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Physical Education Assessment Ideas

Assessment in physical education is more important than ever. It is a great way to see if students are really learning in our physical education classes. Written assessments are a terrific medium for showcasing what students have learned to administrators and parents. The following resources and ideas are presented to help teachers incorporate assessment into their programs.

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Assessment is essential and integral to effective teaching and learning in PE as it provides information on students’ strengths, weaknesses, and educational requirements, which informs future planning and teaching [ 1-9 ]. Assessment is also vital for the provision of grades (achieved and predicted), informing others of attainment (parents, teachers etc.), and is used to judge the effectiveness of teachers and the school [ 7, 10 ]. Moreover, feedback from assessment has been recognized for increasing pupil motivation and engagement, and helps create a positive learning environment [ 11, 12 ].

In PE there are many modes of assessment but for the purpose of this article we will focus on the most significant modes (formative and summative) and reference systems (criterion, norm, and ipsative).

Formative assessment has been described as ‘ongoing’ and takes place during teaching-learning situations in PE. It is important as it involves providing pupils with constructive feedback, diagnosing future learning needs, describing students’ progress, and determining their strengths and weaknesses [ 2, 3, 4, 13, 14 ]. It has also been closely related to ‘Assessment for Learning’ and has been commended for its emphasis on describing progress, identifying pupils’ needs, planning for next steps in learning, and providing vital information for summative assessment [ 1, 15, 16 ].

Summative assessment is an overall assessment which takes place at the end of an interval, unit, key stage or year. It has also been described as ‘Assessment of Learning’ as it provides a synopsis of students’ levels of attainment at the end of a specified interval, and is used to provide examination grades [ 1, 2, 7, 9, 15 ]. Summative assessment has been asserted as the ‘systematic recording of the pupil’s overall progress and achievement, and is made up of a series of formative assessments’ [ 3 ].

As previously mentioned, there are three reference systems that have been used for assessment in PE, these are: Norm Referenced; Criterion Referenced; and Ipsative Referenced assessment [ 1, 2, 7, 17, 18 ]. Norm Referenced assessment is when students are compared with one another [ 7, 18 ]. This form of assessment has been regarded as ‘group centred’, as comparisons within the group are made to establish how successful the pupil is in relation to others of the same age [ 2 ]. However, Norm Referencing assessment has been criticised, as the goal for learning is a moving target due to other pupils’ performances determining the standard of learning [ 18 ]. This can be detrimental to students’ self-esteem, as when pupils progress to ‘above average’, it is at the expense of others who become ‘below average’ [ 2 ]. Additionally, dependent upon the ability of the class determines the students’ attainment, as in a high calibre class pupils may receive on average a lower mark, compared to a mediocre class who receives on average a higher mark [ 17 ]. Notwithstanding, Norm Referencing has been deemed inevitable, as it is used in public grading systems, and for selecting pupils for school representation and teams [ 2 ].

Criterion Referenced assessment is comparing pupils performance to a predetermined criteria or standard [ 2, 7, 17, 18 ]. For example, in the UK the National Curriculum’s attainment targets/level descriptors, GCSE’s, A Levels, and other national governing body awards are all examples of Criterion Referenced assessment since students’ performances are judged based on established criteria [ 7 ]. Criterion Referencing is ‘activity centered’ assessment, as all students can potentially achieve the target, eliminating comparison with others, thus promoting collaborative learning as pupils are working together towards a common goal [ 18 ]. Criterion Referenced assessment should not to be viewed in conflict with the other referencing systems, but rather to be used in conjunction with them [ 2 ]. Therefore, the advantage of Criterion Referenced assessment and set standards is that it provides educators with a more accurate measuring stick to assess pupils learning, and provides details of the additional work students must complete to reach the next level of achievement [ 18 ].

Ipsative Referencing assessment compares a pupil’s current performance with their previous performance in the same activity [ 2, 7, 17 ]. Ipsative Referencing is regarded as ‘child centered’, as pupils focus on beating their previous achievement, which is useful for recording learning and progress [ 2, 7 ]. This form of referencing promotes a mastery climate, again eliminating comparison with others, which enhances pupils’ self-esteem, motivation, and accountability [2]. Furthermore, Ipsative Referencing provides a foundation for self and teacher assessments in Records of Achievement [ 2 ].

In conclusion, Norm, Criterion, and Ipsative referenced assessment should not be viewed as mutually exclusive, as they are all beneficial for supporting students’ learning when employed together. It is expected that all PE teachers implement a range of assessment methods in every lesson, as it helps teachers and pupils to progress in their teaching and learning. For assessments to be managed efficiently and effectively, it is important for the criteria to be precise, clearly identified, and related to each other [ 2 ]. Moreover, to develop appropriate and reliable assessment criteria calls for dedicated and devoted teachers, who possess strong observational skills, detailed knowledge of activities and their techniques, and can make sound judgements of pupils’ ability [ 2, 8, 19 ].

