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Abstract: The Newest Vital Sign (NVS) assesses health literacy in clinical settings. This exploratory study examined the feasibility of using the NVS as a self-administered questionnaire (SAQ) in a low-income, primary care setting. Adult hypertensive patients were recruited in 2011-2012 (n=238). Quantitative and qualitative analyses were conducted to examine potential issues with self-administration. Patients had low rates of adequate health literacy (28.4%). Only half of respondents completed the NVS (54.4%). Being Black, female, and having additional chronic illnesses increased the likelihood of being a partial responder as opposed to being a completer. Easier math problems and reading comprehension items were attempted in greater numbers by partial responders. Results indicate issues with interpretation and the need for better scoring instructions. Future studies that self-administer the NVS should consider slight modifications. The NVS provides important information about patients' health literacy and it is a valuable tool to assess patients' understanding of food labels.
Key words: Health literacy; low income population; hypertension; self-administered questionnaire.
Health literacy is an increasingly important factor to consider when examining health disparities. It may be particularly relevant for patients with chronic illness who must make lifestyle changes to manage their condition. Health literacy is associ- ated with treatment adherence, emergency care utilization, hospitalizations, effective provider-patient communication, and comprehension of informed consent documents for medical treatment and research participation, as well as other health outcomes.1-3 Understanding patients' health literacy is thus an essential component of cultural sen- sitivity for health care providers.4
Most health literacy measures are administered by an interviewer. In a clinical setting, this administration would require valuable staff time. The Newest Vital Sign (NVS) is a short, easy-to-use tool to assess patient health literacy in the health care setting.5 The NVS consists of six items based on an ice cream nutrition label (see Fig- ure 1). Four items are word problems of increasing complexity that focus on applied numeracy skills. Two items assess reading comprehension and application (see Figure 2). The NVS scores indicate the likelihood of adequate literacy. The NVS takes three to 11 minutes to administer.6 If the NVS can be used as a self-administered question- naire (SAQ), it will eliminate the need for an interviewer for most patients except the visually impaired or truly illiterate.
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