{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T17:35:33Z","timestamp":1778002533676,"version":"3.51.4"},"reference-count":73,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2021,2,27]],"date-time":"2021-02-27T00:00:00Z","timestamp":1614384000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001871","name":"Funda\u00e7\u00e3o para a Ci\u00eancia e a Tecnologia","doi-asserted-by":"publisher","award":["UIDB\/04295\/2020"],"award-info":[{"award-number":["UIDB\/04295\/2020"]}],"id":[{"id":"10.13039\/501100001871","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Self-management of health requires skills to obtain, process, understand, and use health-related information. Assessment of adolescents\u2019 functional health literacy requires valid, reliable, and low-burden tools. The main objective of this study was to adapt and study the psychometric properties of the Newest Vital Sign for the Portuguese adolescents\u2019 population (NVS-PTeen). Classic psychometric indicators of reliability and validity were combined with item response theory (IRT) analyses in a cross-sectional survey, complemented with a 3-month test-retest assessment. The NVS-PTeen was self-administered to students enrolled in grades 8 to 12 (12 to 17 years old) in a school setting. Overall, 386 students (191 girls) from 16 classes of the same school participated in the study (mean age = 14.5; SD = 1.5). Internal reliability of the NVS-PTeen was \u03b1 = 0.60. The NVS-PTeen total score was positively and significantly correlated with Portuguese (r = 0.28) and mathematics scores (r = 0.31), school years (r = 0.31), and age (r = 0.19). Similar to the original scale (for the U.S.), the NVS-PTeen is composed of two dimensions, reading-related literacy and numeracy. Temporal reliability is adequate, though with a learning effect. IRT analyses revealed differences in difficulty and discriminative capacity among items, all with adequate outfit and infit values. Results showed that the NVS-PTeen is valid and reliable, sensible to inter-individual educational differences, and adequate for regular screening of functional health literacy in adolescents.<\/jats:p>","DOI":"10.3390\/nu13030790","type":"journal-article","created":{"date-parts":[[2021,2,27]],"date-time":"2021-02-27T20:55:44Z","timestamp":1614459344000},"page":"790","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Functional Health Literacy: Psychometric Properties of the Newest Vital Sign for Portuguese Adolescents (NVS-PTeen)"],"prefix":"10.3390","volume":"13","author":[{"given":"Osvaldo","family":"Santos","sequence":"first","affiliation":[{"name":"Instituto de Sa\u00fade Ambiental, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal"},{"name":"Unbreakable Idea Research, Lda., 2550-426 Painho, Portugal"},{"name":"Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal"}]},{"given":"Miodraga","family":"Stefanovska-Petkovska","sequence":"additional","affiliation":[{"name":"Instituto de Sa\u00fade Ambiental, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0428-6643","authenticated-orcid":false,"given":"Ana","family":"Virgolino","sequence":"additional","affiliation":[{"name":"Instituto de Sa\u00fade Ambiental, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal"},{"name":"Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2943-3526","authenticated-orcid":false,"given":"Ana Cristina","family":"Miranda","sequence":"additional","affiliation":[{"name":"Instituto de Sa\u00fade Ambiental, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9784-8272","authenticated-orcid":false,"given":"Joana","family":"Costa","sequence":"additional","affiliation":[{"name":"Instituto de Sa\u00fade Ambiental, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal"}]},{"given":"Elisabete","family":"Fernandes","sequence":"additional","affiliation":[{"name":"Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal"}]},{"given":"Susana","family":"Cardoso","sequence":"additional","affiliation":[{"name":"MARE, Escola Superior de Turismo e Tecnologia do Mar, Instituto Polit\u00e9cnico de Leiria, 2520-614 Peniche, Portugal"},{"name":"CiTechCare, Instituto Polit\u00e9cnico de Leiria, 2410-541 Leiria, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2783-0544","authenticated-orcid":false,"given":"Ant\u00f3nio","family":"Vaz Carneiro","sequence":"additional","affiliation":[{"name":"Instituto de Sa\u00fade Ambiental, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal"},{"name":"Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal"},{"name":"Institute for Evidence Based Healthcare, 1649-028 Lisboa, Portugal"},{"name":"Cochrane Portugal, 1649-028 Lisboa, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2021,2,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"S\u00f8rensen, K., Van den Broucke, S., Fullam, J., Doyle, G., Pelikan, J., Slonska, Z., and Brand, H. (2012). Health literacy and public health: A systematic review and integration of definitions and models. BMC Public Health, 12.","DOI":"10.1186\/1471-2458-12-80"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1080\/10810730601031090","article-title":"Health literacy - identification and response","volume":"11","author":"Ratzan","year":"2006","journal-title":"J. Health Commun."