather than distract from the content.	15
	17	The material’s visual aids have clear titles or captions.	15
	18	The material uses illustrations and photographs that are clear and uncluttered.	15
	19	The material uses simple tables with short and clear row and column headings.
	Understandability score (%): 98.8
Actionability	20	The material clearly identifies at least one action the user can take.	15
	21	The material addresses the user directly when describing actions.	15
	22	The material breaks down any action into manageable, explicit steps.	15
	23	The material provides a tangible tool (e.g., menu planners, checklists) whenever it could help the user take action.	15
	24	The material provides simple instructions or examples of how to perform calculations.	15
	25	The material explains how to use the charts, graphs, tables, or diagrams to take actions.	15
	26	The material uses visual aids whenever they could make it easier to act on the instructions.	15
	Actionability score (%): 100

Table 3

Development of Educational Materials

Topic	Subjects	Major contents	Example statements for actionability
Diet	- Low-salt diet	to investigate daily intake of sodium; to provide cautionary information before eating; to suggest sodium amount in each food consumed frequently.	“Check sodium amount indicated in nutritional labeling when buying foods.” “Eat less foods containing high amount of sodium.” “Season food with soy sauce rather than salt.”
	- Sodium levels in each food
	- Limit high-fat foods	to suggest ways to reduce high fat when cooking foods; to suggest fat amount and calorie of foods easily consumed.	“Change the cooking method from frying to steaming, roasting and boiling.” “Trim any fat from the meat and pork, and use only lean meat.” “Remove fat several times when cooking bone soup, beef soup and others.”
	- Cholesterol level in foods (per 100g)
Smoking	- Protecting oneself from second-hand smoking	to explain the danger of second-hand smoking and to suggest time period of exposing to second-hand smoking and effects of smoking by picture.	“If you are exposed to smoking even if you are non-smoker, it can result in respiratory diseases, cardiovascular diseases, cancers and early death.”
Smoking	- Amount of second-hand smoking in non-smokers
Drinking alcohol	- To keep healthy drinking habits	to suggest healthy drinking habits and appropriate drinking amount according to gender; to suggest alcohol amount measured by standard glass for various kinds of alcoholic beverages.	“Do not exceed the recommended amount of alcohol.” “Drink alcohol slowly with water.” “Drink with several intervals.”
Drinking alcohol	- Alcohol amount measured by standard glass
Exercise	- Exercise over 30 minutes a day, 5 times a week	to suggest appropriate frequency and time of exercise and ways to increase physical activities in daily life.	“Take for a walk pushing a stroller in the park and around home.” “Stretch when time allows from work.” “Use stairs rather than elevator.”
	- Increasing physical activity in daily life
	- Self-awareness regarding strength levels of each aerobic physical activity
Weight control	- Maintaining appropriate weight	to suggest importance of maintaining appropriate weight and standard of abdominal obesity; to suggest ways to prevent obesity.	“Increase physical activities.” “Reduce sedentary time.”
	- Standard of abdominal obesity
	- Prevention of obesity
Stress management	- Reducing stress level	to suggest ways to reduce stress in daily life and have positive attitudes.	“Maintain healthy rhythm of life such as hobby, entertainment and others.” “Get proper sleep.” “Write thank you letter.” “Write past experience of success.”
Stress management	- Keeping positive attitudes
Chronic disease management	- Regular heath checkup	to explain the importance of regular health checkups; to suggest normal and abnormal levels of blood pressure and glucose.	“You must know your blood pressure, blood glucose, and cholesterol levels through regular health checkups.”
	- Classification of blood pressure
	- Classification of blood glucose
	- Management of chronic diseases	to suggest the importance and ways of chronic disease management; to provide a list of clinics for migrants.	“Medication for hypertension, diabetes, hyperlipidemia should follow by doctor’s prescription, and it should be never changed or stopped without permission.”
	- Free clinics for migrants
Presymptoms of cardiovascular diseases	- Knowing presymptoms of cardiovascular diseases	to suggest the types of presymptoms of cardiovascular diseases and behaviors when they appear.	“If you are treated at hospital immediately when there are presymptoms that appear shortly in body and disappear, damage caused by disease could be reduced.“
Heart checklist	- Checklist	to confirm one’s health condition by checking the heart checklist.	“What is your blood pressure?” “How often do you exercise?” “How salty is your food?”
Heart checklist	- Results
Stretching	- To do stretching	to suggest ways of stretching by pictures.	“Raise your arms over head and stretch them side to side.”