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Background The Newest Vital Sign (NVS) is a new rapid screening instrument for low literacy in medical settings. No studies currently compare the NVS with the Short Test of Functional Health Literacy in Adults (S-TOFHLA). Purpose Compare the performance of the NVS to the S-TOFHLA and assess the operating characteristics of the NVS. Methods A convenience sample of patients at two federally qualified health centers (FQHCs) were interviewed and given two literacy assessments, the S-TOFHLA and the NVS. The S-TOFHLA is a reading comprehension and numeracy assessment with well-studied internal consistency, reliability, and validity. Scores range from 0 to 100, with scores less than 53 identifying poor health literacy. The NVS is a nutrition label that tests patients9 general literacy and numeracy skills with six questions. A score of 4 to 6 indicates adequate literacy. Results Of the 119 patients tested, the average age was 55 years old (35-55), 70% were female, 61% were African American, and 39% had not graduated from high school. Administration time was approximately 7 minutes for the S-TOFHLA and 5 to 7 minutes for the NVS. The internal consistency of the NVS was good (α = 0.81). The correlation between scores on the NVS and scores on the S-TOFHLA was 0.61 (p Conclusion The NVS showed a moderate correlation with the highly validated S-TOFHLA and did well as a screen predicting low literacy as defined by the S-TOFHLA in two FQHCs.

Background Most current type 2 diabetes patient education materials are too complex for patients to understand and use. Objective To solicit stakeholder input to develop a patient-centered guide to help patients effectively manage their diabetes. Methods Sixteen focus groups followed by 63 cognitive interviews of patients and providers from private and public health settings in rural and urban communities in four states (LA, TX, CA, and NC) were conducted between 03/05 and 05/06. Focus groups were conducted using a structured moderator9s guide that elicited feedback on current materials, barriers, and facilitators to patient management and suggestions for essential content. In addition, individual interviews elicited feedback on drafts of the guidebook and provided insight into comprehension, cultural appropriateness, and usefulness. Results Focus group participants included 55 patients with diabetes, 85 physicians, 13 nurses, and 3 dietitians. Patients, identified by participating providers, were 62% female and 27% African American and ranged in age from 21 to 84. Physicians expressed a desire to teach patients yet were pessimistic about their ability to help patients make behavior changes. Physicians felt that patients needed to know the severity of diabetes, associated health risks, the meaning of hemoglobin A1C tests, and the importance of checking blood sugar regularly. Patients generally felt that current diabetes materials were overwhelming, covered too much information, and were written in an unappealing clinical tone. Many patients felt that they “knew more than they did.” Patients requested practical, everyday advice on how to live with diabetes. They particularly wanted practical strategies for such things as handling hunger, eating out, and safe ways to approach exercise. In fine-tuning the guidebook, individual patient interviews (67% female, 35% African American, 42% Latino, age range 35-73) revealed that patients preferred material that contained a conversational tone, suggestions from real people with diabetes, and photographs-not clip art-illustrating portion size and practical eating and exercise strategies. Conclusions Patients and doctors differ in their views of the information needed in diabetes education material. A collaborative effort between patients and doctors to develop user-friendly material can yield more appealing and possibly more effective patient education.

Background In 1999 the American Academy of Pediatrics recommended that universal newborn hearing screening (UNHS) be part of the standard of care for all newborns. Despite the availability of written UNHS materials in most states, parent awareness of UNHS remains low. The Institute of Medicine recently reported that 90 million Americans have trouble understanding and using health information and that most patient information is unnecessarily complex. Purpose To determine the reading level and user friendliness of available UNHS parent education materials regarding initial screening and retesting. Methods Seventy-six English language materials were evaluated for reading level using the Flesch Reading Ease Formula and user friendliness using a checklist modified from established models. The checklist contained 23 specific criteria grouped into 5 categories: layout, illustrations, message clarity, manageable information (information limited and focused on parents "need to know "), and cultural appropriateness. Each brochure was evaluated individually by three research assistants and each criterion scored according to the amount of improvement needed—little/none, some, or much—to make the brochure user friendly. Results The average reading level of the materials was 10th-12th grade, 27% were written at college level, and none were written at the recommended 6th grade level. Most brochures had some user-friendly attributes such as cultural appropriateness (82%), adequate font size (71%), and clear illustrations (80%). Most brochures needed some improvement in layout, clarity of the message, and providing a manageable amount of information. Criteria that needed most work were ample white space (37%), limiting paragraphs to 4-5 lines (44%), and focusing on parents9 "need to know " (24%). Conclusion States have made a good start in developing UNHS materials. Materials could be improved by lowering the reading level to at least a 7th to 8th grade level, making them more parent centered, and limiting the amount of information given. All materials must focus on what parents need to know and do in a timely manner.

Background The metabolic syndrome (MS) refers to a cluster of risk factors, including central obesity, elevated BP, insulin resistance, and dyslipidemia (DLP) characterized by elevated triglycerides (TG) and low high-density lipoprotein cholesterol (HDL). MS currently affects 27% of US adults and is associated with increased cardiovascular morbidity and mortality. Aggressive lowering of low-density lipoprotein cholesterol (LDL) is critical in coronary artery disease (CAD) prevention. However, when TG levels are high, as often seen in MS, LDL value cannot be calculated. Non-HDL cholesterol (total cholesterol (TC) - HDL) is a measure of all apo-B containing lipoproteins with high atherogenic potential and is considered as a secondary target for lipid therapy in patients with high TG or MS. The purpose of this study was to determine the association between MS and TC, LDL, and non-HDL. Methods Diagnosis of MS was based on NCEP criteria among 928 outpatients in a public hospital. t-Test was used for comparison of lipid components between those with and without MS. Results Seventy percent of patients were black, 68% female; 53% had MS. Among MS patients, 87% had TG > 150 (mg/dL); 85% low HDL; 63% TC > 200; 64% LDL > 100; 69% non-HDL > 130. The results of statistical analysis are as follows: Conclusions The prevalence of MS is high in this patient population. The prevalence of DLP is high in patients with MS. Besides TG and HDL, only non-HDL, but not TC or LDL, is significantly associated with MS. These results suggest that use of non-HDL as the therapeutic target for lipid management is appropriate in MS patients when LDL is not calculable.