Michael McKee MD MPH Department of Family Medicine and National Center for Deaf Health Research Nothing to financially disclose Rochester Prevention Research Center National Center for Deaf Health Research ID: 775038
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Slide1
Validation of the Newest Vital Sign in American Sign Language for Deaf Users
Michael McKee MD, MPH
Department of Family Medicine and
National Center for Deaf Health Research
Slide2Nothing to financially disclose
Rochester Prevention Research Center National Center for Deaf Health Research
Slide3Background
Deaf American Sign Language (ASL) users Visual based languageCultural basis for hearing lossFund of information issues despite normal intelligenceSocial marginalization (similarities with other immigrant populations)Lack of access to incidental learning opportunitiesLow English reading levelNo available health literacy tool available for Deaf ASL usersMost current health literacy tools rely on phonetics, pronunciation (REALM) or extensive reading comprehension (TOFHLA)
Rochester Prevention Research Center National Center for Deaf Health Research
Slide4Research 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
Slide5Newest Vital Sign (NVS)
(Weiss, 2005)
Rochester Prevention Research Center National Center for Deaf Health Research
QUESTIONS
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
6. (Ask only if the patient responds “no” to question 5): Why not?
Because it has peanut oil.
Slide6Methods
Adaption and Translation Work (NVS ASL-NVS version)Translation Work Group- translated (and back-translated)Touch screen computer-based survey interfaceIn-depth cognitive interviews and beta-testing (n=14)Modifications to ASL-NVS surveyASL-NVS Validation AnalysisPeabody Individual Achievement Test-Revised (PIAT-R) reading comprehension subtestChew’s 3 Health Literacy ScreenerEducational Attainment
Rochester Prevention Research Center National Center for Deaf Health Research
Slide7Rochester Prevention Research Center National Center for Deaf Health Research
Slide8Rochester Prevention Research Center National Center for Deaf Health Research
Slide9Study Population
Eligibility Criteria:Age (40-70) Greater Rochester MSA, New YorkDeaf 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
Slide10Rochester Prevention Research Center National Center for Deaf Health Research
Table 1. Demographics by Hearing Status.Demographic VariableDeaf (n = 133)Hearing (n = 211)p-valueNewest Vital Sign (Score) <.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 grade70.31 (90)29.33 (61) 8th grade or more29.69 (38)70.67 (147)
*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%
Slide11Correlations with ASL-NVS and NVS
Correlations with NVSSpearman Correlation Coefficients Prob > |r| under H0: Rho=0 Number of Observations DeafHearing NVS CategoriesPIAT Grade Level (treated continuously)0.590.64<.0001<.0001PIAT Grade Level (8th grade vs >8th grade )0.500.65<.0001<.0001EDUCATION (HS, some college, and 4 year and above 0.410.59 <.0001<.0001Chew’s Health Literacy Screener Questionnaire-0.32- (0.37-0.47).0002<.0001
Rochester Prevention Research Center National Center for Deaf Health Research
Slide12Ordinal Logistic Regression Models (ASL-NVS and NVS)
Odds Ratio Estimates Probability of outcome decreasingEffectPoint Estimate95% Wald Confidence IntervalsPr > ChiSq Age1.0651.0311.1010.0001Female vs Male0.7250.4531.1590.179Other including Multi-racial vs Non-Hispanic White4.3092.3487.907<.0001EDUCATION 1: HS or less vs 4-year college or more12.6135.40329.441<.0001EDUCATION 2: Some college vs 4-year college or more2.8671.7014.834 INCOME 1: Less than $25k vs 3: $50k+4.5472.5058.255<.0001INCOME 2: $25k - < $50k vs 3: $50k+1.9190.9933.709 Deaf vs Hearing6.0383.57410.202<.0001
Rochester Prevention Research Center National Center for Deaf Health Research
Slide13Discussion
ASL-NVS and NVS both demonstrate high correlation with the PIAT-RModerate correlation with Chew’s 3 health literacy questionnaire and educational attainmentASL-NVS appears to be a valid health literacy instrument for Deaf individualsDeaf ASL users appear to struggle with higher inadequate health literacy rates compared with hearing individuals even after adjustment for other factorsPotential 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
Slide14Future Directions
Use of ASL-NVS to measure effects of low health literacy on cardiovascular riskTesting of web- and computer-based NVS for wider disseminationPlatform development for other linguistic minority groupsDevelopmental steps for health literacy mechanisms and interventions for Deaf ASL users
Rochester Prevention Research Center National Center for Deaf Health Research
Slide15Team and Support
Research Assistants:Martha TuttleJackie PranskyMentors:Thomas Pearson, MD, MPH, PhDKevin Fiscella, MD, MPHMichael Paasche-Orlow, MDPhilip Zazove, MDConsultant: Barry Weiss, MDNational 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
Slide16Contact:
Michael McKee, MD, MPH1381 South AvenueRochester, NY 14620585-506-9484 x 124585-568-6532 (vp)michael_mckee@urmc.rochester.eduwww.urmc.edu/ncdhrhttp://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