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      Establishing Content Validity for the Nutrition Literacy Assessment Instrument

      , PhD, RD, LDN, , PhD, RD, LDN

      Preventing Chronic Disease

      Centers for Disease Control and Prevention

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          Abstract

          Introduction

          Identification of low levels of health literacy is important for effective communication between providers and clients. Assessment instruments for general health literacy are inadequate for use in nutrition education encounters because they do not identify nutrition literacy. The primary objective of this 2-part study was to assess content validity for the Nutrition Literacy Assessment Instrument (NLAI).

          Methods

          This study included a 35-item online survey of registered dietitians (134 of whom answered all questions) and a pilot study in which 5 registered dietitians used the NLAI among 26 clients during nutrition education consultations. To assess agreement with the NLAI by survey participants, we used the following scale: “necessary” (70% agreement), “adequate” (80% agreement), or “good” (90% agreement); comments were analyzed by using content analysis. For the pilot, we made comparisons between subjective assessments, the Rapid Estimate of Adult Literacy in Medicine (REALM), and the NLAI. Registered dietitians also completed a postpilot–study survey.

          Results

          For the online survey, we found good agreement (average, 89.7%) for including each section of the NLAI. All sections accomplished their purpose (average, 81.5%). For the pilot, REALM and NLAI correlation ( r = 0.38) was not significant; the subjective assessment of clients by dietitians and NLAI lacked agreement 44% of the time, and registered dietitians provided instruction on deficient knowledge and skills identified by the NLAI 90% of the time.

          Conclusion

          The NLAI is a content-valid measure of nutrition literacy. Additional validation of the NLAI is important because an objective instrument is needed for identifying nutrition literacy, a construct that appears to be different from health literacy.

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          Most cited references 21

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          Development of a brief test to measure functional health literacy.

          We describe the development of an abbreviated version of the Test of Functional Health Literacy in Adults (TOFHLA) to measure patients' ability to read and understand health-related materials. The TOFHLA was reduced from 17 Numeracy items and 3 prose passages to 4 Numeracy items and 2 prose passages (S-TOFHLA). The maximum time for administration was reduced from 22 minutes to 12. In a group of 211 patients given the S-TOFHLA, Cronbach's alpha was 0.68 for the 4 Numeracy items and 0.97 for the 36 items in the 2 prose passages. The correlation (Spearman) between the S-TOFHLA and the Rapid Estimate of Adult Literacy in Medicine (REALM) was 0.80, although there were important disagreements between the two tests. The S-TOFHLA is a practical measure of functional health literacy with good reliability and validity that can be used by health educators to identify individuals who require special assistance to achieve learning goals.
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            Nutrition and health literacy: a systematic review to inform nutrition research and practice.

            Health literacy is defined as the degree to which individuals obtain, process, and understand basic health information and services to make informed health decisions. Health literacy is a stronger predictor of health than age, income, employment, education, and race. Although the field has grown during the past decade, most health literacy research does not explicitly focus on food or nutrition, and dietetics practitioners often remain unaware of patients' health literacy level. The purpose of this systematic review was to summarize the literature on nutrition and health literacy to enhance dietetics practitioners' awareness of the importance of health literacy in practice and research. Of the 33 studies reviewed, four focused on measurement development, 16 on readability assessments, and 13 on individual literacy skills assessments. Collective evaluation revealed four noteworthy gaps, including the need to use more comprehensive assessment approaches that move beyond readability and numeracy to address the full spectrum of health literacy factors; the need to apply more robust experimental studies to examine the effectiveness of health literacy interventions among individuals, communities, health care providers, and health care systems; the need to explore the moderating and mediating roles of an individual's health literacy status on nutrition outcomes; and the need to examine long-term effects of health literacy interventions on nutrition outcomes. This article defines health literacy gaps and opportunities in nutrition research and practice, and calls for continued action to elevate the role of dietetics practitioners in addressing health literacy. Copyright © 2012 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.
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              Accuracy in the estimation of food servings against the portions in food photographs.

              In diet surveys, quantitative underestimation of food consumption may be due to intentional misreporting or false portion-size reporting. Perception of food photographs used as aids for assessing the actual amounts may have an effect. This study was carried out to assess the validity of food photographs. A real-time test protocol where 52 presented food servings were compared against photographed portions with similar food items. Volunteers from the Rehabilitation Company Petrea (in Turku) were recruited, 161 adults participated, and for 146 subjects, complete data were collected. The proportions of correct estimations and reporting errors, in weights and percentages, are presented by gender and food group. Food descriptors, portion-size options and subject characteristics were studied as potential determinants of accuracy in portion-size estimation. The total proportion of exactly correct estimations was 51% in men and 49% in women. The overall reporting error was -10 g in men and +1 g in women for the 52 food servings. Underreporting was typical for bread, spread and cold cuts and dishes in both genders. Over-reporting was typical for cereals in both genders and for snacks, vegetables and fruit in women. The estimation error was associated with the portion-size options but not associated with the energy density of food items, education or body mass index. Food portions in photographs seem to be a useful aid for the quantification of most food items. However, validation studies are needed to test the applicability of photographs for estimating current portions and for searching better tools in dietary surveys.
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                Author and article information

                Journal
                Prev Chronic Dis
                Prev Chronic Dis
                PCD
                Preventing Chronic Disease
                Centers for Disease Control and Prevention
                1545-1151
                2013
                03 July 2013
                : 10
                Affiliations
                Author Affiliation: Karen Chapman-Novakofski, University of Illinois, Urbana, Illinois.
                Author notes
                Corresponding Author: Heather Gibbs, PhD, RD, LDN, Clinical Assistant Professor, Department of Dietetics and Nutrition, University of Kansas Medical Center, Mail Stop 4013, 3901 Rainbow Blvd, Kansas City, KS 66160. E-mail: hgibbs@ 123456kumc.edu .
                Article
                12_0267
                10.5888/pcd10.120267
                3702232
                23823698
                Categories
                Original Research
                Peer Reviewed

                Health & Social care

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