title: Development and validation of a measure of health literacy in the UK: the newest vital sign.
abstract: BACKGROUND
  Health literacy (HL) is an important public health issue. Current measures have drawbacks in length and/or acceptability. The US-developed Newest Vital Sign (NVS) health literacy instrument measures both reading comprehension and numeracy skills using a nutrition label, takes 3 minutes to administer, and has proven to be acceptable to research subjects. This study aimed to amend and validate it for the UK population.
  
  
  METHODS
  We used a three-stage process; (1) a Delphi study with academic and clinical experts to amend the NVS label to reflect UK nutrition labeling (2) community-based cognitive testing to assess and improve ease of understanding and acceptability of the test (3) validation of the NVS-UK against an accepted standard test of health literacy, the Test of Functional Health Literacy in Adults (TOFHLA) (Pearson's r and the area under the Receiver Operating Characteristic (ROC) curve) and participant educational level. A sample size calculation indicated that 250 participants would be required. Inclusion criteria were age 18-75 years and ability to converse in English. We excluded people working in the health field and those with impaired vision or inability to undertake the interview due to cognitive impairment or inability to converse in English.
  
  
  RESULTS
  In the Delphi study, 28 experts reached consensus (3 cycles). Cognitive testing (80 participants) yielded an instrument that needed no further refinement. Validation testing (337 participants) showed high internal consistency (Cronbach's Alpha = 0.74). Validation against the TOFHLA demonstrated a Pearson's r of 0.49 and an area under the ROC curve of 0.81.
  
  
  CONCLUSIONS
  The NVS-UK is a valid measure of HL. Its acceptability and ease of application makes it an ideal tool for use in the UK. It has potential uses in public health research including epidemiological surveys and randomized controlled trials, and in enabling practitioners to tailor care to patient need.
authors: London South Bank University, London, UK. rowlang2@lsbu.ac.uk
authors: Gill
authors: G
authors: Rowlands
authors: Nina
authors: N
authors: Khazaezadeh
authors: Eugene
authors: E
authors: Oteng-Ntim
authors: Paul
authors: P
authors: Seed
authors: Suzanne
authors: S
authors: Barr
authors: Barry D
authors: BD
authors: Weiss
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003071:Cognition; D003697:Delphi Technique; D004522:Educational Status; D005260:Female; D005515:Food Labeling / Q000592:standards*; D006266:Health Education / Q000379:methods*; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy / Q000458:organization & administration / Q000592:standards; D054624:Health Status Disparities; D006801:Humans; D007407:Interviews as Topic; D008131:London; D008297:Male; D008403:Mass Screening / Q000295:instrumentation* / Q000592:standards; D008875:Middle Aged; D009749:Nutrition Surveys; D012372:ROC Curve; D015203:Reproducibility of Results; D012923:Social Class; D011795:Surveys and Questionnaires; D055986:Vital Signs; D055815:Young Adult
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