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Public Health Nutr. 2018 Aug;21(11):2038-2045. doi: 10.1017/S1368980018000253. Epub 2018 Apr 25.

Canadian adaptation of the Newest Vital Sign©, a health literacy assessment tool.

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1Bureau of Nutritional Sciences,Food Directorate,Health Canada,251 Sir Frederick Banting Driveway,Tunney's Pasture,Ottawa,Ontario,Canada,K1A 0K9.
2Department of Human Nutrition,St. Francis Xavier University,Antigonish,Nova Scotia,Canada.
3University of Arizona College of Medicine,Tucson,AZ,USA.
4Department of Nutritional Sciences,University of Toronto,Toronto,Ontario,Canada.



The Newest Vital Sign© (NVS) was developed in the USA to measure patient health literacy in clinical settings. We adapted the NVS for use in Canada, in English and French, and created a computerized version. Our objective was to evaluate the reliability of the Canadian NVS as a self-administered computerized tool.


We used a randomized crossover design with a washout period of 3-4 weeks to compare health literacy scores obtained using the computerized version with scores obtained using the standard interviewer-administered NVS. ANOVA models and McNemar's tests assessed differences in outcomes assessed with each version of the NVS and order effects of the testing.


Participants were recruited from multicultural catchment areas in Ontario and Nova Scotia.


English- and French-speaking adults aged 18 years or older.


A total of 180 (81 %) of the 222 adults (112 English/110 French) initially recruited completed both the interviewer-NVS and computer-NVS. Scores for those who completed both assessments ranged from 0 to 6 with a mean of 3·63 (sd 2·11) for the computerized NVS and 3·41 (sd 2·21) for the interview-administered NVS. Few (n 18; seven English, eleven French) participants' health literacy assessments differed between the two versions.


Overall, the computerized Canadian NVS performed as well as the interviewer-administered version for assessing health literacy levels of English- and French-speaking participants. This Canadian adaptation of the NVS provides Canadian researchers and public health practitioners with an easily administered health literacy assessment tool that can be used to address the needs of Canadians across health literacy levels and ultimately improve health outcomes.


Canada; Computerized assessment; Health literacy; Newest Vital Sign


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