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 journalArticle

998 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
Publication statusPublished - Nov 2005



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

ASJC Scopus subject areas

  • Family Practice

Cite this

Weiss, B. D., Mays, M. Z., Martz, W., Castro, K. M., DeWalt, D. A., Pignone, M. P., ... Hale, F. A. (2005). Quick assessment of literacy in primary care: The newest vital sign. Annals of Family Medicine, 3(6), 514-522. https://doi.org/10.1370/afm.405