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"901","DOI":"10.1093\/heapro\/dax015","article-title":"Improving health literacy in community populations: A review of progress","volume":"33","author":"Nutbeam","year":"2018","journal-title":"Health Promot. Int."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1093\/heapro\/15.3.259","article-title":"Health literacy as a public health goal: A challenge for contemporary health education and communication strategies into the 21st century","volume":"15","author":"Nutbeam","year":"2000","journal-title":"Health Promot. Int."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.socscimed.2011.04.004","article-title":"Critical health literacy: A review and critical analysis","volume":"73","author":"Chinn","year":"2011","journal-title":"Soc. Sci. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1007\/s00038-009-0058-2","article-title":"The costs of limited health literacy: A systematic review","volume":"54","author":"Eichler","year":"2009","journal-title":"Int. J. Public Health"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.healthpol.2018.11.012","article-title":"Framing health literacy: A comparative analysis of national action plans","volume":"123","author":"Weishaar","year":"2019","journal-title":"Health Policy"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.1093\/eurpub\/ckv043","article-title":"Health literacy in Europe: Comparative results of the European Health Literacy Survey (HLS-EU)","volume":"25","author":"Pelikan","year":"2015","journal-title":"Eur. J. Public Health"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1016\/j.procs.2016.09.277","article-title":"Health Literacy Survey Portugal: A contribution for the knowledge on health and communications","volume":"100","author":"Espanha","year":"2016","journal-title":"Procedia Comput. Sci."},{"key":"ref_10","first-page":"259","article-title":"Literacia em sa\u00fade, dos dados \u00e0 a\u00e7\u00e3o: Tradu\u00e7\u00e3o, valida\u00e7\u00e3o e aplica\u00e7\u00e3o do European Health Literacy Survey em Portugal","volume":"34","author":"Pedro","year":"2016","journal-title":"Rev. Port. Saude Publica"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1136\/bmjopen-2017-020080","article-title":"Quality of health literacy instruments used in children and adolescents: A systematic review","volume":"8","author":"Guo","year":"2018","journal-title":"BMJ Open"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1093\/her\/cym069","article-title":"Health literacy and adolescents: A framework and agenda for future research","volume":"23","author":"Manganello","year":"2008","journal-title":"Health Educ. Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1108\/HE-07-2012-0039","article-title":"Measuring child and adolescent health literacy: A systematic review of literature","volume":"113","author":"Ormshaw","year":"2013","journal-title":"Health Educ."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1111\/jspn.12072","article-title":"Health literacy in adolescents: An integrative review","volume":"19","author":"Perry","year":"2014","journal-title":"J. Spec. Pediatr. Nurs."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1089\/jayao.2015.0059","article-title":"Health literacy in adolescents and young adults: An updated review","volume":"5","author":"Lin","year":"2016","journal-title":"J. Adolesc. Young Adult Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.pec.2013.09.006","article-title":"Association between health literacy and child and adolescent obesity","volume":"94","author":"Chari","year":"2014","journal-title":"Patient Educ. Couns."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1016\/j.acap.2014.01.004","article-title":"Low caregiver health literacy is associated with higher pediatric emergency department use and nonurgent visits","volume":"14","author":"Morrison","year":"2014","journal-title":"Acad. Pediatr."},{"key":"ref_18","unstructured":"Feldman, S.S., and Elliott, G.R. (1990). At the Threshold: The Developing Adolescent, Harvard University Press."