• Piotrowski, S. (2000) Assessment, Recording and Reporting. In, Bailey, R., and Macfadyen, T. (Eds) Teaching Physical Education 5-11. London: Continuum. pp. 49-61
• Carroll, B. (1994) Assessment in Physical Education. Burgess Science Press: Basingstoke.
• Mawer, M. (1995) The effective teaching of Physical Education. Essex: Pearson Education Limited. pp. 229-248
• Bailey, R. (2001) Teaching Physical Education: A handbook for primary and secondary school teachers. London: Kogan Page. pp. 137-152
• Coates, B (2001) Assessment Planning for KS3 PE. Cambridge: Pearson Publishing. pp. 1-13
• Walker, D., (2001) Assessment, Recording and Reporting of Pupil Attainment in Physical Education – A Voice form the Real World. The British Journal of Teaching Physical Education. 32(4): pp. 24-25
• Macfadyen, T., and Bailey, R. (2002) Teaching Physical Education 11-18. London: Continuum. Pp. 75-89
• Lockwood, A., and Newton, A. (2004) Assessment in PE. In Capel, S. (Eds) Learning to Teach Physical Education in the Secondary School: A companion to School Experience. Second Edition. Oxon: RoutledgeFalmer. pp.165
• O’Neill, J., and Ockmore, D. (2006) Assessing pupils’ learning. In Capel, S., Breckon, P., and O’neill, J. (Eds)A Practical Guide to Teaching Physical Education in the Secondary School. Oxon: Routledge. pp. 133-143
• Peach, S., and Bamforth, C. (2003) Tackling the problems of Assessment, Recording and Reporting in Physical Education and Initial Teacher Training 2: an update and evaluation of the project and recommendations for future good practive. The British Journal of Teaching Physical Education. 34(1): pp. 22-26
• James, A.R., Griffin, L., and Dodds, P. (2009) Perceptions of middle school assessment: an ecological view. Physical Education and Sport Pedagogy. 14(3): pp. 323-334
• Koka, A. and Hein, V. (2006) Perceptions of teachers’ positive feedback and perceived threat to sense of self in physical education: a longitudinal study. European Physical Education Review. 12(2): pp 165-179
• Morley, D. and Bailey, R. (2004) Talent Identification and provision in PE – A strategic approach. The British Journal of Teaching Physical Education. 35(1): pp. 41-44
• Strand, B.N., and Wilson, R. (1993) Assessing sport skills. Leeds: Human Kinetics
• Williams, A. (1988) Teaching Physical Education: A Guide for Mentors and Students. London: David Fulton Publishers Ltd. pp.67-78
• Giles-Brown, L. (2006) Physical Education Assessment Toolkit. Leeds: Human Kinetics.
• Piotrowski, S., & Capel, S. (2000) Formal and Informal Modes of Assessment in Physical Education. In: Capel, S., & Piotrowski, S. (Eds.) issues in physical education. London: RoutledgeFalmer. pp. 99-115

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The Importance of Assessment in Physical Education

It may be fairly obvious how educators can implement assessment and data when it comes to Mathematics or Language Arts; however looking through the lens of Physical Education may seem more difficult. There are a good deal of educators and school administrators who think assessing and tracking data on students during Physical Education class is unnecessary or even impossible. I, and many others in education, however, am in the other camp. I do see merit in using these tools with students when it comes to their personal fitness and wellness.

I have been working in and around Physical Education, Fitness, and Wellness for my entire 20 year career (and counting) as an educator and administrator. One thing I can tell you is that education is always evolving, as it should.  Children are learning at a much faster and furious pace. As such, along with that rapid pace comes rising expectations for demonstrated skills by these children.  Since they are learning faster they are also being expected to know more and “show what they know” in a more formal manner.  This 21st century learning is heavily embedded in data and the students exhibiting growth in their skill set.  By osmosis, these same expectations carry over into the realm of Wellness classes.  I say it is great that they do carry over; because with all the new technology and best practices available now, it is much easier and efficient to show this type of growth in PE and Fitness classes around the country.

These assessments actually can provide many benefits to you as the teacher as well as your students.  Assessments and PE truly make a great partnership. As with any symbiotic relationship, they really do need each other. These assessments and the data they reveal, can be utilized in a multitude of ways in order to help encourage and support your school’s PE/Wellness program.  Still not sure how?  Take a look at these brief examples…

Assessment in P.E. Examples:

What better way to demonstrate growth in PE than to develop a Fitness or Wellness class/program along with a series of benchmarks and movements along the way to help children improve?  Education is about learning and improving your skill set (cognitive or physical). How perfectly this correlates to PE!

Think about it, students enter your PE class, and then are presented with a series of challenges or “tests” to develop a foundational baseline, a baseline that is easily trackable and presentable.  Teachers then discuss with students individually where they are at relative to the program or personal goals and then send them off on individual plans and paths to improve their baseline scores and data.  Every move they make in class from then on is designed to help them improve their “fitness, fundamentals and fun” factors.  The journey begins!

Add to this programming the intrinsic factor of personal motivation and you are off and running even faster.  I have been around long enough to notice that once you add a quantifiable component, such as a number of crunches, pounds lifted, distance run time, enhanced flexibility, etc…, the internal competitive fires begin to be stoked.  People naturally want to improve, especially if someone is “keeping score.” I have seen very few K-12 students not want to better their scores for their benchmarks, no matter what the category.  The kids love trying to improve and surpass their own scores.  As long as you keep the scores individual in nature then I believe this is a great way to motivate your students to improve their fitness levels.  They will jump at the chance to improve and the end result is kids being more active in you class. It’s a win for everyone! Gopher has a wide selection of Physical Education assessment equipment including pedometers , heart rate monitors and push-up testers .

Assessments are a necessary component in today’s world of education.  Teachers and students need to be able to demonstrate growth of student skills.  Armed with that premise, assessment and Physical Education really should not exist without each other In today’s data-driven world, what better way to demonstrate students’ skills as well as motivate and encourage lifelong movement goals; inspire activity; and ultimately demonstrate improvement than to track the measurable progress of school children?

7 Responses

So what do you give a number grade on? At my school, I see students 1x a week for 50 minutes for 10 weeks and they rotate to 2 other PE teachers. 3 days of PE per week all year.

1 teacher teaches Fitness, another outdoor activities and 1 the last teacher teaches tea/individual sports. We assess skills but it’s hard to place a grade seeing a student 1x a week. We give a completion grade for peer evaluations on skills.

It would be great to give a written test or a fun project but without seeing them more than 1x it’s hard to see improvement. We don’t want to grade on dressing out as that’s a given. So do we grade on participation.

I would love to hear some ideas. I love the SPARK curriculum but it’s impossible to complete a single unit 1x a week in middle school.

Hi Jay, Thanks for checking in and collaborating. I love that your students have physical education all year long, that is great for them! The rotating teacher does pose an interesting assessment challenge, however I’ve seen and experienced similar situations. With some professional collaborations and record-keeping I do think you and your department can develop a thorough assessment protocol. I would suggest implementing the 2 following procedures:

1 > I would recommend implementing a minimum of 2 written assessments per trimester (so each PE teacher would administer 2 written quizzes or similar assessments.) It is important for the students to demonstrate cognitive understanding of whatever topic, rules, strategies, etc…that your department is teaching. These quizzes could be as short as 5 quick questions and probably no more than 10 so that you can quickly get moving once the quizzes have been administered.

