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, Frank A. Hale

Research output: Contribution to journalArticlepeer-review

1600 Scopus citations


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. METHODS: We 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 α and assessed criterion validity by measuring correlations with TOFHLA scores. Using TOFLHA scores <75 to define limited literacy, we plotted receiver-operating characteristics (ROC) curves and calculated likelihood ratios for cutoff scores on the new instrument. RESULTS: The final 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 α > 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.

Original languageEnglish (US)
Pages (from-to)514-522
Number of pages9
JournalAnnals of family medicine
Issue number6
StatePublished - Nov 2005


  • Health literacy
  • Literacy
  • Physician-patient communication
  • Spanish

ASJC Scopus subject areas

  • Family Practice


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