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Morehouse School of Medicine
Atlanta, Georgia
African American


Patients complete a health literacy screening and physicians are trained to adjust their communication based on the results.

In the waiting room prior to their doctor visits, patients complete the Newest Vital Sign, a six-question screening tool which was developed as part of the Pfizer Clear Health Communication Initiative. Intake staff, nurses, and research assistants then enter the patients’ scores in their electronic medical records for the physician to see.

Physicians are trained to be particularly careful in their communication with patients with a health literacy score of lower than four, which indicates that they may have limited or low health literacy. Physician training utilizes the Health Literacy Educational Kit developed by the American Medical Association (AMA) Foundation which contains a documentary and instructional video, an in-depth manual for clinicians, the AMA Council on Scientific Affairs report on health literacy, literacy fact sheets, and materials for community presentations. Provider training includes familiarization with the screening tool and patient-provider role-playing exercises. Physicians are also given the option to complete the AMA Health Literacy Educational Kit as a self-study.


Studies show that patients with low health literacy may be less adherent and less able to participate in their own disease management, resulting in poorer outcomes and health disparities. Patient adherence to prescribed treatment is crucial in managing chronic diseases such as hypertension. However, low health literacy is not simply a patient problem.

The implications for quality are shared by the provider and health care system in partnership with the patient. Communication is multi-directional, with the complexity of health care placing a greater burden on the clinician to ensure understanding. However, despite best efforts, clinicians are not always able to accurately assess literacy abilities of their patients and ensure their comprehension of the information provided.

By providing communications training and access to health literacy scores, physicians will be empowered to communicate with patients at an appropriate health literacy level, improving the encounter, quality of care and health outcomes.

Summary Results

Screening patients for health literacy and training providers to respond to the results did not significantly affect blood pressure. Of the study participants, 37% screened positive for possible limited health literacy. Patients also responded well to the health literacy screening, with 99% reporting feeling no shame and 97% recommending its continued use. 


Time, Costs, and Clinical Utilization of Screening for Health Literacy: A Case Study Using the Newest Vital Sign (NVS) Instrument
Journal of the American Board of Family Medicine. 2011; 24(3): 281-289.
Full Article (subscription may be required)

Patients’ Perceptions of Screening for Health Literacy: Reactions to the Newest Vital Sign
Journal of Health Communication, 2010; 15(4): 402-412.
Full Article (subscription may be required)

Additional Resources

  • Newest Vital Sign: Six-question health literacy screening tool developed as part of the Pfizer Clear Health Communication Initiative
  • Health Literacy Educational Kit: Developed by the American Medical Association Foundation

Principal Investigators

  • Verna L. Welch, PhD, MPH
  • Jonathan VanGeest, PhD