Validity and reliability of the Japanese version of the Newest Vital Sign: a preliminary study

PLoS One. 2014 Apr 24;9(4):e94582. doi: 10.1371/journal.pone.0094582. eCollection 2014.


Health literacy (HL) refers to the ability to obtain, process, and understand basic health information and services, and is thus needed to make appropriate health decisions. The Newest Vital Sign (NVS) is comprised of 6 questions about an ice cream nutrition label and assesses HL numeracy skills. We developed a Japanese version of the NVS (NVS-J) and evaluated the validity and reliability of the NVS-J in patients with chronic pain. The translation of the original NVS into Japanese was achieved as per the published guidelines. An observational study was subsequently performed to evaluate the validity and reliability of the NVS-J in 43 Japanese patients suffering from chronic pain. Factor analysis with promax rotation, using the Kaiser criterion (eigenvalues ≥1.0), and a scree plot revealed that the main component of the NVS-J consists of three determinative factors, and each factor consists of two NVS-J items. The criterion-related validity of the total NVS-J score was significantly correlated with the total score of Ishikawa et al.'s self-rated HL Questionnaire, the clinical global assessment of comprehensive HL level, cognitive function, and the Brinkman index. In addition, Cronbach's coefficient for the total score of the NVS-J was adequate (alpha = 0.72). This study demonstrated that the NVS-J has good validity and reliability. Further, the NVS-J consists of three determinative factors: "basic numeracy ability," "complex numeracy ability," and "serious-minded ability." These three HL abilities comprise a 3-step hierarchical structure. Adequate HL should be promoted in chronic pain patients to enable coping, improve functioning, and increase activities of daily living (ADLs) and quality of life (QOL).

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Aged
  • Analgesics, Opioid / therapeutic use
  • Chronic Pain / drug therapy
  • Female
  • Health Literacy*
  • Humans
  • Japan
  • Likelihood Functions
  • Male
  • Middle Aged
  • Needs Assessment
  • Quality of Life
  • ROC Curve
  • Reproducibility of Results
  • Surveys and Questionnaires
  • Translating


  • Analgesics, Opioid

Grant support

A Grant-in-Aid for Research on Evaluation and Multidisciplinary Research Project for Measures to Help the Handicapped (Survey study of chronic musculoskeletal pain) to Masahiko Sumitani A Grant-in-Aid for Scientific Research (C) from the Japan Society for the Promotion of Science (Grant Number 23590814) to Hiroki Sugimori. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.