2 > We utilize a “3-2-1” grading system for every student for every class. At the end of every class our PE Teachers assign a participation/effort grade to every student for each class. Students are made aware that the 3-2-1 system is in place, with the following subjective point distribution: 3 = Outstanding Effort and Participation, 2 = Good Effort and Participation, 1 = Limited Effort and Participation, and a 0 = no effort and participation whatsoever. You can then determine how many cumulative points combined with their quiz grades = A, B, C, etc…

Please let us know what you think and how your collaborations work out with your teaching colleagues, it is great that you are looking to find a systematic way to assign grades in Physical Education!

Hey, great article!!

Can assessments be discouraging to students as well? Some may have low self esteem, and afraid to measure their current potential. Is it common to see?

Hi Martin, thanks for checking in, you definitely bring up an interesting, thoughtful, and valuable question. I think any time that assessments are utilized those assessments have the ability to bolster, baseline, or bring down self esteem for sure. However, we subscribe to the philosophy that if the content we are teaching is important, we should strive to be sure that our students have learned the information that we have disseminated. We try to do this in a few ways:

We try to utilize 2 types of assessments >the 1st is cognitive quizzes where we check for understanding at the end of our units to determine that students understand how to be informed spectators (we want them to know how to keep score of the activities/games, understand the flow (quarters, innings, halves, etc…) and observe or explain how they activity/game is played or performed. The 2nd assessment would be fitness components where we don’t measure their skill ability (some PE programs do assess this) but we try to assess how well they are working to their own individual fitness capacity, basically that they are working at or within their own personal parameters…this is a great individual opportunity to raise their self esteem as it is personal and individual.

I think as long the units, activities, or games are taught in a manner that focuses on major concepts and/or rules then the students will tend to score pretty well as long as they are paying attention (cognitive) and working to their own ability (fitness) most of the time. This would then bring PE/Wellness/Fitness classes on par with the majority of other educational disciplines. We also emphasize and remind our students that learning information and being able to explain or demonstrate what you’ve learned is a great life skill that will help them all through their lives.

Overall, I love your question and we believe that PE/Wellness classes are a great place to build and raise self esteem. The fact that this is a focus for you would candidate to me that you are already doing an excellent job protecting and raising your students’ self esteem, keep up the great work! 🙂

I like the tip you gave that education would always evolve and thrive for the better of the community. Last night, my best friend told me his family was hoping to find a legal nurse consulting that could provide research for the catastrophic injury that their cousin is dealing with because of permanent damage. He asked if I had any ideas. I’m glad for this instructive article. I’ll tell him they can consult a trusted legal nurse consulting service for information about the process.

I am a teaching prospective P.E. teacher in a single subject credential program and, in one of my univesity classes, my classmates and I were debating about whether students should be informed that they are being assessed when it comes to performing psychomotor skills (e.g. if the instructor is using a rubric to assess the learning of a skill based on presence/absence of the learning cues that have been highlighted in the lesson). Some of my classmates argued that the students should be informed and the results should be shared so that they can track their progress of psychomotor learning. My instinct is for them not to know they are being assessed–I will just use the data from my assessments to record their baselines, provide personalized feedback based on that data to help them improve, and track their progress.

It seems obvious to me that they should know they are being assessed on cognitive concepts during quizzes, as well as during individual fitness assessments, but it feels weird for me to let them know that I’m evaluating and tracking how well they are dribbling a basketball, for example. I don’t know why it feels different, but it does. I feel like complex motor skills can just be so challenging for some students to learn and and there are extremely variable learning curves between individuals (perhaps more than in many subject areas?). It can be embarrasing enough for students with underdevloped skills to practice/perform in front of their peers. The idea that they would also have to worry that they are being formally evaluated by their teacher just feels like it could be very intimidating for those students. If it were me, I think i would actually peform worse under those circumstanes, and with that knowlege.

I agree. I just interviewed for an elementary school PE position, and they brought up a state standard on motor skills, and asked how I would assess students skills. Like… why do we need to be assessing them in the first place? Is it for school funding? I motivate my students through fun and play. As Vygotsky said, play is the work of children. I believe in process, not product-oriented activity. We are teaching kids to be so goal oriented, but I believe that it’s about the journey, not the destination.

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FTCE Physical Education K-12 (063) Practice Test

Prepare for your test with realistic questions.

The FTCE Physical Education K-12 exam is administered by the Florida Department of Education (FDOE) to assess prospective teachers of K-12 Physical Education in the state of Florida.

Click “Start Test” above to take a free FTCE Physical Education K-12 practice test!

FTCE Physical Education K-12 Exam Outline

The FTCE Physical Education K-12 exam contains approximately 100 multiple-choice questions and has a time limit of 2.5 hours.

The exam is split into 13 knowledge-based competencies:

• The history and philosophy of the physical education profession (3%)
• Standards-based physical education curriculum development (10%)
• Developmentally appropriate physical education instructional strategies (13%)
• Human growth and development and motor learning as they relate to physical education (8%)
• Developmentally appropriate movement skills and concepts related to physical education (12%)
• Lifetime health, wellness, and physical fitness (12%)
• Cognitive, social, and emotional development through physical education and physical activity (7%)
• Various types of assessment strategies that can be used to determine student levels and needs in physical education (10%)
• Strategies that promote an effective learning environment (7%)
• Laws, legislation, and liabilities that pertain to physical education (4%)
• Appropriate safety considerations, rules, strategies, and terminology related to physical education and a variety of physical activities (5%)
• Professional ethics, advocacy, and development (4%)
• The appropriate use of technology as related to physical education (5%)

Check Out Mometrix's FTCE Physical Education Study Guide

Get practice questions, video tutorials, and detailed study lessons

FTCE Physical Education K-12 Exam Registration

To register for the exam, you must first create an FTCE/FELE account. Once your account has been created, log in and select the Physical Education K-12 exam. From there, you can register for the exam, pay the $150 testing fee, and schedule your testing appointment.

On exam day, you should arrive at the testing center 15-30 minutes earlier than your scheduled appointment. After you arrive, you will be asked to sign in and provide two valid forms of government-issued ID. Your photograph will then be taken, and a biometric scan of your palm vein will be taken for identification and security purposes.

You will then be asked to place all personal items in a locker outside the testing room, or you may be asked to leave them in your car.

Once the test begins, you will be allowed to take breaks. However, the timer will not be stopped during your break, so use your break time carefully.

How the Exam is Scored

Your FTCE score is determined by taking the number of questions you answered correctly and converting it to a scaled score. To pass, you will need to get a scaled score of at least 200.

