Health Literacy Assessment of University Employees with the Newest Vital Sign (NVS)

Background/Problem

Health literacy has been defined as the ability to obtain, process, communicate, and understand basic health information and services in order to make appropriate health decisions. Research has consistently shown dire consequences for individuals and society if health literacy is not achieved. Over twenty years of research shows that health information is presented in a way that is not usable by most Americans. Almost 9 out of 10 adults have difficulty using routinely available health information from our health care systems, media, retailers, and community agencies. Health literacy is a stronger predictor of health status than age, income, race, ethnicity, education level or employment status. Low literacy is associated with poorer health outcomes; health disparities; higher risk of disease, disability and hospitalization; fewer self-management skills; poorer compliance; more medical and medication errors; having less access to care; and incurring more health care costs versus individuals and populations with adequate health literacy. Limited health literacy is so common that some experts advocate considering assessment as a “sixth vital sign” in all clinical practice settings. The Institute of Medicine (IOM) has recommended that making the commitment to become a “Health Literate Health Care Organization” will not only help the 77 million people who have limited health literacy but also anyone else who may have difficulty accessing, navigating, or successfully using health services. Health literacy is essential for full patient engagement, sound decision-making, and self-management activities and should be woven into all aspects of health system planning and operations.

The National Occupational Research Agenda (NORA) has identified workers with poor occupational health literacy as a population with more risk for a higher incidence of injuries, illnesses and fatalities. Occupational health literacy is defined as how well workers are able to obtain, communicate, process, and understand occupational health and safety information and services to make decisions about their health in the workplace. There are many benefits to building health literate organizations and thus is advocated by health and policy experts in the field. Improvements in occupational health literacy can be attained by adopting strategies similar to those known to improve general health literacy. The health literacy level of Ohio State University (OSU) employees is not currently known.

Project description and instrumentation

The purpose of this DNP scholarly quality improvement project is to assess the baseline level of health literacy in new and existing OSU employees using the Newest Vital Sign (NVS) tool. The NVS is a bilingual screening tool that identifies patient risk for low or limited health literacy based on an interpretation of an ice cream nutrition label. The NVS can be administered in approximately three minutes in a clinical setting. This six-question tool was developed to be used as a quick, accurate, clinical screening tool for identifying limited health literacy in English and Spanish-speaking patients. Scoring 0 - 1 on the NVS suggests limited health literacy, 2 - 3 suggests possible limited literacy, and 4 - 6 indicates adequate literacy. The NVS was compared and found to correlate with the longer established Test of Functional Health Literacy Assessment (TOFHLA) tool. Internal consistency was established using Cronbach’s alpha (α =0.76), criterion validity (r = 0.59) with area under the receiver operating curve (ROC) of 0.88 for the English version. The English version will be used for this project. Demographic data to be collected include age, gender, native language, total years of formal education, job title, and whether the participant is a new or existing employee. In addition to the NVS score, the time needed for the tool administration will be recorded.

Project design

This observational, cross-sectional, survey design Doctor of Nursing Practice (DNP) scholarly project uses a convenience sample of OSU employees that visit University Health Services (UHS) for onboarding, medical surveillance activities, or non-urgent medical care. UHS is a clinic located on the OSU campus in the Medical Center complex in Columbus, OH. OSU Institutional Review Board exempted approval was obtained for the project. Data collection began in October 2014 and concludes in December 2014. Data will be analyzed in January 2015 using descriptive statistics such as Chi square analysis or cross table tabulations and will be summarized in tables. No personally identifiable information is collected, data handling procedures are secure, and only aggregate demographic data will be reported. Results will be reported for 120 participants.

Preliminary data

Preliminary data for 98 university employee participants revealed a mean age of 36.5 years (range 19 – 61 years), a mean of 16.6 years (range 12 – 24 years) of formal education, and a mean NVS score of 4.73 (range 0 – 6).  There were 47 males (48%) and 51 females (52%) in this preliminary sample.  Participants reported 11 native languages other than English.

Implications

Determining the level of health literacy in a sample of OSU employees and testing the feasibility of using the NVS in practice may inform the development of more effective coaching techniques and programming to help individuals and groups improve their personal and occupational health outcomes. Although evidence is limited, studies have shown that health outcomes can be improved by reducing the health literacy demand on patients. If all employees of organizations are initially approached as if they are at risk for not understanding their health conditions or how to address them, then health care providers can take action to confirm and ensure employees’ understanding, and ultimately help improve health care quality and outcomes for the employees/patients they serve.