Self-perceived food literacy in relation to the quality of overall diet and main meals: A cross-sectional study in Japanese adults.

This cross-sectional study aimed to assess the relationship between self-perceived food literacy (SPFL) and quality of overall diet and main meals in Japanese adults. In total, 5998 adults aged 20-79 years were included in this analysis. The SPFL was assessed using the Japanese version of the 29-item Dutch SPFL scale (score range 1-5). Using validated dietary information, the Healthy Eating Index-2015 (HEI-2015) was calculated (score range 0-100). The mean SPFL was 3.18; the internal consistency of the overall scale was considered good (Cronbach's alpha: 0.80). The mean HEI-2015 for overall diet was 50.4. The SPFL was significantly and positively associated with the HEI-2015. Using multiple linear regression, one point increase of SPFL corresponded to an increase in HEI-2015 by a point of 4.8 for overall diet, 6.2 for breakfast, 4.6 for lunch, and 3.6 for dinner (all P < 0.0001). Six of the eight domains of SPFL (i.e., food preparation skills, resilience and resistance, healthy snack styles, examining food labels, healthy budgeting, and healthy food stockpiling) were significantly associated with the HEI-2015 for overall diet. When the HEI-2015 for each meal was examined, the domains showing significant associations with all three meals included food preparation skills, healthy snack styles, and healthy budgeting. The healthy food stockpiling was associated with the HEI-2015 for breakfast and lunch, but not dinner. The social and conscious eating and daily food planning were associated with the breakfast HEI-2015 only, with the resilience and resistance associated with the dinner HEI-2015 only. In conclusion, the SPFL was cross-sectionally associated with the quality of overall diet and main meals in Japanese adults. Further observation and intervention studies are needed to confirm the associations observed here.

Prevalence and Correlates of Dietary and Nutrition Information Seeking Through Various Web-Based and Offline Media Sources Among Japanese Adults: Web-Based Cross-Sectional Study.

BACKGROUND: The advent of the internet has changed the landscape of available nutrition information. However, little is known about people's information-seeking behavior toward healthy eating and its potential consequences. OBJECTIVE: We aimed to examine the prevalence and correlates of nutrition information seeking from various web-based and offline media sources. METHODS: This cross-sectional study included 5998 Japanese adults aged 20 to 79 years participating in a web-based questionnaire survey (February and March 2023). The dependent variable was the regular use of web-based and offline media as a reliable source of nutrition information. The main independent variables included health literacy, food literacy, and diet quality, which were assessed using validated tools, as well as sociodemographic factors (sex, age, education level, and nutrition- and health-related occupations). RESULTS: The top source of nutrition information was television (1973/5998, 32.89%), followed by web searches (1333/5998, 22.22%), websites of government and medical manufacturers (997/5998, 16.62%), newspapers (901/5998, 15.02%), books and magazines (697/5998, 11.62%), and video sites (eg, YouTube; 634/5998, 10.57%). Multivariable logistic regression showed that higher health literacy was associated with higher odds of using all the individual sources examined; odds ratios (ORs) for 1-point score increase ranged from 1.27 (95% CI 1.09-1.49) to 1.81 (95% CI 1.57-2.09). By contrast, food literacy was inversely associated with the use of television (OR 0.65, 95% CI 0.55-0.77), whereas it was positively associated with the use of websites of government and medical manufacturers (OR 1.98, 95% CI 1.62-2.44), books and magazines (OR 2.09, 95% CI 1.64-2.66), and video sites (OR 1.53, 95% CI 1.19-1.96). Furthermore, diet quality was positively associated with the use of newspapers (OR 1.02, 95% CI 1.01-1.03) and books and magazines (OR 1.03, 95% CI 1.02-1.04). Being female was associated with using television and books and magazines, whereas being male was associated with using websites of government and medical manufacturers, newspapers, and video sites. Age was positively associated with using newspapers and inversely associated with using websites of government and medical manufacturers and video sites. People with higher education were more likely to refer to websites of government and medical manufacturers and newspapers but less likely to use television and video sites. Dietitians were more likely to use websites of government and medical manufacturers and books and magazines than the general public but less likely to use television and video sites. CONCLUSIONS: We identified various web-based and offline media sources regularly used by Japanese adults when seeking nutrition information, and their correlates varied widely. A lack of positive associations between the use of the top 2 major sources (television and web searches) and food literacy or diet quality is highlighted. These findings provide useful insights into the potential for developing and disseminating evidence-based health promotion materials.