You will receive your official score report within four weeks after testing.

Get complex subjects broken down into easily understandable concepts

How many questions are on the FTCE Physical Education K-12 exam?

There are 100 multiple-choice questions on the exam.

How long is the FTCE Physical Education K-12 exam?

The time limit for the exam is 2.5 hours.

What is the passing score for the FTCE Physical Education K-12 exam?

To pass the exam, you must achieve a minimum scaled score of 200.

How much does the FTCE Physical Education K-12 exam cost?

The examination fee is $150.

By Eric Richter

Eric is the Product Development Manager responsible for developing and updating the Mometrix Teacher Certification and K-12 products. Eric has a bachelor’s degree in Sociology and a master’s of education in Teaching ESOL.

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by Mometrix Test Preparation | This Page Last Updated: December 8, 2023

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PE Diagnostic Test (Grade 4)

Physical ed.

10 questions

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How does endurance enhance performance in physical activities?

You can lift a lot more weight

You can run further

You will be smarter

None of the above

Why do you need to warm up and cool down?

So the teacher does not have to teach as much

So I don't hurt my muscles

So I can get stronger

Please list at least 3 activities that are good for your health.

To safely stretch you should...

Eat plenty of food first

Bounce up and down as fast as possible

Slowly warm up your muscles

The Push up test assesses...

Upper Body Strength

Flexibility

Body Composition

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One foot to the same one foot

two feet to two feet

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By jumping around, I can increase my rate.

What is this photo?

Hip-hop Dance Choreography

Philippine Folk Dance

Fundamental Dance Position

What are the two things you should know how to do before you enter Physical Education 4?

Dancing to a Beat

Proper Posture

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CUET UG Question Paper 2024: The NTA conducted the CUET UG 2024 exam on May 17 for Geography, Physical Education, Business Studies, and Accountancy in offline mode for admissions to various central and State universities. Candidates can download the question papers for the subject test and the language test from this page.

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TS EAMCET Result 2024: TS EAPCET results OUT at eapcet.tsche.ac.in; how to check scores, toppers' list here

Ts eamcet result 2024: in the telangana state engineering, agriculture, and pharmacy common entrance test, the overall pass percentage registered is 74.98%..

The Telangana State Council of Higher Education (TSCHE) announced the Telangana State Engineering, Agriculture and Pharmacy Common Entrance Test (TS EAPCET) 2024 result today, May 18. Candidates who appeared for TS EAPCET can check their scores on the official website at eapcet.tsche.ac.in.

The TSCHE administered the entrance test for admissions to various undergraduate courses in engineering, agriculture and pharmacy streams between May 7 and May 11. Jawaharlal Nehru Technological University, Hyderabad (JNTUH), on behalf of the TSCHE, conducted the exams this year.

Also read: TS EAMCET Hall Ticket 2024: TSCHE releases EAPCET admit cards. How to download and other details

Here's how to check scores.

Follow the below-mentioned steps to download the TS EAPCET scorecard online.

Step 1: Visit the official website of TS EAPCET at eapcet.tsche.ac.in.

Step 2: On the home page, click on the TS EAPCET Result 2024 rank card link.

Step 3: Provide the requisite login details and click on submit.

Step 4: A new page will open displaying the ranks of candidates.

Step 5: Download and save the result

Step 6: Take a printout and keep the hard copy for future reference.

Also read: NEET-UG 2024: NTA to hold undergraduate medical entrance exam tomorrow; guidelines, time, other details here

In the Telangana State Engineering, Agriculture, and Pharmacy Common Entrance Test, the pass percentage in the Engineering stream for males was 74.38%, while that of females was 75.85%, and the overall pass percentage registered was 74.98%.

Engineering toppers

Rank 1: Sativada Jyothiraditya

Rank 2: Golla Lekha Harshaa

Rank 3: Rishi Shekher Shukla

The pass percentage for males in Agriculture and Pharmacy was recorded to be 88.25% while for females it stood at 90.18%, and the total pass percentage registered is 89.66%.

Also read: NEET-UG exam 2024 update: Students can now give medical exam from any of THESE 14 overseas centres

Agriculture and pharmacy toppers.

Rank 1: Aloor Praneetha

Rank 2: Nagudasari Radha Krishna

Rank 3: Gaddam Shri Varshini

As many as 2,54,814 candidates took the engineering entrance examination this year, while 1,00,449 candidates appeared for the agriculture and pharmacy entrance examination.

Around 94.45% of the candidates who registered for TS EAMCET opted for the Engineering stream. The attendance registered for Pharmacy and Agriculture stood at 91.24%. 

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• Open access
• Published: 10 May 2024

An evaluation of written materials for supporting hypertensive patient education and counselling when performing a new medicine service in Poland

• Magdalena Jasińska-Stroschein 1 ,
• Justyna Dymek 2 ,
• Mariola Drozd 3 ,
• Olga Sierpniowska 4 ,
• Artur Jędra 5 ,
• Agnieszka Stankiewicz 6 ,
• Paulina Stasiak 1 ,
• Sylwia Cholewa 1 ,
• Magdalena Nowakowska 7 &
• Magdalena Waszyk-Nowaczyk 7  

BMC Medical Education volume  24 , Article number:  521 ( 2024 ) Cite this article

217 Accesses

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Metrics details

Background. The New Medicine Service (NMS) was developed in England more than ten years ago, as a three-stage consultation led by community pharmacists to support patients taking new medication for a chronic disease. In Poland, the scheme was officially introduced in January 2023. However, its implementation into common practice has been presented with various obstacles, including the need to develop relationships with general practitioners, resolve the payment structure, and provide training with adequate supporting materials. Hence, written materials have been designed for use as an optional tool for counselling patients receiving an NMS in community pharmacies. Methods. The present study evaluates the ability of these materials to inform patients about the need to adhere to anti-hypertensive medication. A group of 401 randomly-selected adult visitors to pharmacies and/or healthcare centres were surveyed; one third had hypertension in their history. Results. The structure, grammar and readability of the text achieved the required threshold of 40% according to the Plain Language Index. The designed materials effectively informed the patients about anti-hypertensive medication, reflected in an increased score in a knowledge test, and were rated positively regarding information level, comprehensibility and presentation. Conclusion. The proposed material may serve as an additional, “patient-friendly” educational tool for use as part of an NMS.