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1016\/j.conb.2007.03.009","article-title":"Emotional and cognitive changes during adolescence","volume":"17","year":"2007","journal-title":"Curr. Opin. Neurobiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.yfrne.2005.10.003","article-title":"Pubertal hormones organize the adolescent brain and behavior","volume":"26","author":"Sisk","year":"2005","journal-title":"Front. Neuroendocrinol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Adams, G.R., and Berzonsky, M.D. (2006). Blackwell Handbook of Adolescence, Blackwell Publishing Ltd.","DOI":"10.1002\/9780470756607"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.bandc.2009.10.007","article-title":"Pubertal development and behavior: Hormonal activation of social and motivational tendencies","volume":"72","author":"Dahl","year":"2010","journal-title":"Brain Cogn."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1641","DOI":"10.1016\/S0140-6736(12)60149-4","article-title":"Adolescence and the social determinants of health","volume":"379","author":"Viner","year":"2012","journal-title":"Lancet"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1016\/j.socscimed.2018.06.012","article-title":"Linking perceived discrimination during adolescence to health during mid-adulthood: Self-esteem and risk-behavior mechanisms","volume":"232","author":"Yang","year":"2019","journal-title":"Soc. Sci. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1177\/1403494815576360","article-title":"How well do parental and peer relationships in adolescence predict health in adulthood?","volume":"43","author":"Landstedt","year":"2015","journal-title":"Scand. J. Public Health"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1177\/1757975909348101","article-title":"High school health curriculum and health literacy: Canadian student voices","volume":"16","author":"Begoray","year":"2009","journal-title":"Glob. Health Promot."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1080\/13573322.2013.769948","article-title":"Health literacy in schools: Prioritising health and well-being issues through the curriculum","volume":"20","author":"Kilgour","year":"2015","journal-title":"Sport. Educ. Soc."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1093\/heapro\/16.2.197","article-title":"Schools, health literacy and public health: Possibilities and challenges","volume":"16","author":"Leger","year":"2001","journal-title":"Health Promot. Int."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Okan, O., Lopes, E., Bollweg, T.M., Br\u00f6der, J., Messer, M., Bruland, D., Bond, E., Carvalho, G.S., S\u00f8rensen, K., and Saboga-Nunes, L. (2018). Generic health literacy measurement instruments for children and adolescents: A systematic review of the literature. BMC Public Health, 18.","DOI":"10.1186\/s12889-018-5054-0"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Br\u00f6der, J., Okan, O., Bauer, U., Bruland, D., Schlupp, S., Bollweg, T.M., Saboga-Nunes, L., Bond, E., S\u00f8rensen, K., and Bitzer, E.-M. (2017). Health literacy in childhood and youth: A systematic review of definitions and models. BMC Public Health, 17.","DOI":"10.1186\/s12889-017-4365-x"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1007\/BF02640361","article-title":"The Test of Functional Health Literacy in adults: A new instrument for measuring patients\u2019 literacy skills","volume":"10","author":"Parker","year":"1995","journal-title":"J. Gen. Intern. Med."},{"key":"ref_32","first-page":"124","article-title":"Rapid Estimate of Adult Literacy in Medicine (REALM): A quick reading test for patients","volume":"37","author":"Murphy","year":"1993","journal-title":"J. Read."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1370\/afm.405","article-title":"Quick assessment of literacy in primary care: The Newest Vital Sign","volume":"3","author":"Weiss","year":"2005","journal-title":"Ann. Fam. Med."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Rowlands, G., Khazaezadeh, N., Oteng-Ntim, E., Seed, P., Barr, S., and Weiss, B.D. (2013). Development and validation of a measure of health literacy in the UK: The Newest Vital Sign. BMC Public Health, 13.","DOI":"10.1186\/1471-2458-13-116"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"211","DOI":"10.3122\/jabfm.2008.03.070217","article-title":"How long does it take to assess literacy skills in clinical practice?","volume":"21","author":"Johnson","year":"2008","journal-title":"J. Am. Board Fam. Med."},{"key":"ref_36","unstructured":"Santos, O., Oliveira, A., Carvalho, C., Lunet, N., Azevedo, A., Paiva, D., and do Carmo, I. (September, January 29). Self-administration of the Newest Vital Sign in Portuguese young adults: Study of its internal reliability. Proceedings of the Abstracts from the ICBM 2012 Meeting, Budapeste, Hungary."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"861","DOI":"10.20344\/amp.9135","article-title":"Limited health literacy in Portugal assessed with the Newest Vital Sign","volume":"30","author":"Paiva","year":"2017","journal-title":"Acta Med. Port."