Abstract
The Newest Vital Sign (NVS) is a simple, quick and accurate screening test for health literacy (HL). It has been validated for different languages but, to date, not for the Croatian language. The aim of this study was to develop a linguistically validated Croatian version of the NVS and to use it at a later stage in a pilot study of health literacy assessment of hospital patients in Croatia. A full linguistic validation procedure was applied, including forward and backward translation, expert panel review, cognitive interview with 10 respondents from general population, and full involvement in the procedure of one of the screening test developers, the lead author of the NVS-UK version. HL testing on 100 hospital patients (55% women, median age 63.5 years) revealed 58% of patients had less than adequate HL level (scores less than 4), and mean NVS total score was 3.34. A positive significant association was observed between HL and educational level (p = 0.002). A high percentage of patients (92%) did not object to being tested for HL by their primary care physician or in hospital, and 99% of patients would recommend HL testing among patients in general. The respondents' positive views on HL testing and mean completion time of 4 minutes indicate that the Croatian version of the NVS (NVS-HR) could be recommended for use in both clinical and research settings in Croatia.
Highlights
Various tests of health literacy (HL) have been developed over the past years as a result of the finding that poor HL may be a stronger predictor of a person’s health than age, income, employment status, education level, and race [1]
The Newest Vital Sign (NVS)-UK version was translated into Croatian by two independent professional translators, native speakers of Croatian, who were given an instruction to take into account the Croatian style of ice cream nutrition labels found in the market, which are in line with the EU and Croatian regulations [31], but at the same time to keep the Croatian translation as close as possible to the source text of the NVS-UK, and to check the NVS-US for further assistance, if needed
Cognitive interviews in this study revealed why some respondents miscalculated in Question 1 (Q1)–confusing ’portion’ with ’package’, which was done by 59 hospital patients tested for HL as they replied incorrectly ’250 kcal’
Summary
Various tests of health literacy (HL) have been developed over the past years as a result of the finding that poor HL may be a stronger predictor of a person’s health than age, income, employment status, education level, and race [1]. Health literacy with Croatian NVS among elderly persons, poorer overall health status and higher mortality rates. In Europe, a study on HL in eight EU countries [4] showed that people with low HL have a higher prevalence of long-term conditions, which in turn are more likely to be limiting, and that low HL level is significantly associated with worse self-assessed health. Research on HL in Croatia is still in its infancy, with no studies published at the national level [5] and previous published studies either using a nonvalidated instrument [6] or focusing mostly on readability, comprehension or informed consent issues [5,7,8,9,10,11]
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