Peer Review reports

The New Medicine Service (NMS) was introduced in England in 2011 by community pharmacists to support patients taking new medication for a chronic disease. Briefly, the NMS consists of a structured and documented one-to-one intervention comprising a set of three consultations, to be completed within the first four weeks of starting a new medication; its aim is to resolve individual patient specific drug problems by providing information, education and advice [ 1 ]. Recent findings indicate that the NMS offers various potential benefits, including supporting better medication adherence for chronically-ill patients, including these starting on cardiovascular medication [ 2 , 3 ]. Its educational function covers the supplementation and reinforcement of information provided by the prescriber, to help patients make informed choices about their care. An NMS was officially introduced in Poland in January 2023 by the present authors, as a three-stage, structured consultation supported by a set of proposed documents (Fig.  1 ) [ 4 , 5 ]. The introduction was made possible by legislation in 2020 obliging pharmacists to provide pharmaceutical care. Pharmacists recently were presented with the opportunity to take a more patient-centred role beyond simply dispensing medicines by performing standardized pharmaceutical consultations (e.g., NMS), medication reviews, prescribing the fully-reimbursed drugs pro auctore and pro familiae , and administering COVID-19 vaccinations; however, the service faces many problems, particularly lack of financing. Nevertheless, cardiovascular disease (CVD) with arterial hypertension (HTN) is currently eligible for pharmaceutical consultation, including NMS.

New medicine service flow chart – Polish adaptation

CVD remains a predominant cause of illness and death globally [ 6 ]. Poor control of HTN has been correlated with a higher risk of cardiac abnormalities including myocardial infarction, stroke, ischemic and brain haemorrhage and peripheral arterial disease [ 7 ]. The prevalence of HTN is believed to be 32.5% among Polish residents between 18 and 80 years of age, and that among 10.8 million Polish patients suffering from HTN, only 2.6 million are receiving successful treatment. Current guidelines indicate one major cause of poor control of BP is non-adherence to treatment [ 8 , 9 ].

A variety of interventions aimed at improving medication adherence in HTN have been assessed to date. These approaches include patient education about medication therapies (e.g., their rationale, proven benefits, indications, contraindications, adverse reactions, dosage regimens), counselling about secondary lifestyle modifications (e.g., blood pressure control, alcohol and smoking cessation, exercise, healthy diet, etc.), as well as monitoring and risk screening [ 10 ]. Other tools could include adherence aids (pillbox which the patient practices filling, personalized illustrated medication schedule), event diaries (e.g., symptom monitoring diary cards) as well as educational booklets and leaflets (written, audiovisual or downloadable formats) [ 11 ]. Some of these tasks might be completed with different types of eHealth tools, including phone calls, blood pressure telemonitoring, emails, websites, smartphone applications and SMS [ 12 ].

The current paper evaluates the ability of a set of written educational materials to inform patients regarding adherence to anti-hypertensive medications. The analysis was performed on material introducing angiotensin converting enzyme inhibitors (ACEI) and thiazide/thiazide-like diuretics, the most popular first-line anti-hypertensive class agents in Poland. The materials, in Polish and English language versions, were designed to be downloaded from the national website for the NMS [ 13 ].

Study design and participants

The study was performed as an observational survey with Polish patients. It received ethical approval from the Bioethics Committee in Poznan (Poland) (KB 108/23). The study sample comprised a randomly-selected group of adults visiting pharmacies or healthcare centres. The inclusion criteria comprised an age of at least 18 years, and the ability to read the presented materials. No history of chronic disease including HTN was necessary. The study was performed over four months from February 1 to May 31, 2023.

The educational materials were created according to the current summaries of product characteristics (SmPCs), guidelines and recommendations [ 7 , 14 , 15 ]. They were then subjected to preliminary review by an interdisciplinary team of physicians and pharmacists, and evaluated with regard to their language content. All materials and their graphic design (Canva Pro) were prepared by the authors of the paper.

The materials consisted of leaflets introducing five classes of first-line hypertensive drugs: thiazide/thiazide-like diuretics, angiotensin converting enzyme, angiotensin II receptor antagonists, calcium channel blockers and beta-blockers. The readability of the language (Polish version) was evaluated according to the Plain Language Index (PLI) available at https://logios.dev/ ; the tool evaluates the text with regard to simple Polish language [ 16 ].

In detail, the PLI index measures ten style features, with 10% points being available for each feature. The material exceeds the PLI threshold of ≥ 40%. However, it is important to note that the algorithm does not verify the substance of the text. The following categories were evaluated by the PLI index: (1) FORMAL (whether the language style is formal and official); (2) TERMS (two-word SPECIALIST EXPRESSIONS: noun + adjective); (3) TOP100 (most frequent words in the text); (4) DWORDS (difficult – rare and long words); (5) PRON (pronouns in the text); (6) N/V (nouns/verb ratio); (7) GRAM (inadequately-used grammatical forms); (8) ASL (sentence length); (9) SENDER (how often the sender reveals their “presence” in the text, by using the words: “me”, “mine”, “our”); (10) RECEIVER (how often the sender addresses the recipient directly, by using the words: “you”, “your”, “take”).

The material, regarding HTN treatment, was then tested in an observational trial. The participants were informed of the nature of the study and that participation was voluntary, confidential and anonymous. All gave their consent to take part. They were asked to read the material, and then complete the test (see below). The participants received an individual five-minute consultation to explain the purpose of the survey and how to complete the documentation. The knowledge test was completed twice, i.e. before being presented with the material (PRE-TEST) and after reading it (POST-TEST). In addition, at the end of the study, the participant completed a questionnaire about their overall rating of the material and various aspects, such as its presentation and readability. Although the participants were not given a time limit to familiarize themselves with the material or to complete the questionnaire, the researcher recorded the time spent reading the leaflet, as well as any comments about the overall comprehensibility of the proposed material. The participants familiarized themselves with the educational material and completed all the questionnaires at the survey location, i.e. community pharmacies or healthcare centres. Only fully-completed questionnaires were included in the analysis.

