HLTH 5053 Module 2 Health Materials Critique Example

A Fact Sheet at Grade Twelve for Readers at Grade Five: Critiquing a City's Extreme Heat Materials With PEMAT and the CDC Clear Communication Index

Student Name

American College of Education

HLTH5053: Public Health Literacy and Communication

Module 2 Assignment

Instructor Name

October 12, 2026

The Materials Under Review

The previous module showed that most residents of the six senior buildings screened as possibly having limited health literacy, that under a quarter could explain an advisory, and that most get weather news from television, radio and building notices. This module examines whether the city health department's current heat materials fit that audience. Three materials were reviewed: a one-page fact sheet titled Heat Advisory: Protect Yourself, distributed in English only; the text message the department sends through the city's alert system when a heat advisory is issued; and a lobby poster placed in each senior building every June.

Judging materials by impression invites disagreement, so the review used two structured tools and a readability formula, with two reviewers scoring each item independently and resolving differences by discussion.

The Tools

The Patient Education Materials Assessment Tool, known as PEMAT, rates materials on two scales. Understandability asks whether people of varied backgrounds and literacy levels can process and explain the key messages; actionability asks whether they can identify what they can do. Shoemaker et al. (2014), who developed the tool, found strong internal consistency and reliability, and in consumer testing, materials rated actionable produced higher comprehension scores than poorly actionable ones, 76% compared with 63%. They also found strong negative correlations between reading grade level and both PEMAT scores and consumer testing results, a reminder that difficult text undermines everything else.

The CDC Clear Communication Index adds dimensions PEMAT treats lightly. It contains four introductory questions and 20 scored items grouped into message clarity and presentation, behavioral guidance, numbers and risk communication (Centers for Disease Control and Prevention, 2025). Its risk items are especially relevant for heat, where the core message is that danger rises quickly and some people face more of it than others. Reading grade level was estimated with the Flesch-Kincaid formula in a standard word processor.

The Fact Sheet

The fact sheet scored 54% on PEMAT understandability and 40% on actionability, and 55 out of 100 on the Clear Communication Index. Its reading level was grade 11.8. The main message was not stated at the top; instead, the sheet opened with the National Weather Service's definition of a heat advisory and the heat index thresholds that trigger it. Terms such as heat index, hyperthermia and electrolytes were used without explanation. Recommendations were given as a list of ten general tips, including stay hydrated and avoid strenuous activity, without saying how much to drink or where to go. The phone number for rides to cooling centers appeared in small print at the bottom, and the sheet did not name a single cooling center. The fact sheet tells readers what a heat advisory is and almost nothing about what they should do in the next hour.

The Text Alert and the Poster

The text alert read, in full: HEAT ADVISORY in effect until 8 PM Thursday. Heat index values up to 108. Limit outdoor activity, stay hydrated, check on neighbors. Visit the city website for cooling centers. It scored 60% for understandability and 33% for actionability, and 45 on the Clear Communication Index. Its strengths were brevity and a clear time frame. Its weaknesses were an unexplained number, generic advice that assumes the reader will go outside, and a link to a website that most of the audience does not use.

The lobby poster performed best, with 67% understandability, 60% actionability and a Clear Communication Index score of 70. It used a large photograph of a fan and a glass of water, short sentences and the address of the nearest cooling center. It was weakened by being posted in June and left up all summer, so residents stopped noticing it, and by the absence of any Spanish or Vietnamese text.

Patterns Across the Materials

Three patterns cut across all three materials. First, each assumed a reader who understands weather terminology and numbers, although the audience assessment showed that fewer than a quarter could explain a heat advisory. Second, none gave specific, personal actions for a person alone in an apartment without air conditioning, the situation of highest risk. Third, none was available in Spanish or Vietnamese, although about a quarter of residents prefer those languages. The poster's better scores came from features that could be applied to the other materials: a clear visual, short sentences and a specific place to go.

What Residents Said

Scores from trained reviewers can miss how real readers react, so the team also showed the three materials to ten residents, chosen to include people whose Newest Vital Sign results suggested limited literacy (Weiss et al., 2005), people who prefer Spanish or Vietnamese, and people with poor eyesight. Each was asked to read or listen to a material and explain, in their own words, what it asked them to do. Their answers confirmed the scores and added detail. Most could not say what to do after reading the fact sheet; several focused on the number 108 in the text alert and asked whether it was the temperature inside their apartment. Residents who prefer Spanish or Vietnamese could not use any of the materials without help. The poster fared better, but two residents with vision problems could not read the address of the cooling center from a normal viewing distance. Three residents said the most useful thing would be a phone call from someone they knew. These interviews shaped the revisions below, especially the decision to replace numbers with plain descriptions of danger and to rely on people as well as print.

Revisions

The department should revise all three materials to a common standard. Each should open with a single main message in plain words, such as It will be dangerously hot until Friday. Stay somewhere cool and talk to someone every day. Each should give three specific actions, for example: go to the cooling center at the named library, open from 10 to 6, or phone the printed ride line and a driver will come; drink a glass of water every hour even if you are not thirsty; and call the listed nurse line if you feel dizzy, confused or have a headache. Each should be written below a sixth-grade reading level, printed in at least 16-point type for print materials, and translated into Spanish and Vietnamese by qualified translators, then reviewed by native-speaking residents.

The text alert should be rewritten to fit these rules in under 160 characters and paired with an automated voice call in each language for residents who opt in. The poster should be replaced with a heat-day version posted only during warnings, so that its appearance itself signals danger. Revised materials will be re-scored with both tools and tested with ten residents from the buildings before the summer, with the department's own target of at least 70% on both PEMAT scales and at least 90 on the Clear Communication Index.

References

Centers for Disease Control and Prevention. (2025, May 29). The CDC Clear Communication Index. https://www.cdc.gov/ccindex/index.html

Shoemaker, S. J., Wolf, M. S., & Brach, C. (2014). Development of the Patient Education Materials Assessment Tool (PEMAT): A new measure of understandability and actionability for print and audiovisual patient information. Patient Education and Counseling, 96(3), 395-403. https://doi.org/10.1016/j.pec.2014.05.027

Weiss, B. D., Mays, M. Z., Martz, W., Castro, K. M., DeWalt, D. A., Pignone, M. P., Mockbee, J., & Hale, F. A. (2005). Quick assessment of literacy in primary care: The Newest Vital Sign. Annals of Family Medicine, 3(6), 514-522. https://doi.org/10.1370/afm.405