Assessing Health Literacy and Communication Skills in Medical Referrals: A Survey Study

Hoda Rastegari, Peter J. Schulz, Mohammad Kamali, Akbar Nasrollahi

Research output: Contribution to journalArticlepeer-review


Background and Objectives: The aim of this study is to draw a comprehensive picture of patients’ functional and critical health literacy and its association with socio-demographic variables and self-efficacy. We investigated the referrals to Isfahan health centers, in particular the dimensions of reading ability, numeracy, and eHealth literacy using two different measures, the Newest Vital Sign (NVS) for the functional and the eHEALS for critical aspects. Materials and methods: The surveys were administered to a random sample (N = 384), which resembled Iran Isfahan residents in terms, educational attainment and self-efficacy but not age and gender. For testing individuals with low health literacy, the NVS is a reliable and quick screening tool. eHEALS helps to measure patients’ capabilities in Internet searches. Both of tools are validated in Persian. Pearson’s correlation coefficient, χ2-test, independent t-test and regression were also used to assess the association between health literacy measures, self-efficacy and predictor variables. (p <0.05) Results: More than 60% of our respondents had an inadequate or marginal level of health literacy with NVS, and with eHEALS, more than 50% were classified accordingly. The newest vital sign and eHEALS scores showed an association with higher education one of the predictors of health literacy. Higher eHEALS scores were associated with higher self-efficacy score. eHEALS and NVS provides a valid self-reported assessment of patients’ eHealth literacy and useful appraisal of patients’ functional health literacy, respectively. Conclusion: In our sample, more than 50% of patients had a low level of literacy. eHEALS provides a valid self-reported assessment of patients’ eHealth literacy, and NVS provides a useful appraisal of patients’ functional health literacy. Determining health literacy in patients leads to a better understanding of their perception, application, and decision-making in health problems. Paper Type: Research Article.

Original languageEnglish
Pages (from-to)37-52
Number of pages16
JournalJournal of Health Literacy
Issue number3
StatePublished - Oct 2022

Bibliographical note

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© 2022, Mashhad University of Medical Sciences. All rights reserved.


  • Health literacy
  • NVS
  • eHEALS
  • patient
  • self-efficacy


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