Instruments

a) The educational material comprised several paragraphs concerning the following topics: the criteria for the diagnosis of HTN, blood pressure monitoring, HTN therapy management. It also focussed on a particular therapeutic agent, its mechanism of action, indications, side effects, special warnings, information for special groups of patients, such as pregnant or nursing mothers, as well as the proper usage of the medication. The material was designed with the possibility of personalization, as it provided a space to complete the patient name, medication brand name and dosage according to general practitioner (GP) recommendations, as well as additional pharmacist information. The final version of the material, including the preliminary language check and comments from the participants, is given in Appendix B (Figures B1 − B5).

b) Specific knowledge test. This quiz included thirteen questions intended to verify that the participants understood the proper use of the hypotensive medications (thiazide/thiazide-like diuretics or angiotensin converting enzyme inhibitor) given in the material. The first six questions (questions 1 to 6) required the participants to indicate one answer out of four. The next two multiple-choice questions required them to choose from eight possible answers, with more than one answer being correct (questions 7 and 8). Finally, the next five questions were true/false statements, with the study participants indicating one of three options: true , false or I do not know (questions 9 to 13) (see Appendix A ).

c) A questionnaire for subjective appraisal of the educational material. The tool contained three sections. The first consisted of five multiple-choice questions about age, gender, place of residence, education and history of chronic disease. The second included eight statements about the attitudes of the respondent toward the proposed educational material, including its readability, sufficiency of provided information, comprehensibility and presentation; the responses were based on a 5-point Likert scale. The respondents were also asked to subjectively rate their knowledge about hypotensive medication before and after reading the leaflet. The possible responses were arranged on a five-point scale ranging from “strongly disagree” (1 point) to “strongly agree” (5 points). The Likert Scale was proposed as it allows respondents to self-report the extent of their agreement or disagreement with a statement; such an approach might reveal subtle differences in subjects’ opinions, instead of a simple “yes” or “no” answer. The last section included two open-ended questions about participant comments concerning the educational material.

The knowledge test and the subjective appraisal of the material did not require information about the health of the respondent (quality of life, chronic disease management or well-being). However, one question enquired into any history of chronic disease, with the aim of differentiating the patients into subgroups for further analysis, i.e. subjects with history of HTN and the remaining ones.

All the materials were provided in Polish and were translated into English. The knowledge test was constructed randomly and subjectively by a seven-member panel comprising interdisciplinary academic experts with relevant expertise and experience within Pharmacy education (panels: pharmacotherapy, pharmaceutical care, drug information and communication), as well as community pharmacists with experience in patient counselling. The panel proposed a list of 25 common questions about the indications, contraindications, side effects, special warnings and proper usage of hypotensive medications; these were prepared according to their prior experience with non-adherent patients who may had misunderstood other informative materials such as patient information leaflets (PILs). Finally, this list was shortened to 13 that were included in the final version of the knowledge test. Any disagreements regarding the selection or interpretation of questions were resolved through verbal discussion until consensus was reached.

To test the questions and reduce the risk of any misunderstanding or misinterpretation, the materials and instruments were pre-tested on a sample of 10 randomly-selected respondents from the target population. Their responses were used for further clarification of the materials before the beginning of the survey and hence were not included in the subsequent analysis.

Data analysis. The results were analysed with STATISTICA 13.1 software (StatSoft Polska Sp. z o.o. 30–110 Kraków, Poland). Selected categorical socio-demographic variables were compared with the chi-square test. To identify participant attitudes toward the material, the non-parametric Kruskal–Wallis one-way analysis of variance was used to compare the mean ranks for quantitative responses (1–5 points), according to a set of covariates (e.g., history of HTN).

For each question in the knowledge test, any change in understanding about anti-hypertensive drugs associated with the learning material was assessed with the Cochrane Q-test. For this purpose, an individual correct response, given by a particular respondent in the PRE- and POST-TEST, was awarded 1 point, and an incorrect answer with 0 points. The total score achieved by a particular respondent, before and after reading the material, was presented as a percentage of possible correct answers, where 100% indicated a flawlessly completed test. The absolute difference between total scores achieved before and after reading the material was calculated, and then analysed using one-way analysis of variance (ANOVA) or Kruskal–Wallis one-way analysis of variance, with post hoc comparisons according to subgroups, e.g. male vs. female. The normality of the distribution of a parameter was checked with the Shapiro-Wilk test, and the homogeneity of variance with the Brown-Forsythe test. Correlation analyses were performed using the non-parametric Spearman’s test. A P -value of less than 0.05 was considered statistically significant.

A total of 401 patients completed the survey, i.e. with a 100% response rate; these were randomly allocated to the thiazide/thiazide-like diuretic (D) and angiotensin converting enzyme inhibitor (A) group. More detailed demographic characteristics of the study participants are presented in Table A1 (Appendix A ). Of the group, 32.8% reported a history of HTN and were reading material about thiazide/thiazide-like diuretics, while 29.0% were reading about angiotensin-converting enzyme ( P  > 0.05, difference between groups). None of the other covariates, including age, gender and education, differentiated the subgroups.

Language readability

After adjustment, the readability, grammar and structure of the proposed educational material were found to be suitable for specialist texts (i.e. ≥40% PLI) (Table A2, Appendix A ).

The knowledge test

The median time for learning the leaflet was six minutes (IQR; 6, 8), the knowledge test was completed within less than 10 min (pre-and post-test), and the approximate time spent on the survey was 20 min. The percentage scores obtained in POST-TEST and PRE-TEST are presented in Table A3 (Appendix A ). A significantly higher percentage of correct answers was found in the POST-TEST than the PRE-TEST ( P  < 0.001) with the exception of Question 6.

The median score achieved before reading the leaflet was 46.8% (IQR; 31.2, 60.0) for thiazide/thiazide-like diuretics, and 43.7% (31.2, 56.2) for angiotensin-converting enzyme inhibitors; this value increased significantly in the POST-TEST to 86.7% (73.3, 93.3, P  < 0.001 – vs. PRE-TEST) and to 75.0% (62.5, 81.2, P  < 0.001 vs. PRE-TEST).

Patients noted a subjective improvement in coping with the hypotensive drug (Fig.  2 ). No significant difference in basic knowledge about hypotensive drugs i.e., the PRE-TEST value, was found between the patients with a history of HTN and those without ( P  > 0.05) (Table A3, Appendix A ). Both hypertensive and normotensive respondents indicated that the educational material improved their knowledge about hypotensive medication (Fig.  3 ). No significant difference in the increase in total test score, and hence understanding, was found between hypertensive and normotensive patients ( P  > 0.05). The final outcome did not appear to be influenced by any other sociodemographic covariates ( P  > 0.05) (Table A4, Appendix A ).

