Research ArticleOriginal Research

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

Barry D. Weiss, Mary Z. Mays, William Martz, Kelley Merriam Castro, Darren A. DeWalt, Michael P. Pignone, Joy Mockbee and Frank A. Hale
The Annals of Family Medicine November 2005, 3 (6) 514-522; DOI: https://doi.org/10.1370/afm.405

Article Figures & Data

Figures

Tables

  • Table 1.

    Reliablity and Validity of English and Spanish Candidate Scenarios and Total Test

    ScenarioNumber of ItemsReliability:Cronbach αValidity*: Pearson r
    * Correlation of scenario score and score on criterion (ie, Test of Functional Health Literacy in Adults, Spanish Version).
    † This scenario (nutrition label) was selected as the single best scenario, and is the content of the Newest Vital Sign – Spanish.
    English
        1.Prescription for headache medication30.230.43
        2.Consent form for angiography40.400.51
        3.Self-care instructions for heart failure50.380.20
        4.Nutrition label from ice cream†60.760.59
        5.Instructions for tapering prednisone30.660.35
    Total210.780.64
    Spanish
        1.Prescription for headache medication30.370.38
        2.Consent form for angiography40.370.55
        3.Self-care instructions for heart failure50.33−0.01
        4.Nutrition label from ice cream†60.690.49
        5.Instructions for tapering prednisone30.390.37
    Total210.690.59
  • Table 2.

    Demographic Characteristics and Scores on the English and Spanish Language Versions of the TOFHLA and NVS

    Characteristics and ScoresEnglish (n = 250)Spanish (n = 250)
    TOFHLA = Test of Functional Health Literacy in Adults; NVS = Newest Vital Sign; SEM = standard error of the mean.
    * Comparison by independent samples t test between English and Spanish samples, P <.001.
    † Comparison by independent samples t test between English and Spanish samples, P <.001.
    ‡ Comparison by analysis of covariance between English and Spanish samples, adjusted for sex and years of education, P <.001.
    § Comparison by analysis of covariance between English and Spanish samples, adjusted for sex and years of education, P <.001.
    Demographics
    Age (years)
        Mean (SD)41.3 (14.8)40.8 (13.9)
        Range18–8518–77
    Ethnic/racial group (%)
        Non-Hispanic white430
        Hispanic43100
        African American50
        Native American40
        Unknown or other50
    Education (y)
        Mean (SD)12.7 (2.8)10.7 (3.2)
        Range2–240–23
    Insurance status (%)
        Private6645
        Government programs2732
        Uninsured722
    Test scores
    TOFHLA, mean (SEM)*86.3 (0.9)75.7 (1.2)
    NVS – mean (SEM)†3.4 (1.9)1.6 (1.5)
    TOFHLA adjusted, mean (SEM)‡84.6 (1.0)77.4 (1.0)
    NVS adjusted, mean (SEM)§33 (0.1)1.8 (0.1)
  • Table 3.

    Stratum-Specific Likelihood Ratios for Cutoff Scores on the English and Spanish Versions of the Newest Vital Sign, Stratified by TOFHLA Score

    Number Correct on NVS-ETOFHLA <75*TOFHLA ≥ 75*SSLR†SSLR‡Grouped
    NVS-E = Newest Vital Sign-English; TOFHLA = Test of Functional Health Literacy in Adults SSLR = stratum-specific likelihood ratio.
    * 75 is the TOFHLA cut-off score below which individuals are considered to have marginal or inadequate literacy. Individuals with scores >75 are considered to have adequate literacy.
    † Stratified by TOFHLA scores <75 (marginal or inadequate literacy) vs 75 (adequate literacy).
    ‡ SSLRs for detecting low literacy at each score on the NVS in English (1-A) and Spanish (1-B). Because of the similarity in SSLRs in adjacent groups, we suggest grouping scores into 3 categories: 0–1, 2–3, 4–6.
    English
    0986.1} 5.4
    119205.1
    25251.1} 1.2
    36241.4
    40490} 0
    50370
    60480
    Total39211
    Spanish
    038322.2} 1.8
    130371.5
    217340.9} 0.6
    33280.2
    40150} 0
    50100
    6060
    Total88162

Additional Files

  • Supplemental Appendixes

    Appendix 1. The Newest Vital Sign � Spanish; Appendix 2. Scatter Plot of Relationship Between Scores on the Newest Vital Sign and the Test of Functional Health Literacy in Adults

    Files in this Data Supplement:

  • The Article in Brief

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

    Barry D. Weiss, MD , and colleagues

    Background As many as one half of all American adults lack the literacy skills needed to obtain and understand health information and services. This can affect their health and their ability to make medical decisions. Existing tests to determine patients� level of health literacy are often long or available only in English. This study tested a new tool, available in English and Spanish, that is designed to be quick and accurate.

    What This Study Found The new test (called the Newest Vital Sign) is the first literacy screening tool available in both English and Spanish that can be administered in approximately 3 minutes. It is suitable for testing patients� literacy level in primary care practices.

    Implications

    • The Newest Vital Sign is quick and effective in the primary care setting.
    • Future research could determine whether the Newest Vital Sign is effective in different medical settings, and whether raising clinicians� awareness of health literacy by using the test leads to better patient-doctor communication and better patient health.
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