Factors associated with adherence to recommendations for medical visits following annual health checkups among Japanese employees: A prospective cohort study.

There are growing concerns in Japanese workplaces that many employees do not follow recommendations to visit medical institutions for further examinations following annual health checkups. Although previous studies have shown that job- and health-related factors affect adherence to such recommendations, these longitudinal associations are unknown. We examined the longitudinal associations between job- and health-related factors and visiting medical institutions after annual health checkups among Japanese employees. We conducted a prospective cohort study in a food-related company in fiscal year 2019. Participants completed a self-administered questionnaire to assess job- and health-related factors. Of 2914 employees who completed the questionnaire, 615 received recommendations to visit medical institutions following annual health checkups in fiscal year 2020; these employees comprised our sample. We used logistic regression analysis to examine the associations between each factor and medical institution visits. Of participants, 474 (77.1 %) were men, 432 (70.2 %) were aged over 40 years, and 293 (47.6 %) visited a medical institution. Logistic regression analysis showed that participants with a primary doctor and those with obesity were more likely to visit medical institutions. In Japanese workplaces, having a primary doctor may be important in increasing adherence to medical visit recommendations following annual health checkups. However, more focus is also needed on employees without obesity who may be more confident about their health and so less likely to follow recommendations. Further intervention studies focusing on these factors are needed to identify effective interventions to improve adherence to medical recommendations.

Evaluating the understandability and actionability of online CKD educational materials.

BACKGROUND: Previous studies have not fully determined whether online education materials on chronic kidney disease (CKD) for Japanese patients are easy to understand and help change their behavior. Therefore, this study quantitatively assessed the understandability and actionability of online CKD education materials. METHODS: In September 2021, we searched Google and Yahoo Japan using the keywords "kidney," "kidney disease," "CKD," "chronic kidney disease," and "renal failure" to identify 538 webpages. We used the Japanese version of the Patient Education Materials Assessment Tool (PEMAT), ranging from 0 to 100%, to evaluate the understandability and actionability of webpages. We set the cutoff point to 70%. RESULTS: Of the 186 materials included, the overall understandability and actionability were 61.5% (± 16.3%) and 38.7% (± 30.6%), respectively. The materials were highly technical in their terminology and lacked clear and concise charts and illustrations to encourage action. Compared to lifestyle modification materials on CKD overview, symptoms/signs, examination, and treatment scored significantly lower on the PEMAT. In addition, the materials produced by medical institutions and academic organizations scored significantly lower than those produced by for-profit companies. CONCLUSION: Medical institutions and academic organizations are encouraged to use plain language and to attach explanations of medical terms when preparing materials for patients. They are also expected to improve visual aids to promote healthy behaviors.

Encouraging COVID-19 vaccination by focusing on anticipated affect: A scoping review.

Objective: This study reviewed studies of the anticipated affect related with COVID-19 vaccination to understand gaps in currently available studies and practice implications. Methods: We systematically searched MEDLINE, CINAHL, and other multiple databases for English language articles of studies that investigated COVID-19 vaccination related anticipated affects. Results: We identified seventeen studies. Thirteen studies focused anticipated regret from inaction (i.e., not vaccinated). Other studies focused anticipated regret from action (i.e., vaccinated), guilt from inaction, pride from action, and positive feelings from action. Eleven studies showed that anticipated regret from inaction was significantly associated with COVID-19 vaccination behavior or intention. Three of the 11 studies showed that anticipated regret from inaction was more strongly associated with vaccination behavior or intention than cognitive belief. Conclusion: Most studies showed that positive associations between anticipated regret and COVID-19 vaccination outcomes. The use of messages that target cognitive beliefs as well as those that appeal to anticipated affect may be effective to promote COVID-19 vaccination. However, most studies employed a cross-sectional design and examined negative affect. Future studies should adopt an experimental design as well as examine positive affect.

Public perception of the resumption of HPV vaccine recommendation in Japan: Twitter content analysis.