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12955-014-0176-2","article-title":"Sample size used to validate a scale: A review of publications on newly-developed patient reported outcomes measures","volume":"12","author":"Anthoine","year":"2014","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1331\/JAPhA.2013.12249","article-title":"Newest Vital Sign as a proxy for medication adherence in older adults","volume":"53","author":"Salgado","year":"2013","journal-title":"J. Am. Pharm. Assoc."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"75","DOI":"10.12707\/RIII1399","article-title":"Cross-cultural adaptation and validation of the Portuguese version of the Newest Vital Sign","volume":"IV","author":"Martins","year":"2014","journal-title":"Rev. Enferm. Ref."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1023\/A:1015291021312","article-title":"Assessing health status and quality-of-life instruments: Attributes and review criteria","volume":"11","author":"Aaronson","year":"2002","journal-title":"Qual. Life Res."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1007\/BF02288391","article-title":"The theory of the estimation of test reliability","volume":"2","author":"Kuder","year":"1937","journal-title":"Psychometrika"},{"key":"ref_43","unstructured":"Nunnally, J.C., and Bernstein, I.H. (1994). Psychometric Theory, McGraw-Hill, Inc."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"853","DOI":"10.2147\/PPA.S165994","article-title":"Quick screen of patients\u2019 numeracy and document literacy skills: The factor structure of the Newest Vital Sign","volume":"12","author":"Huang","year":"2018","journal-title":"Patient Prefer. Adherence"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Meyer, P. (2014). Applied measurement with Jmetrik, Rutledge.","DOI":"10.4324\/9780203115190"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"(2013). World Medical Association (WMA) World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA, 310, 2191\u20132194.","DOI":"10.1001\/jama.2013.281053"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"747","DOI":"10.15171\/ijhpm.2015.151","article-title":"Health literacy impact on national healthcare utilization and expenditure","volume":"4","author":"Rasu","year":"2015","journal-title":"Int. J. Heal. Policy Manag."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1016\/j.gerinurse.2016.12.003","article-title":"The impact of inadequate health literacy on patient satisfaction, healthcare utilization, and expenditures among older adults","volume":"38","author":"MacLeod","year":"2017","journal-title":"Geriatr. Nurs."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1111\/j.1552-6909.2009.01059.x","article-title":"Understanding the impact of health literacy on women\u2019s health","volume":"38","author":"Shieh","year":"2009","journal-title":"J. Obstet. Gynecol. Neonatal Nurs."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"878","DOI":"10.1111\/j.1525-1497.2006.00540.x","article-title":"The meaning and the measure of health literacy","volume":"21","author":"Baker","year":"2006","journal-title":"J. Gen. Intern. Med."},{"key":"ref_51","first-page":"e19","article-title":"The use of the Newest Vital Sign in children","volume":"3","author":"Weiss","year":"2019","journal-title":"HLRP Heal. Lit. Res. Pract."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"267","DOI":"10.4074\/S0013754512003035","article-title":"Cognitive and brain development in adolescence","volume":"3","author":"Keating","year":"2012","journal-title":"Enfance"},{"key":"ref_53","first-page":"40","article-title":"Literacia em sa\u00fade mental sobre depress\u00e3o: Um estudo com adolescentes portugueses","volume":"21","author":"Rosa","year":"2019","journal-title":"Rev. Port. Enferm. Sa\u00fade Ment."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1179\/1753807615Y.0000000016","article-title":"Development of the Health Literacy Assessment Scale for Adolescents (HAS-A)","volume":"8","author":"Manganello","year":"2015","journal-title":"J. Commun. Healthc."},{"key":"ref_55","unstructured":"(2020, December 30). P\u00fablico Comunica\u00e7\u00e3o Social SA Ranking das Escolas. Available online: https:\/\/www.publico.pt\/ranking-das-escolas-2017\/lista."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/j.pedhc.2013.05.005","article-title":"Using the \u201cNewest Vital Sign\u201d to assess health literacy in children","volume":"28","author":"Driessnack","year":"2014","journal-title":"J. Pediatr. Heal. Care"},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Kogure, T., Sumitani, M., Suka, M., Ishikawa, H., Odajima, T., Igarashi, A., Kusama, M., Okamoto, M., Sugimori, H., and Kawahara, K. (2014). Validity and reliability of the Japanese version of the Newest Vital Sign: A preliminary study. PLoS One, 9.","DOI":"10.1371\/journal.pone.0094582"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"2038","DOI":"10.1017\/S1368980018000253","article-title":"Canadian adaptation of the Newest Vital Sign\u00a9, a health literacy assessment tool","volume":"21","author":"Mansfield","year":"2018","journal-title":"Public Health Nutr."