Comparison of Newest Vital Sign and Brief Health Literacy Screen scores in a large, urban Hispanic cohort

Patient Educ Couns. 2023 Apr;109:107628. doi: 10.1016/j.pec.2023.107628. Epub 2023 Jan 10.


Objective: Prior studies comparing subjective and objective health literacy measures have yielded inconsistent results. Our aim was to examine the concordance between Newest Vital Sign (NVS) and Brief Health Literacy Screen (BHLS) scores in a large cohort of English- and Spanish-speaking urban Hispanic adults.

Methods: Item means, standard deviations, corrected-item total correlations, Cronbach's alpha, and Spearman correlations and area under receiver operating characteristic (AUROC) curve analysis were used to compare NVS and BHLS items and total scores.

Results: N = 2988 (n = 1259 English; n = 1729 Spanish). Scores on both measures demonstrated good internal consistency (NVS: α = .843 English, .846 Spanish; BHLS: α = .797 English, .846 Spanish) but NVS items had high difficulty; more than half of respondents scored 0. Measures were only weakly correlated (rs = .21, p < .001, English; rs = .19, p < .001, Spanish). The AUROC curves were .606 (English) and .605 (Spanish) for discriminating the lowest NVS scoring category.

Conclusion: Subjective health literacy scores were poor predictors of objective scores. Objective scores demonstrated floor effects, precluding discrimination at low levels of the trait continuum.

Practice implications: Subjective health literacy scores may fail to identify individuals with limited health literacy.

Keywords: Health literacy; Hispanic or Latino; Psychometrics.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Health Literacy*
  • Hispanic or Latino
  • Humans
  • ROC Curve
  • Reproducibility of Results
  • Surveys and Questionnaires
  • Vital Signs