Michael McKee

Report
Validation of the Newest Vital Sign in
American Sign Language for Deaf Users
M I C H A E L M C K E E M D, M P H
DE PA R T MENT O F FA MI LY ME D I CINE A ND
NAT IO NA L CE NT E R F O R D E A F HE A LT H R E S E A R CH
Nothing to financially disclose
Rochester Prevention Research Center
National Center for Deaf Health Research
Background
• Deaf American Sign Language (ASL) users
• Visual based language
• Cultural basis for hearing loss
• Fund of information issues despite normal intelligence
• Social marginalization (similarities with other immigrant populations)
• Lack of access to incidental learning opportunities
• Low English reading level
• No available health literacy tool available for Deaf ASL users
• Most current health literacy tools rely on phonetics, pronunciation (REALM) or
extensive reading comprehension (TOFHLA)
Rochester Prevention Research Center
National Center for Deaf Health Research
Research Objective
• Creation and validation of a health literacy measure in American Sign
Language (ASL) to assess the prevalence of health literacy and its
association with cardiovascular risk factors among Deaf ASL users
Rochester Prevention Research Center
National Center for Deaf Health Research
Newest Vital Sign (NVS)
QUESTIONS
1. If you eat the entire container, how many calories will you eat? 1,000
2. If you are allowed to eat 60 g of carbohydrates as a snack, how much ice cream
could you have?
Any of the following is correct: 1 cup; half the container; 2 servings
3. Your doctor advises you to reduce the amount of saturated fat in your diet. You
usually have 42 g of saturated fat each day, which includes 1 serving of ice cream.
If you stop eating ice cream, how many grams of saturated fat would you be
consuming each day? 33
4. If you usually eat 2500 calories in a day, what percentage of your daily value of
calories will you be eating if you eat one serving? 10%
Pretend that you are allergic to the following substances: Penicillin, peanuts,
latex gloves, and bee stings.
5. Is it safe for you to eat this ice cream? No
(Weiss, 2005)
Rochester Prevention Research Center
National Center for Deaf Health Research
6. (Ask only if the patient responds “no” to question 5): Why not?
Because it has peanut oil.
Methods
• Adaption and Translation Work (NVS ASL-NVS version)
• Translation Work Group- translated (and back-translated)
• Touch screen computer-based survey interface
• In-depth cognitive interviews and beta-testing (n=14)
• Modifications to ASL-NVS survey
• ASL-NVS Validation Analysis
• Peabody Individual Achievement Test-Revised (PIAT-R) reading
comprehension subtest
• Chew’s 3 Health Literacy Screener
• Educational Attainment
Rochester Prevention Research Center
National Center for Deaf Health Research
Rochester Prevention Research Center
National Center for Deaf Health Research
Rochester Prevention Research Center
National Center for Deaf Health Research
Study Population
• Eligibility Criteria:
• Age (40-70)
• Greater Rochester MSA, New York
• Deaf ASL users (n=133)
• Hearing English speakers (n=211)
• No demographic variable differences except race/ethnicity
(p=0.0011)
• Racial/ethnic predispositions comparable to national based surveys
Rochester Prevention Research Center
National Center for Deaf Health Research
Table 1. Demographics by Hearing Status.
Demographic Variable
Deaf (n = 133) Hearing (n = 211)
Newest Vital Sign (Score)
p-value
<.0001
Inadequate (0-1)
43.84 (64)
23.92 (50)
Indeterminate (2-4)
36.99 (54)
30.14 (63)
Adequate (5-6)
19.18 (96)
45.93 (96)
PIAT Grade Level Reading
<.0001
Less than 8th grade
70.31 (90)
29.33 (61)
8th grade or more
29.69 (38)
70.67 (147)
Rochester Prevention Research Center
National Center for Deaf Health Research
*Adjustment for age, sex,
race/ethnicity, education did
not change the significance of
this finding
NVS Score (0-1)– Inadequate
after adjustment
Deaf: 41.0%
Hearing: 22.8%
Correlations with ASL-NVS and NVS
Correlations with NVS
Spearman Correlation Coefficients
Prob > |r| under H0: Rho=0
Number of Observations
Deaf
PIAT Grade Level (treated continuously)
th
th
PIAT Grade Level (8 grade vs >8 grade )
EDUCATION (HS, some college, and 4 year and above
Chew’s Health Literacy Screener Questionnaire
Rochester Prevention Research Center
National Center for Deaf Health Research
0.59
<.0001
0.50
<.0001
0.41
<.0001
-0.32
.0002
Hearing
NVS Categories
0.64
<.0001
0.65
<.0001
0.59
<.0001
- (0.37-0.47)
<.0001
Ordinal Logistic Regression Models (ASLNVS and NVS)
Odds Ratio Estimates
Probability of outcome decreasing
Effect
Point
Estimate
95% Wald Confidence
Intervals
Pr > ChiSq
Age
1.065
1.031
1.101
0.0001
Female vs Male
0.725
0.453
1.159
0.179
Other including Multi-racial vs Non-Hispanic White
4.309
2.348
7.907
<.0001
EDUCATION 1: HS or less vs 4-year college or more
12.613
5.403
29.441
<.0001
EDUCATION 2: Some college vs 4-year college or more
2.867
1.701
4.834
INCOME 1: Less than $25k vs 3: $50k+
4.547
2.505
8.255
INCOME 2: $25k - < $50k vs 3: $50k+
1.919
0.993
3.709
Deaf vs Hearing
6.038
3.574
10.202
Rochester Prevention Research Center
National Center for Deaf Health Research
<.0001
<.0001
Discussion
• ASL-NVS and NVS both demonstrate high correlation with the PIAT-R
• Moderate correlation with Chew’s 3 health literacy questionnaire and educational
attainment
• ASL-NVS appears to be a valid health literacy instrument for Deaf individuals
• Deaf ASL users appear to struggle with higher inadequate health literacy rates
compared with hearing individuals even after adjustment for other factors
• Potential implications for linguistic and cultural adaptation and validation of health
literacy instruments for linguistic minorities
• Limitations
Rochester Prevention Research Center
National Center for Deaf Health Research
Future Directions
• Use of ASL-NVS to measure effects of low health literacy on cardiovascular
risk
• Testing of web- and computer-based NVS for wider dissemination
• Platform development for other linguistic minority groups
• Developmental steps for health literacy mechanisms and interventions for
Deaf ASL users
Rochester Prevention Research Center
National Center for Deaf Health Research
Team and Support
• Research Assistants:
• Martha Tuttle
• Jackie Pransky
• Mentors:
• Thomas Pearson, MD, MPH, PhD
• Kevin Fiscella, MD, MPH
• Michael Paasche-Orlow, MD
• Philip Zazove, MD
• Consultant: Barry Weiss, MD
• National Center for Deaf Health Research (U48 DP001910 and U48 DP000031 from the US Centers for
Disease Control and Prevention)
• Grant Support: National Heart, Lung and Blood Institute at the National Institute of Health
(K01HL103140)
Rochester Prevention Research Center
National Center for Deaf Health Research
Contact:
Michael McKee, MD, MPH
1381 South Avenue
Rochester, NY 14620
585-506-9484 x 124
585-568-6532 (vp)
[email protected]
www.urmc.edu/ncdhr
http://www.urmc.rochester.edu/people/?u=27088319
Dr. McKee is supported by the National Heart, Lung and Blood Institute at the National Institute of
Health (K01HL103140).
Rochester Prevention Research Center
National Center for Deaf Health Research

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