International application of health literacy measures: Adaptation and validation of the newest vital sign in The Netherlands

Mirjam P. Fransen, Karlijn E.F. Leenaars, Gillian Rowlands, Barry D. Weiss, Henk Pander Maat, Marie Louise Essink-Bot

Research output: Contribution to journalArticlepeer-review

54 Scopus citations


Objective: The newest vital sign assesses individual reading and numeracy skills. The aim of this study was to create a Dutch version (NVS-D) and to assess its feasibility, reliability, and validity in The Netherlands. Methods: We performed a qualitative study among experts (n= 27) and patients (n= 30) to develop the NVS-D and to assess its feasibility. For validation, we conducted a quantitative survey (n= 329). Reliability was assessed by Cronbach's alpha. Construct validity was examined by analyzing association patterns. Receiver operating characteristic (ROC) curves determined optimal cut-off scores. Results: Cronbach's alpha was 0.76. In accordance with a priori hypotheses we found strong associations between NVS-D, general vocabulary, prose literacy and objective health literacy, and weaker associations between NVS-D and subjective health literacy. A score of ≥4 out of 6 best distinguished individuals with adequate versus inadequate health literacy. Conclusion: The results suggest that the NVS-D is a reliable and valid tool that allows international comparable health literacy research in The Netherlands. Practice implications: The NVS-D can be applied in research on the role of health literacy in health and health care, and the development of interventions. The methods can be applied in cross-cultural adaptation of health literacy measures in other countries.

Original languageEnglish (US)
Pages (from-to)403-409
Number of pages7
JournalPatient Education and Counseling
Issue number3
StatePublished - Dec 1 2014


  • Cross-cultural adaptation
  • Health literacy
  • Measurement
  • Newest vital sign
  • Validation

ASJC Scopus subject areas

  • General Medicine


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