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1016\/j.bj.2018.07.001","article-title":"Adaptation and validation of a measure of health literacy in Taiwan: The Newest Vital Sign","volume":"41","author":"Tseng","year":"2018","journal-title":"Biomed. J."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"281","DOI":"10.3122\/jabfm.2011.03.100212","article-title":"Time, costs, and clinical utilization of screening for health literacy: A case study using the Newest Vital Sign (NVS) instrument","volume":"24","author":"Welch","year":"2011","journal-title":"J. Am. Board Fam. Med."},{"key":"ref_61","first-page":"190","article-title":"A psychometric assessment of the Newest Vital Sign among youth in Guatemala city","volume":"3","author":"Hoffman","year":"2015","journal-title":"J. Child Adolesc. Behav."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1177\/0009922813504025","article-title":"Can the Newest Vital Sign be used to assess health literacy in children and adolescents?","volume":"53","author":"Warsh","year":"2014","journal-title":"Clin. Pediatr."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"53","DOI":"10.5116\/ijme.4dfb.8dfd","article-title":"Making sense of Cronbach\u2019s alpha","volume":"2","author":"Tavakol","year":"2011","journal-title":"Int. J. Med. Educ."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1037\/1040-3590.8.4.350","article-title":"Uses and abuses of coefficient alpha","volume":"8","author":"Schmitt","year":"1995","journal-title":"Psychol. Assess."},{"key":"ref_65","unstructured":"Cruvinel, A.F.P., M\u00e9ndez, D.A.C., Chaves, G.C., Gutierres, E., Lotto, M., Oliveira, T.M., and Cruvinel, T. (2018). The Brazilian validation of a health literacy instrument: The Newest Vital Sign. Acta Odontol. Scand., 1\u20138."},{"key":"ref_66","doi-asserted-by":"crossref","unstructured":"Zotti, P., Cocchi, S., Polesel, J., Mis, C.C., Bragatto, D., Cavuto, S., Conficconi, A., Costanzo, C., De Giorgi, M., and Drace, C.A. (2017). Cross-cultural validation of health literacy measurement tools in Italian oncology patients. BMC Health Serv. Res., 17.","DOI":"10.1186\/s12913-017-2359-0"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1016\/j.pec.2014.08.017","article-title":"International application of health literacy measures: Adaptation and validation of the Newest Vital Sign in The Netherlands","volume":"97","author":"Fransen","year":"2014","journal-title":"Patient Educ. Couns."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1080\/10810730.2011.604383","article-title":"Applicability of internationally available health literacy measures in the Netherlands","volume":"16","author":"Fransen","year":"2011","journal-title":"J. Health Commun."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"1907","DOI":"10.1017\/S1368980017000787","article-title":"Cross-cultural adaptation and validation of the Newest Vital Sign (NVS) health literacy instrument in general population and highly educated samples of Brazilian adults","volume":"20","author":"Rodrigues","year":"2017","journal-title":"Public Health Nutr."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"S94","DOI":"10.1111\/j.1524-4733.2007.00272.x","article-title":"What is sufficient evidence for the reliability and validity of patient-reported outcome measures?","volume":"10","author":"Frost","year":"2007","journal-title":"Value Heal."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"i1","DOI":"10.1093\/pubmed\/fdr122","article-title":"Multiple risk behaviour in adolescence","volume":"34","author":"Kipping","year":"2012","journal-title":"J. Public Health"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1542\/peds.2010-0068","article-title":"Media literacy education for elementary school substance use prevention: Study of media detective","volume":"126","author":"Kupersmidt","year":"2010","journal-title":"Pediatrics"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"e20161937","DOI":"10.1542\/peds.2016-1937","article-title":"Promoting health literacy for children and adolescents","volume":"138","author":"Winkelman","year":"2016","journal-title":"Pediatrics"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/13\/3\/790\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:30:11Z","timestamp":1760160611000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/13\/3\/790"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,27]]},"references-count":73,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2021,3]]}},"alternative-id":["nu13030790"],"URL":"https:\/\/doi.org\/10.3390\/nu13030790","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,27]]}}}