On 12 November 2021, after a stagnation of 8.5 years, Japan decided to resume proactive recommendations for HPV vaccines. However, it is not known how the public reacted to the resumption of proactive recommendations for HPV vaccines, which are key elements in health communication that promote HPV vaccination. This study aimed to capture discussions on HPV vaccination on Twitter and to identify user characteristics, sentiments, discussed themes and their potential reach before and after 12 November 2021, when the Ministry of Health, Labour, and Welfare's decision to resume proactive recommendation for HPV vaccines was first reported by the media in Japan. This study conducted a content analysis of tweets related to HPV vaccines posted on 11 November and 12 November 2021. Tweets were coded in terms of user characteristics, sentiments (i.e. positive, negative and neutral) and themes. Reach was measured by the number of retweets, likes and followers. A total of 3623 tweets were identified. The results showed that approximately 50% of health professionals and researchers tweeted neutral content about HPV vaccines. The most frequently discussed theme was the safety and side effects of HPV vaccines, which was accompanied by mainly negative sentiments. Although health professionals and researchers are influential on Twitter, half of them tweeted neutrally about HPV vaccines. Influential professionals, such as health professionals and researchers, are expected to disseminate accurate information to correct misinformation and recommend HPV vaccination on Twitter to overcome the HPV vaccination crisis, which is characterized by the low vaccination rates.

Web-Based Content on Diet and Nutrition Written in Japanese: Infodemiology Study Based on Google Trends and Google Search.

BACKGROUND: The increased availability of content of uncertain integrity obtained through the internet is a major concern. To date, however, there has been no comprehensive scrutiny of the fitness-for-purpose of web-based content on diet and nutrition. OBJECTIVE: This cross-sectional study aims to describe diet- and nutrition-related web-based content written in Japanese, identified via a systematic extraction strategy using Google Trends and Google Search. METHODS: We first identified keywords relevant for extracting web-based content (eg, blogs) on diet and nutrition written in Japanese using Google Trends. This process included identification of 638 seed terms, identification of approximately 1500 pairs of related queries (top) and search terms, the top 10% of which were extracted to identify 160 relevant pairs of related queries (top) and search terms, and identification of 107 keywords for search. We then extracted relevant web-based content using Google Search. RESULTS: The content (N=1703) examined here was extracted following a search based on 107 keywords. The most common themes included food and beverages (390/1703, 22.9%), weight management (366/1703, 21.49%), health benefits (261/1703, 15.33%), and healthy eating (235/1703, 13.8%). The main disseminators were information technology companies and mass media (474/1703, 27.83%), food manufacturers (246/1703, 14.45%), other (236/1703, 13.86%), and medical institutions (214/1703, 12.57%). Less than half of the content (790/1703, 46.39%) clearly indicated the involvement of editors or writers. More than half of the content (983/1703, 57.72%) was accompanied by one or more types of advertisement. The proportion of content with any type of citation reference was 40.05% (682/1703). The themes and disseminators of content were significantly associated with the involvement of editors or writers, accompaniment with advertisement, and citation of reference. In particular, content focusing on weight management was more likely to clearly indicate the involvement of editors or writers (212/366, 57.9%) and to be accompanied by advertisement (273/366, 74.6%), but less likely to have references cited (128/366, 35%). Content from medical institutions was less likely to have citation references (62/214, 29%). CONCLUSIONS: This study highlights concerns regarding the authorship, conflicts of interest (advertising), and the scientific credibility of web-based diet- and nutrition-related information written in Japanese. Nutrition professionals and experts should take these findings seriously because exposure to nutritional information that lacks context or seems contradictory can lead to confusion and backlash among consumers. However, more research is needed to draw firm conclusions about the accuracy and quality of web-based diet- and nutrition-related content and whether similar results can be obtained in other major mass media or social media outlets and even other languages.

Evaluating understandability and actionability of online education materials for home-care patients with COVID-19 in Japan.

OBJECTIVE: In Japan, educational materials on the home care of coronavirus disease 2019 (COVID-19) were developed owing to limited access to medical care during the pandemic. This study quantitatively evaluated the understandability, actionability, natural flow, and readability of 87 materials published by local governments in Japan for patients with COVID-19. Their understandability and actionability were rated using the Japanese version of the Patient Education Material Evaluation Tool for Printed Materials (PEMAT-P). Natural flow and readability were rated using Global Quality Score (GQS) and jReadability, respectively. RESULTS: Of the 87 materials, 55 (62.1%) were understandable and 33 (37.9%) were actionable according to the PEMAT-P. Regarding understandability, the materials used medical terms without providing definitions and lacked summaries. Regarding actionability, the materials did not demonstrate explicit steps or utilize visual aids to help the readers take action. The mean (SD) of GQS was 3.44 (0.98), indicating a moderate level of naturalness and comprehensiveness of the materials. The mean (SD) score for readability was 2.4 (0.6), indicating a "lower advanced" level. However, challenges regarding the materials' plain language remained, such as defining medical terms, summarizing the content for understandability, and using charts and tables that encourage patients to act.

