Patients' perceptions of screening for health literacy in primary care: Reactions to the Newest Vital Sign

BACKGROUND: Limited health literacy, or the diminished capacity to obtain, understand, and act upon health-related information, has been identified as an important cross-cutting factory affecting the quality of health care and as a contributing factor in disparate care outcomes for racial and ethnic minorities. Difficulties in caring for patients with unidentified low health literacy have prompted interest in health literacy screening in the clinical setting. Several prior studies, however, have indicated that health literacy testing can lead to feelings of shame and stigmatization. In this study, we examine patient reaction to a relatively new instrument, Newest Vital Sign (NVS), developed specifically for use in primary care. Unlike prior instruments, the NVS does not expose patients' reading difficulties to an examiner and therefore may be better tolerated.

METHODS: Data was collected in 2008 in the Morehouse School of Medicine, Department of Family Medicine Primary Care Clinics. Health literacy screening was implemented as part of routine intake procedures using the NVS, with scores entered into the patient record. Following the visit, subjects completed a short questionnaire, which included a series of questions assessing their screening experiences.

RESULTS: A total of 179 subjects completed both the NVS and the reaction survey. Nearly all (>99%) subjects reported that the screening did not cause them to feel shameful. Contrary to previous studies, there were also no differences in the reported prevalence of shame (p<0.33) by literacy level. Finally, when asked if they would recommend clinical screening, 97% of subjects answered in the affirmative.

CONCLUSIONS: These results suggest that screening for limited health literacy in primary care may not automatically elicit feelings of shame. Even patients with the lowest levels of literacy were both comfortable with and strongly supportive of clinical screening using the Newest Vital Sign. Further research may examine, comparatively, the impact of different instruments on patients' experience with screening.