Environmental health literacy in American Indian communities: Evaluating per-and polyfluoroalkyl substance (PFAS) educational materials
By Logan Young, Vanessa Watts Simonds, Christine Martin, Margaret Eggers, John Doyle, and Shuangying Yu
Environments
May 26, 2026
DOI: 10.3390/environments13060293
American Indian communities may be at increased risk of water-related PFAS exposure. However, communicating the health risks of PFAS exposure requires attention to concepts of health literacy and aligning educational messages with the community’s understanding of health. The purpose of this study was to determine the health literacy demand of PFAS educational materials, with specific attention to their appropriateness for American Indian communities. Publicly available PFAS educational materials were evaluated using the Simple Measure of Gobbledygook (SMOG), the Patient Education Material Assessment Tool (PEMAT), and a cultural appropriateness tool. The mean reading level of the materials was above 12th grade. The PEMAT scores for the 33 print materials were 62% (understandability), 34% (actionability), and 61% (cultural appropriateness). For the videos, the scores were 62% (understandability), 53% (actionability), and 68% (cultural appropriateness). Neither the print nor the video materials met acceptable health literacy standards, meaning the materials are not well-designed for a variety of health literacy levels. There was a lack of actionable directives that should be addressed in future PFAS educational materials. This study highlights the importance of working closely with community partners to develop education materials that match the skills and preferences of the intended audience.
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