Evaluating the understandability and actionability of online educational videos on pre-dialysis chronic kidney disease.

AIM: It remains undetermined whether online education videos for Japanese patients with chronic kidney disease (CKD) are easy to understand and allow adoption of behavioural changes. This study quantitatively assessed the understandability and applicability of online education videos for patients with CKD. METHODS: In September 2021, we identified 200 videos on YouTube using the Japanese translations of the keywords 'kidney,' 'kidney disease,' 'CKD,' and 'chronic kidney disease.' We used the Japanese version of the Patient Education Materials Assessment Tool to evaluate the understandability and usability of webpages on a scale of 0% to 100%. The cut-off was set at 70%. RESULTS: A total of 54 videos were evaluated. The overall understandability and actionability of the materials were 57.6 (SD = 22.6) and 53.7 (SD = 33.4), respectively. Approximately 70% and 60% of the materials were considered insufficiently understandable and actionable, respectively. Most videos lacked a summary and had difficulty in using only everyday language. Most videos included at least one action for the audience to take. However, many failed to break down the action into sequential steps. They also lack visual aids to encourage the audience to take action. CONCLUSION: Our results suggest that current information on pre-dialysis chronic kidney disease was not presented in a manner that can be applied by laypeople.

Development of the Japanese Version of Pregnancy-Related Anxiety Questionnaire-Revised-2: Measurement and Psychometric Properties.

Tools to evaluate pregnancy-specific anxiety are lacking in Japan. This study aimed to develop a Japanese version of the Pregnancy-Related Anxiety Questionnaire-Revised-2. After scale translation and cognitive interviews, we conducted a cross-sectional study among 120 ≥18-year-old, singleton (pregnant with one baby) Japanese women before 15 weeks of pregnancy, recruited from four facilities. A total of 112 women completed the questionnaires. We tested the internal consistency, measurement error and reliability, structural validity, measurement invariance across nulliparous and parous women, construct validity by calculating omega, standard error of measurement (SEM), intraclass correlation coefficient (ICC), confirmatory factor analysis (CFA), multigroup CFA, multitrait-scaling analysis, correlational analyses with other measurements, and t-test to compare nulliparous and parous groups. Omega was 0.90 for the total score. SEM was 3.4 and ICC was 0.76. The CFA revealed an optimal fit for the three-factor model based on the original scale. Multigroup CFA supported measurement invariance across the nulliparous and parous groups, and multitrait-scaling analysis revealed 100% scaling success. The correlation coefficients with other scales of childbirth anxiety and general anxiety were 0.70 and 0.24. The mean total score of the nulliparous women was higher than that of the parous women (34.5 vs. 30.3, p = 0.001). Therefore, the scale was determined to have good validity and reliability.

Addressing message fatigue for encouraging COVID-19 vaccination.

During the prolonged COVID-19 pandemic, health communication researchers and practitioners should be aware of the unintended effects of message fatigue. Message fatigue is a motivational state caused by repeated and prolonged exposure to similar health-related messages that induces resistance to health behaviors. Messages encouraging COVID-19 vaccination tend to focus on scientific evidence and efficacy information. However, prolonged exposure to similarly framed repeated pro-COVID-19 vaccination messages may cause message fatigue, generate psychological reactance, and lead to ineffective persuasive outcomes. Scholars of message fatigue argue that health communication practitioners should select a less common frame to reduce fatigue responses and increase favorable attitudes toward message recommendations. Entering the second year since COVID-19 vaccination has begun, to reduce message fatigue, future pro-COVID-19 vaccination communication should increase the diversity of messages different than the frequently used types. This opinion piece proposes alternative dissemination of cognitive, affective, narrative, and non-narrative pro-COVID-19 vaccination messages.

Intervention studies to encourage HPV vaccination using narrative: A scoping review.

