Table_1_Understandability of passive smoking prevention leaflets in Japan.DOCX

PurposeThere are few studies in Japan evaluating informational materials about passive smoking prevention with respect to health literacy. This study applied a range of health literacy assessment tools to assess the understandability of public-sector leaflets about passive smoking prevention.
MethodsWe collected 26 anti-passive smoking leaflets published online by Japanese prefectural governments. We used three internationally recognized health literacy assessment tools to evaluate their understandability: the Clear Communication Index (CCI), the Suitability Assessment of Materials (SAM), and the Patient Education Materials Assessment Tool (PEMAT, further divided into scales for understandability and actionability).
ResultsAlthough none of the assessed materials met the CCI's scoring threshold for “easy to understand,” the highest-scoring leaflet, which received a top-two ranking in three of the four scales (excluding the PEMAT understandability scale), was characterized by its conciseness and its easy-to-understand structure, including the use of checklists and flowcharts to engage reader interest. There was a significant correlation between CCI and SAM, and between SAM and the PEMAT understandability scale. However, the PEMAT actionability scale did not significantly associate with the other assessment scales.
ConclusionsThe understandability of written informational materials about passive smoking prevention in Japan could be improved by referring to multiple assessment scales.

研究目的：目前日本针对被动吸烟预防相关宣传材料的健康素养（health literacy）适配评估研究较为稀缺。本研究采用多套健康素养评估工具，对日本公共部门发布的被动吸烟预防宣传折页的易懂性开展测评。
研究方法：本研究收集了日本各都道府县政府在线发布的26份被动吸烟预防宣传折页。采用三项国际公认的健康素养评估工具对其易懂性进行测评：清晰沟通指数（Clear Communication Index, CCI）、材料适宜性评估量表（Suitability Assessment of Materials, SAM），以及患者教育材料评估工具（Patient Education Materials Assessment Tool, PEMAT，该工具进一步分为易懂性子量表与行动指导性子量表两个维度）。
研究结果：本次测评的所有宣传材料均未达到清晰沟通指数（CCI）设定的“易于理解”评分阈值。但得分最高的宣传折页在四项测评量表（排除PEMAT易懂性子量表）中的三项跻身前二，该折页以内容简洁、架构清晰易懂为显著特征，其采用清单与流程图的形式以提升读者关注度。此外，CCI与SAM的评分间存在显著相关性，SAM与PEMAT易懂性子量表的评分亦存在显著相关性；然而PEMAT行动指导性子量表的评分与其余三项评估工具的评分均无显著关联。
研究结论：日本当前被动吸烟预防类书面宣传材料的易懂性可通过参考多维度测评量表得到优化提升。