Cultural Adaptation of Health Literacy Measures: Translation Validation of the Newest Vital Sign in Arabic-Speaking Parents of Children With Type 1 Diabetes in Kuwait

Abstract

Purpose The purpose of the study was to assess the feasibility of use and reliability of the Arabic version of the Newest Vital Sign (NVS-Ar) in parents of children with type 1 diabetes (T1D). Methods The final translated version of NVS-Ar was administered to 175 adult caregivers of children with T1D who are native Arabic speakers. The association between NVS-Ar scores for the parents/legal guardians and A1C for their children was assessed. The internal consistency was evaluated by Cronbach’s α, and reliability was assessed by test-retest method. Results The median (interquartile range) score was 4.0 (3-5). The internal consistency of the NVS-Ar was moderate (α = .58). The intraclass correlation coefficient was .61. There was no correlation between NVS-Ar score and A1C (Spearman’s ρ = .055; P = .62). Furthermore, there was significant inverse association between adequate health literacy and optimal glycemic control among the children, which remained evident even after adjusting for the duration of T1D, age, or education of the parents/guardians. However, it lost statistical significance after adjustment for treatment regimen. Conclusion Study findings indicate that the NVS is unlikely to be a predictive tool for functional health literacy in Arabic settings and that there is a need to properly translate and validate other tools such as the Test of Functional Health Literacy in Adults or, alternatively, to develop a reliable tool.

The Impact of Parental Electronic Health Literacy on Disease Management and Outcomes in Pediatric Type 1 Diabetes Mellitus: Cross-Sectional Clinical Study

“…In contrast, previous studies involving young children [ 31 ] and adolescents [ 40 ] have reported no significant differences in parents’ general health literacy (assessed by the S-TOFHLA) by sociodemographic subgroups. Moreover, Al-Abdulrazzaq et al [ 41 ] found no association between parents’ NVS score and their educational level in a validation study of the Arabic version of the NVS. Parental self-efficacy in the child’s diabetes management (PSESDM) showed an increasing trend by educational level and income in our study, but parental fear of hypoglycemia (HFS) did not differ by sociodemographic subgroups.…”

“…In the study by Pulgaron et al [ 31 ], parents’ numeracy skills were negatively correlated with the child’s HbA 1c level (r=−0.52), which strengthens our results with the NVS measure that also has a strong numerical focus. However, 2 other studies found no association between parental health literacy (S-TOFHLA and NVS) and the child’s HbA 1c level [ 40 , 41 ]. Ross et al [ 43 ] reported that glycemic disease control was worse for those children whose caregivers had lower literacy skills as measured by the National Adult Reading Test (NART).…”

“…In their final model, only parental self-efficacy regarding diabetes management (Perceived Diabetes Self-Management Scale) remained a significant predictor of HbA 1c . Furthermore, Al-Abdulrazzaq et al [ 41 ] found that adequate health literacy was inversely associated with optimal HbA 1c levels, but adjusting for the treatment regimen cancelled its significant effect. We think, however, that the child’s HbA 1c level is multifactorial, and not all relevant factors were taken into account in our research.…”

“…Furthermore, only 3 instruments that assess parental health literacy were identified, but they were not related to pediatric diabetes. Consistently, in studies examining the association of caregiving parents’ general health literacy with their child’s diabetes outcomes and glucose control, parental health literacy was assessed with general tools such as the Short Test of Functional Health Literacy in Adults (S-TOFHLA) [ 31 , 40 ], Newest Vital Sign (NVS) [ 41 , 42 ], Parental Diabetes Numeracy Test (PDNT) [ 31 ], and National Adult Reading Test (NART) [ 43 ]. However, despite its increasing significance, the role of parental electronic health literacy in pediatric diabetes has not been investigated extensively, and its associations with the child’s disease characteristics and glycemic outcomes have remained unexplored.…”

Measuring health literacy: A systematic review and bibliometric analysis of instruments from 1993 to 2021

“…Korean American [201]; Arabic [202,222,223]; Serbian [216]; Turkish [224]; Spanish [225]; Chinese [226]; Italian [66]; American [227]; Chines [228]; Hebrew [229]; English-Spanish [230] -Weiss et al [16] Newest Vital Sign (NVS) American [208,227,231,232]; Brazilian Portuguese [233,234]; Italian [66,235]; Taiwanese [236]; Brazilian [237]; UK [238]; Dutch [239]; Turkish [240]; Arabic [223,241]; -…”