Public Release: 

Physicians: Simple 'instrument' allows medical staff to check patients' literacy

University of North Carolina at Chapel Hill

Health-care providers soon will have access to a new tool designed to assess patients' health literacy skills quickly and simply, thanks to medical school researchers at the universities of Arizona and North Carolina at Chapel Hill.

Knowing for sure if patients can understand health information enables doctors and nurses, for example, to boost how well patients fare.

Dr. Barry D. Weiss, professor of family and community medicine at AU, and Drs. Michael Pignone, associate professor, and Darren DeWalt, assistant professor, both in medicine at UNC, and colleagues developed what they call the "Newest Vital Sign." Their chief goals are to improve recognition of limited literacy and its effect on health and health care.

The Newest Vital Sign is a simple, six-question assessment based on an ice cream nutrition label, Pignone said. It enables health workers to gauge individuals' ability to read, comprehend plain English and act on health information in productive ways. It is the only rapid assessment tool developed both in Spanish and English.

"We believe this offers a way for providers to identify patients at risk for literacy-related communication problems," he said. "Here at UNC, we are also developing interventions to help patients with low literacy get the education, training and care they need for conditions like diabetes, asthma, and heart failure. Being able to identify those with communication problems early on and tailor messages to fit each patient's literacy level can reduce most such problems."

Poorer-than-optimal results spring from trouble patients have in navigating the complexities of health care, Pignone said, from interpreting instructions for drugs and self-care regimens to understanding insurance and informed-consent documents. Among the consequences are failure to receive appropriate preventive care, increased hospitalization risks and possibly higher health-care costs.

Reports issued by the Institute of Medicine, the Agency for Healthcare Research and Quality and the American Medical Association in 2004 indicate that as many as half of all adults in the United States have low health literacy.

In a report in the latest issue of Annals of Family Medicine, the researchers describe Newest Vital Sign and say that literacy screening instruments currently available for hospitals, clinics and doctors' offices either take too much time or are available only in English. On the other hand, their new assessment tool can be administered in only three minutes, the UNC physician said. It also can be used to assess health literacy skills while patients' vital signs, such as blood pressure, are measured.

"Patients are given the ice cream nutrition label by the nurse or physician and asked a series of questions about it," Pignone said. "Based on the number of correct answers given, we can determine their literacy level and adjust the way we communicate with patients to help them understand what's going on."

According to the non-profit Partnership for Clear Health Communication, a coalition of national organizations working to promote awareness of and solutions for low health literacy, literacy skills are a stronger predictor of a person's health status than age, income, employment status, educational level and racial or ethnic background.

"While ethnic minority groups are disproportionately affected by low literacy, the majority of those with low literacy in the United States are white, native-born Americans," Weiss said. "Health information often is difficult to understand, but some people are especially vulnerable, including the elderly, recent immigrants, who may be highly literate in their own language, people with chronic disease and those with low incomes."

Costs to the American health-care system caused by excess hospitalizations and emergency care, patient errors in their self treatment and other problems associated with limited health literacy have been estimated to be between $58 billion and $73 billion a year, he said. One study found that patients with less than a third-grade reading level averaged more than $10,000 in annual Medicaid costs, while Medicaid spent less than $3,000 on those with higher reading levels.


Pfizer, Inc., a pharmaceutical company, funded research and development of the Newest Vital Sign. The instrument will be available to medical and public health providers at no cost. To read a report on it, visit the Annals of Family Medicine Web site, ( and view the November-December issue.

Note: Pignone can be reached at (919) 966-2276 or

News Services contact: David Williamson, (919) 962-8596.

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