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...
