title: International application of health literacy measures: adaptation and validation of the newest vital sign in The Netherlands.
abstract: 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.
  
  
  CONCLUSIONS
  The results suggest that the NVS-D is a reliable and valid tool that allows international comparable health literacy research in The Netherlands.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. Electronic address: m.p.fransen@amc.uva.nl.
authors.forename: Mirjam P
authors.initials: MP
authors.lastname: Fransen
authors.affiliation: Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Karlijn E F
authors.initials: KE
authors.lastname: Leenaars
authors.affiliation: Department of Primary Care and Public Health Sciences, King's College London, London, UK; Institut for Folkesundhed, Aarhus Universitet, Aarhus, Denmark.
authors.forename: Gillian
authors.initials: G
authors.lastname: Rowlands
authors.affiliation: Department of Family and Community Medicine, University of Arizona College of Medicine, Arizona, USA.
authors.forename: Barry D
authors.initials: BD
authors.lastname: Weiss
authors.affiliation: Department of Languages, Literature and Communication, Utrecht Institute of Linguistics OTS, Utrecht, The Netherlands.
authors.forename: Henk Pander
authors.initials: HP
authors.lastname: Maat
authors.affiliation: Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Essink-Bot
mesh_terms: D000328:Adult; D000368:Aged; D005240:Feasibility Studies; D005260:Female; D057220:Health Literacy / Q000592:standards*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000295:instrumentation*; D009426:Netherlands; D011594:Psychometrics / Q000706:statistics & numerical data*; D012372:ROC Curve; D011932:Reading; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Cross-cultural adaptation; Health literacy; Measurement; Newest vital sign; Validation