The results of knowledge test before and after learning the materials (median and 25th − 75th quartile)

The knowledge about a drug in the subjective opinion of respondents (median and 25th − 75th quartile) ( a – d )

The patients with a history of HTN required a significantly longer median time to read the leaflet ( P  < 0.05). In both groups, i.e., thiazide/thiazide-like diuretics, and angiotensin converting enzyme inhibitor, participants with only primary or vocational education needed a significantly longer time ( P  < 0.001).

The educational material – appraisal

The participants found the educational material to be clear and well-presented, and provide sufficient information about medications for HTN. The overall rating of the educational material according to a 5-point Likert scale is given in Table A5 (Appendix A ). The final outcome was not differentiated by sociodemographic covariates ( P  > 0.05) (Table A6, Appendix A ). A significant correlation ( P  < 0.01) was found between the total score awarded by a particular respondent and the percentage improvement in leaflet understanding (Fig.  4 ).

Linear regression for the percentage increase in total score achieved in the knowledge test as a function of the overall rating of the educational material − given by each individual respondent ( a – b )

Our study presents a pioneering example of educational materials that community pharmacists can use as an additional tool when performing NMS. The role of community pharmacists has evolved for years in the US and some European countries, and now exceeds the traditional dispensing of medicines; however, in Poland, the process of implementing patient-centred approaches including structured counselling or medicine reviews has generally been very slow. For example, an NMS was only officially introduced in January 2023 [ 4 ]. Pharmacists attribute the reluctance to implement the service to the low availability of supporting materials, together with the need to develop relationships with GPs and the lack of payment structure.

Our findings indicate that the prepared leaflets successfully informed patients about their medications, with an approximately 35% higher score in the POST-TEST. Such evidence-based and critically-evaluated educational materials can support medication adherence by helping the patient make the decision to take medicines, and empower management of chronic therapy, as demonstrated in other studies on patients with asthma, diabetes or rheumatoid disorders [ 17 , 18 , 19 ]. As adherence is best ensured by multifaceted interventions, patient education should be accompanied by other approaches e.g., simplification of treatment regimens, and communication between patients and their health care professionals, follow-up and monitoring [ 10 ].

Each registered medication provides an information insert in its package, i.e. the PIL, which includes relevant data for use. Worryingly, only a third of patients fully understand the leaflet, while less than half usually read it [ 20 ], thus raising concerns of impaired disease management and reduced medication adherence. The materials proposed in our survey have been designed to support education about new medication, and feature simplified language and content. The latter covers various topics, including the basic and crucial aspects of blood pressure monitoring and HTN therapy management, as well as basic data on the product such as dosage, mechanism of action, indications, side effects, special warnings, information for particular groups of patients including pregnant or nursing mothers, special warnings and precautions.

Instead of sections introducing recommended dose and dosage schedules, the material provides a space that can be completed by the pharmacist according to the GP’s recommendations to indicate the dosage for an individual user. Many patients indicate that anxiety arising from reading about potential side effects can influence their withdrawal from treatment or reduce adherence [ 20 ]. Hence, the section introducing medication side effects has been shortened, with the assumption that the pharmacist can use additional materials for healthcare professionals e.g. SmPC, to provide a more personalised service when counselling the patient.

The first finding is that the material significantly improved patient knowledge about the hypotensive medication. This was true for all items except question no 6, introducing the situations where the patient should stop taking the drug immediately. Interestingly, the respondents were more likely to indicate that the patient must not discontinue the medication under any circumstances (60%), rather than discontinue when experiencing any of the noted serious side effects (swelling of the face, lips, mouth, tongue or throat, difficulty in breathing). In addition, the percentage of correct answers did not increase significantly after learning the material, emphasizing the need to discuss this aspect of drug safety with patients rather than provide written materials.

This was also true regarding awareness of the most frequent adverse effects of hypotensive medication. Patient knowledge about the side effects of hypotensive medication was relatively poor – even after reading the leaflet (≈ 50% of correct answers in POST-TEST), compared with the other sections. For example, asthma was regarded as the most frequent adverse event for ACEI (33%), probably due to mistakenly associating dry cough with asthma; this item could be explained more clearly by the health care professional. In addition, 10% indicated that oedema (swelling) was an adverse event for the thiazide/thiazide-like diuretics, which might indicate a misunderstanding in the mechanism of action: diuretics increase excretion of water and sodium by the kidneys, which can reduce oedema and lower blood pressure.

Although the respondents did not require any history of HTN to take part in the current survey, the participants were sorted into hypertensive and normotensive subgroups for analysis. Among the former, the median time for hypotensive therapy (since the diagnosis) was calculated as eight years. Interestingly, the comparative analysis did not reveal any significant differences in basic knowledge, i.e. before learning the material, regarding the rationale for hypotensive therapy, proper usage, overdosage or precautions for the hypotensive medicine. The analysis did not include any questions regarding mechanisms of action or side effects, which were specific to individual therapeutic groups, but focused on the basic rationale for anti-hypertensive therapy and general rules for its proper management.

The HTN patients only obtained higher scores when they were asked about the proper drug supply (swallowing with at least half a glass of water, question no 10). Surprisingly, they provided incorrect responses to question 1, i.e. that the hypotensive drug “sometimes lowers and sometimes decreases BP” (question no 1) (11%), question 2, i.e. what to do when missing a dose (38.4%), or question 6, when experiencing serious side effects (65%) (see above). In addition, some respondents would give their drug to the other person experiencing the same symptoms (question 12) (7.1%). These gaps in patient knowledge about medication can result in poor medication adherence, which is a well-recognized contributing factor of uncontrolled hypertension [ 21 ]. This is supported by studies indicating less than 50% of adherence to treatment, expressed as proportion of days covered, in as many as half of the cohort of patients [ 22 ]. This concerns especially first-line pharmacotherapy agents like thiazide/thiazide-like diuretics and spironolactone [ 23 ], where the most common reasons for withdrawal could be adverse effects of medication or impaired quality of life [ 24 ].