OBJECTIVE: This review aimed to provide an overview of intervention studies that aimed to encourage HPV vaccination using narratives. METHODS: We searched MEDLINE, CINAHL, PsycINFO, and PsycARTICLES for English language articles that quantitatively examined the persuasive effect of narratives on encouraging HPV vaccination through interventions. RESULTS: A total of 25 studies were identified. Most studies were conducted in the United States of America, adopted a convenient sampling of university students, measured vaccination intention as the primary outcome, and used text messages in the interventions. A minority of the studies measured vaccination behavior and examined the long-term effects of persuasion. Narratives were as effective as didactics and statistics in encouraging HPV vaccination in most included studies. The findings were mixed or scarce for the effect of combining narratives and statistics, and the person (the first vs. third), narrator, framing, and content of narratives. CONCLUSION: More findings from a broader range of well-designed studies are needed to determine which narratives can encourage HPV vaccination across different populations. PRACTICE IMPLICATIONS: Findings indicated using narratives can be a part of repertoire of messages encouraging HPV vaccination.

Association between trust in COVID-19 information sources and engaging in infection prevention behaviors in Japan: A longitudinal study.

OBJECTIVE: We examined changes in people's trust in information sources in Japan during the COVID-19 pandemic over the course of 1 year and investigated longitudinal associations between trust in such sources and engaging in infection prevention behaviors. METHODS: We conducted a longitudinal survey of Japanese populations under a declared state of emergency at two time points, August 2020 and August 2021. We surveyed sociodemographic data, seven Trust in COVID-19 information sources and six COVID-19 preventive behaviors. RESULTS: In all, 784 participants completed the two surveys. Physicians were the most consistently trusted information source over the 1-year period. We identified three preventive behaviors that were positively associated with trust in physicians as an information source (social distancing, wearing masks, and washing hands with soap), four preventive behaviors that were positively associated with trusting infected patients (social distancing, using ventilation, wearing masks, and using hand sanitizer), and one preventative behavior that was negatively associated with trust in government (avoiding closed spaces). CONCLUSION: In the ongoing pandemic, information from physicians and patients may encourage people to engage in long-term preventive behaviors. PRACTICE IMPLICATIONS: Physicians and patients should be promoted as trusted and behavior influencing sources of information during the pandemic.

Associations between Vaccination Behavior and Trust in Information Sources Regarding COVID-19 Vaccines under Emergency Approval in Japan: A Cross-Sectional Study.

We examined the association between COVID-19 vaccination behavior and trust in COVID-19-related information sources during the initial period of COVID-19 vaccination in Japan. A cross-sectional survey was conducted in August 2021, 5 months after the start of COVID-19 vaccination for the general public under emergency approval. Participants were recruited using non-probability quota sampling from among Japanese residents who were under a declared state of emergency. Sociodemographic data, vaccination behavior, and levels of trust in eight media sources of information and three interpersonal information sources were assessed using an online survey form. A total of 784 participants completed the survey. The results of multiple logistic regression analysis showed that age, household income, underlying medical conditions, and living with family were significantly associated with COVID-19 vaccination behavior. Regarding COVID-19 vaccine information sources, trust in public health experts as a source of media information and primary care physicians as a source of interpersonal information showed significantly positive associations with COVID-19 vaccination behavior (odds ratio [OR] = 1.157, 95% confidence interval [CI] 1.017-1.31; OR = 1.076; 95% CI 1.006-1.150, respectively). Increasing trust in public health experts and primary care physicians and disseminating vaccine information from these sources will help promote vaccination under emergency approval.

Print Materials to Promote Physical Activities in Japan: Content Analysis from a Goal Theory.

Physical activity has significant health benefits for the heart, body, and mind. However, the percentage of people engaging in exercise routines is low in Japan. Goals are important components of motivation. Scholars suggest that appropriately setting both subordinate goals of what to do and superordinate goals of why to do it may motivate the audience and promote behavior. However, it is not known what goals are presented in print materials that promote physical activity. Therefore, this study aimed to understand the presented goals by performing content analysis of those materials in Japan. We collected print materials such as leaflets, brochures, and posters via website search. The presence of subordinate and superordinate goals and topics for each goal was analyzed. A total of 224 print materials were systematically collected and analyzed. The results showed that 14.3% of the print materials did not present any superordinate goals, whereas 100% of them presented subordinate goals. For superordinate goals, healthy aging was frequently presented. For subordinate goals, 67.4% presented only exercise. There is a difference in presenting goals between the private and government sectors. Since goals affect motivation and behavior change, it may be beneficial to incorporate the findings of the goal theory in future print materials.

Anticipated Affect That Encourages or Discourages Human Papillomavirus Vaccination: A Scoping Review.

