Understandability and actionability of patient education materials for diabetic retinopathy among indigenous and general populations

Clinical relevance: Effective diabetic retinopathy (DR) patient education materials (PEMs) are vital for improving patient outcomes by fostering understanding and self-management. Background: DR is a leading cause of vision impairment and blindness among Australians with diabetes, with Indigenous populations facing higher rates of severe complications. Despite the availability of online PEMs, their understandability and actionability, especially those designed for Indigenous Australians, remains underexplored, creating a gap in effective patient education. Methods: This descriptive study assessed online PEMs using the Patient Education Materials Assessment Tool (PEMAT). Evaluations were conducted with online search platforms for printable and audiovisual PEMs on DR. Two independent reviewers scored the PEMs for understandability and actionability, with discrepancies resolved by a third adjudicator. A 70% threshold was used to indicate acceptable scores. Results: From 540 identified PEMs, 54 met the inclusion criteria. Indigenous-targeted PEMs achieved higher in understandability (80%) than general population PEMs (75%). However, actionability scores were lower across all formats, with printable PEMs having a mean score of 42% for general population and 53% for Indigenous PEMs, and audiovisual PEMs at 29%. Conclusion: While most DR-related PEMs are generally understandable, their low actionability, especially audiovisual formats, indicates a need for clearer, step-by-step guidance to support patient self-management. Improving the structure and content of both printable and audiovisual PEMs can improve engagement and adherence to preventive behaviours among people living with diabetes, potentially reducing the burden of DR.