It is important to emphasise that our survey did not aim to assess the direct impact of the designed educational material on medication adherence. Nevertheless, recent data from hypertensive patients provide a good evidence that higher health literacy can be associated with better medication adherence, and even blood pressure control [ 25 ]. As such, regular patient education and counselling may address the gaps in knowledge indicated among the HTN patients in the present study, thus assisting them in making informed decisions regarding their care, and improving adherence. In general, this also highlights the need to involve Polish pharmacists in patient-centred activities.

The overall appraisal of the proposed material (amount of information, its presentation, readability) was positive. The language was checked and revised for better clarity and readability before the observational study. The participants had an opportunity to give their feedback regarding overall comprehensibility of the material. Some concerns regarded the terminology, and terms perceived as too technical were reworded; for example, ‘electrolytes’, were replaced by ‘potassium level’ or ‘sodium level’ as appropriate; the term for gout was explained by additional colloquial terms for this disease in Polish.

Interestingly, while overall appraisal was not influenced by covariates such as age, gender, education or history of HTN, respondents who gave higher ratings for the material tended to obtain better scores in the knowledge test. This result is in line with previous studies, where the participants claimed to have never ‘bothered’ to read the information included in the PILs for anti-hypertensive or diabetic drugs; their criticisms concerned the limited usefulness of the PIL due to poor readability (e.g., small font size), legibility, length, design, appropriacy of the content, and difficulty of technical language [ 19 ]. This might explain, at least partially, poor disease insight and non-adherence to HTN management [ 26 ]. The current observations also underline the need for comprehensive and “patient-friendly” educational leaflets as part of a wide spectrum of intervention tools aimed at counselling chronically-ill subjects.

The designed educational material was then used to train licensed Polish pharmacists. The six-hour online courses were performed by the present authors in cooperation with four Polish medical universities (Poznan, Lodz, Krakow, Lublin) and the Supreme Pharmaceutical Chamber and Polish Pharmaceutical Society. A total of 4000 pharmacists completed the certified course to perform the New Medicine Service. The course was aimed to (a) introduce the New Medicine Service as a form of pharmaceutical consultation; (b) present the standard operating procedures (SOP), together with the algorithm of service and proposed documentation; (c) present educational strategies for improving patient knowledge about diseases and treatment, including anti-hypertensive medications. The participants reported that they found the proposed material useful for effectively educating hypertensive patients about their disease and pharmacotherapy. Further studies have been planned to design and evaluate other materials that can be used by pharmacists to inform patients.

Limitations

The study has some limitations. The detailed analysis concerned only two subgroups of patients: those evaluating educational material for ACEI and for thiazide/thiazide-like diuretics. The materials concerning the remaining groups of antihypertensive agents (i.e., beta-blockers, calcium receptor antagonists and angiotensin type 2 receptor antagonist) were designed based on a similar scheme, including the language and layout. Also, many of the respondents had completed a high level of education (up to 42% of subjects); however, our findings do not indicate that education, or other demographic factors, influenced the final outcome in the survey.

Conclusions

The role of the pharmacist in caring for hypertensive patient encompasses medication management, education and counselling. This may concern self-monitoring of blood pressure, dietary modification, regular physical activity, as well as adherence to pharmacological treatment recommendations. Provision of adequate, appropriate and effective written educational materials, when integrated with other educational tool and interventions, and in cooperation with health care professionals, might increase the chance of successful disease management.

The materials designed for the present study successfully improved patient knowledge about anti-hypertensive medications, and were positively appraised with regard to their readability, sufficiency of provided information, comprehensibility and presentation. Polish and English language versions of the materials can be downloaded from the national website to support patient-centred activities performed by community pharmacists. However, our findings also indicate that patients with a history of HTN may have gaps in their knowledge about the disease and the treatment, indicating the need for more effective involvement by Polish pharmacists. Particular effort should be put into educating and counselling the patient about the safety profile of anti-hypertensive medications, and presenting management strategies for situations where they might experience any serious and/or life-threatening side effects. In Polish community pharmacies, these activities might be performed during drug dispensing, or as a part of an NMS or other pharmaceutical care services outside the dispatch room. However, the latter needs further financial support by the Polish government to make it a universal service.

Data availability

Data generated or analysed during this study are included in this published article and its supplementary information files.

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Acknowledgements

The authors gratefully acknowledge the assistance of Professor Tomasz Piekot from Plain Polish Lab (University of Wroclaw), in the evaluation of the readability of the language.

This work was supported by the Medical University of Lodz [503/3-011-02/503-31-002].

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Department of Biopharmacy, Medical University of Lodz, Muszynskiego 1, Lodz, 90-151, Poland

Magdalena Jasińska-Stroschein, Paulina Stasiak & Sylwia Cholewa

Department of Social Pharmacy, Jagiellonian University Medical College, Medyczna 9, Kraków, 30-688, Poland

Justyna Dymek

Department of Humanities and Social Medicine, Medical University of Lublin, Al. Racławickie 1, Lublin, 20-059, Poland

Mariola Drozd

Hospital Pharmacy, Independent Public Health Care Institution in Szczebrzeszyn, Zygmunta Klukowskiego 3, Szczebrzeszyn, 22-460, Poland

Olga Sierpniowska

Council of District Chamber of Pharmacy, Zeromskiego 77/6, Warsaw, 01-882, Poland

Artur Jędra

Lubusz Pharmacy Chamber Council, Wojska Polskiego 37, Pharmacy, Zielona Góra, 65-077, Poland

Agnieszka Stankiewicz

Pharmacy Practice and Pharmaceutical Care Division, Department of Pharmaceutical Technology, Poznan University of Medical Sciences, Grunwaldzka 6, Poznan, 60-780, Poland

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MJ-S and MW-N designed the work; SCh, PS and MN performed data acquisition; MJ-S analysed and interpreted obtained data; OS, JD, MD, AJ, and AS designed the formularies and educational materials; MJ-S and MW-N have drafted the work. All authors read and approved the final manuscript.

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Jasińska-Stroschein, M., Dymek, J., Drozd, M. et al. An evaluation of written materials for supporting hypertensive patient education and counselling when performing a new medicine service in Poland. BMC Med Educ 24 , 521 (2024). https://doi.org/10.1186/s12909-024-05523-x

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Received : 02 November 2023

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Published : 10 May 2024

DOI : https://doi.org/10.1186/s12909-024-05523-x

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