We reviewed studies that examined the anticipated affects associated with human papillomavirus (HPV) vaccination to identify gaps in the literature and the currently available practice implications for encouraging HPV vaccination. We systematically searched MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, PsycINFO, PsycArticles, Academic Search Complete, Scopus, and Web of Science to find English articles that quantitatively and qualitatively examined anticipated affects associated with HPV vaccination. A total of twenty-one studies were identified. Seventeen studies examined the anticipated inaction regret (i.e., not being vaccinated). Most of the included studies reported that anticipated inaction regret had a significantly positive association with HPV vaccination outcomes, such as vaccination behavior, intention, willingness, and acceptability. Furthermore, seven studies reported that anticipated inaction regret had a significantly positive and stronger association with vaccination outcomes than cognitive beliefs, such as vaccine effectiveness and safety, and perceived susceptibility and severity. The present review indicated that the stronger the participants' anticipated inaction regret, the more likely they were to receive the HPV vaccine. Messages targeting the anticipated affect may be as effective as or more effective than messages targeting cognitive beliefs in encouraging HPV vaccination among people. However, most of the studies included in the present review adopted a cross-sectional design with vaccination intention and willingness as outcomes. Therefore, future studies should examine the influence of anticipated affects on the utilization of HPV vaccines using experimental designs to accumulate stronger evidence.

Using patient storytelling to improve medical students' empathy in Japan: a pre-post study.

BACKGROUND: Empathy for patients is now internationally accepted as one of the competencies of physicians for patient-centered medical practice and an essential component of medical education. Recently, "patient storytelling" has attracted attention in empathy education for medical students to understand patients' experiences, feelings, and perspectives. This study aimed to quantitatively evaluate how patient storytelling enhanced undergraduate medical students' empathy in Japan to the extent that they sustained it for six months. METHODS: Participants were 159 fourth-year undergraduate medical students in Tokyo in academic years 2018 and 2019. The questionnaire surveys were conducted three times: at the beginning of the class, immediately after the class, and six months after the class. The Japanese version of the Jefferson Scale of Empathy-Student Version was used in this study. Gender, age, and clinical orientation were also obtained through the self-reported questionnaire. We invited a male patient storyteller who was diagnosed with chronic kidney disease to the classes on "Professionalism." The title of his storytelling was "The Power of Medical Professionals' Words." RESULTS: JSE-S scores improved significantly immediately after listening to patient storytelling. The scores remained improved six months after the class. Interest of specialty was significantly positively associated with an immediate change in JSE-S scores. However, gender had no significant association with changes in JSE-S scores either immediately or six months after education. CONCLUSIONS: Our findings may suggest that patient storytelling would be useful to cultivate empathy among undergraduate medical students. It is to be expected that more medical schools will use patient storytelling to educate medical students in humanistic and communication education.

Translation, Cross-Cultural Adaptation, and Validation of the Japanese Version of the Patient Education Materials Assessment Tool (PEMAT).

BACKGROUND: The Patient Education Materials Assessment Tool (PEMAT) systematically evaluates the understandability and actionability of patient education materials. This study aimed to develop a Japanese version of PEMAT and verify its reliability and validity. METHODS: After assessing content validation, experts scored healthcare-related leaflets and videos according to PEMAT to verify inter-rater reliability. In validation testing with laypeople, the high-scoring material group (n = 800) was presented with materials that received high ratings on PEMAT, and the low-scoring material group (n = 799) with materials that received low ratings. Both groups responded to the understandability and actionability of the materials and perceived self-efficacy for the recommended actions. RESULTS: The Japanese version of PEMAT showed strong inter-rater reliability (PEMAT-P: % agreement = 87.3, Gwet's AC1 = 0.83. PEMAT-A/V: % agreement = 85.7, Gwet's AC1 = 0.80). The high-scoring material group had significantly higher scores for understandability and actionability than the low-scoring material group (PEMAT-P: understandability 6.53 vs. 5.96, p < 0.001; actionability 6.04 vs. 5.49, p < 0.001; PEMAT-A/V: understandability 7.65 vs. 6.76, p < 0.001; actionability 7.40 vs. 6.36, p < 0.001). Perceived self-efficacy increased more in the high-scoring material group than in the low-scoring material group. CONCLUSIONS: Our study showed that materials rated highly on Japanese version of PEMAT were also easy for laypeople to understand and action.