Understandability of passive smoking prevention leaflets in Japan.

Purpose: There are few studies in Japan evaluating informationalmaterials 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. Methods: We 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). Results: Although 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. Conclusions: The understandability of written informational materials about passive smoking prevention in Japan could be improved by referring to multiple assessment scales. [ABSTRACT FROM AUTHOR]