Quick Assessment of Literacy in Primary Care: The Newest Vital Sign

Abstract

PURPOSE Current health literacy screening instruments for health care settings are either too long for routine use or available only in English. Our objective was to develop a quick and accurate screening test for limited literacy available in English and Spanish. METHODSWe administered candidate items for the new instrument and also the Test of Functional Health Literacy in Adults (TOFHLA) to English-speaking and Spanish-speaking primary care patients. We measured internal consistency with Cronbach's ␣ and assessed criterion validity by measuring correlations with TOFHLA scores. Using TOFLHA scores <75 to defi ne limited literacy, we plotted receiver-operating characteristics (ROC) curves and calculated likelihood ratios for cutoff scores on the new instrument. RESULTSThe fi nal instrument, the Newest Vital Sign (NVS), is a nutrition label that is accompanied by 6 questions and requires 3 minutes for administration. It is reliable (Cronbach ␣ >0.76 in English and 0.69 in Spanish) and correlates with the TOFHLA. Area under the ROC curve is 0.88 for English and 0.72 for Spanish versions. Patients with more than 4 correct responses are unlikely to have low literacy, whereas fewer than 4 correct answers indicate the possibility of limited literacy.CONCLUSION NVS is suitable for use as a quick screening test for limited literacy in primary health care settings. 1-3 Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. 4 It involves the ability to use and interpret text, documents, and numbers effectively-skills that might seem to be distinct but are highly correlated with one another. 1,[5][6][7] The IOM, AHRQ, and AMA reports all noted that large segments of the American population-as many as one half of all adults-lack the literacy skills needed to function adequately in a health care environment. They would not, for example, be able to reliably and consistently determine the proper dose of cold medicine for a child, nor would they be able to read and understand informed consent documents. 8,9 Individuals with limited literacy come from all segments of society, and most are white, native-born Americans. 10 Individuals with limited literacy have less knowledge about their health problems, [11][12][13][14][15][16] 27,28 which is the instrument most often used for literacy assessment in health care research. The TOFHLA is available in English and Spanish and has good psychometric characteristics, but the length of time required for administration of the TOFHLA (18 to 22 minutes for the full version and 7 to10 minutes for a short version) precludes its use in busy primary care settings. 29 The second test, the Rapid Estimate of Adult Literacy in Medicine (REALM), can be administered quickly (less than 3 minutes) but it, too, has limitations. In particular, the REALM is only available in English. 5,28 This report describes the validation of a new rapid literacy assessment instrume...

Patients With Limited Health Literacy Ask Fewer Questions During Office Visits With Hand Surgeons

“…Directly after the visit, patients completed a sociodemographic survey (including age, sex, race, work status, marital status), the Newest Vital Sign (NVS) health literacy test [39], and three Patient-Reported Outcomes Measurement Information System-based (PROMIS) computerized adaptive questionnaires: Upper-Extremity Function [12], Pain Interference [3], and Depression [33]. The NVS health literacy test is based on a nutrition label from an ice cream container, and the overall score ranges from 0 to 6.…”

Literacy, Cognitive Function, and Health: Results of the LitCog Study

“…Health literacy was assessed by the TOFHLA, REALM, and NVS. [29][30][31] The TOFHLA uses actual materials patients might encounter in healthcare to test reading fluency. 29 A reading comprehension section includes 50 items that use the Cloze procedure; every fifth to seventh word in a passage is omitted and four multiple choice options are provided.…”

“…43 Finally, The NVS is a screening tool used to determine risk for limited health literacy. 31 Patients are given a copy of a nutrition label and asked six questions about how they would interpret and act on the information. Scores are classified as high likelihood (0-1) or possibility (2-3) of limited literacy, and adequate literacy (4-6).…”

“…We targeted widely-used assessments of literacy in healthcare: the Rapid Estimate of Adult Literacy in Medicine (REALM), 29 Test of Functional Health Literacy in Adults (TOFHLA), 30 and the Newest Vital Sign (NVS). 31 The examination of these assessments, coupled with a detailed battery of cognitive tests, afforded the unique opportunity to determine crucial, understudied relationships between literacy skills and general cognitive functioning.…”

The Mini Mental Status Exam as a Surrogate Measure of Health Literacy

“…Finally, the NVS is a screening tool used to determine risk for limited health literacy. 19 Patients are given a copy of a nutrition label and asked six questions about how they would interpret and act on the information (range 0-6; limited literacy ≤ 4).…”