The importance of mathematics in health and human judgment: Numeracy, risk communication, and medical decision making

Abstract Mathematics achievement is important in its own right, and is increasingly recognized as crucial to the nation's economy [ National Mathematics Panel, 2006 . National Mathematics Advisory Panel: Strengthening Math Education Through Research. Accessed September 29, 2006 from http://www.ed.gov/about/bdscomm/list/mathpanel/factsheet.html .; National Science Board, 2006 . National Science Board Commission on 21st Century Education in Science, Technology, Engineering, and Mathematics. Accessed September 29, 2006 from http://www.nsf.gov/nsb/edu_com/ .]. National surveys suggest that Americans are not proficient in mathematics and lack the kinds of numeracy skills that would seem to be necessary for tasks of everyday life such as informed medical decision making. Recent research on numeracy in medical decision making has shown that many adults fail to solve simple ratio and decimal problems, concepts that are prerequisites for understanding health-relevant risk communications. Along with research in education and cognitive development, this work demonstrates that adults have difficulty with a broad range of ratio concepts (including fractions, proportions, and probability judgments). Research confirms that this difficulty, as measured by content-neutral numeracy tests, predicts poorer health outcomes, less accurate perception of health risks, and a compromised ability to make medical decisions. We conclude that numeracy, so-called on analogy with literacy, is similarly essential for making health and other social judgments in everyday life, and that a new focus on explanatory theory is needed to address common errors in understanding and applying numerical information.

[1]  Kathleen N. Lohr,et al.  A Systematic Review of the Literature , 2004 .

[2]  S. Gabriel,et al.  Assessing Values for Current Health: Numeracy Matters , 2000 .

[3]  Lisa M. Schwartz,et al.  The Role of Numeracy in Understanding the Benefit of Screening Mammography , 1997, Annals of Internal Medicine.

[4]  K. Weinfurt,et al.  The correlation between patient characteristics and expectations of benefit from Phase I clinical trials , 2003, Cancer.

[5]  David C. Miller,et al.  International Outcomes of Learning in Mathematics Literacy and Problem Solving: PISA 2003 Results From the U.S. Perspective. Highlights. NCES 2005-003. , 2004 .

[6]  M. Alibali,et al.  Children's Thinking , 1986 .

[7]  K. Stanovich,et al.  Individual differences in reasoning: Implications for the rationality debate? , 2000, Behavioral and Brain Sciences.

[8]  Bevan Yueh,et al.  Numeracy and the shortcomings of utility assessment in head and neck cancer patients , 2004, Head & neck.

[9]  P. Klaczynski Framing effects on adolescent task representations, analytic and heuristic processing, and decision making: Implications for the normative/descriptive gap , 2001 .

[10]  P. Ubel,et al.  Making numbers matter: present and future research in risk communication. , 2007, American journal of health behavior.

[11]  P. Ubel,et al.  How making a risk estimate can change the feel of that risk: shifting attitudes toward breast cancer risk in a general public survey. , 2005, Patient education and counseling.

[12]  G. Gigerenzer Why the distinction between single-event probabilities and frequencies is important for psychology (and vice versa). , 1994 .

[13]  Charles J. Brainerd,et al.  Children’s Logical and Mathematical Cognition , 1982 .

[14]  Carlos A Estrada,et al.  Literacy and Numeracy Skills and Anticoagulation Control , 2004, The American journal of the medical sciences.

[15]  B. Weiss,et al.  Quick Assessment of Literacy in Primary Care: The Newest Vital Sign , 2005, The Annals of Family Medicine.

[16]  K. Stanovich,et al.  Heuristic and analytic processing: age trends and associations with cognitive ability and cognitive styles. , 2002, Journal of experimental child psychology.

[17]  R. Siegler Developmental Sequences within and between Concepts. , 1981 .

[18]  William R. Muth Review of Adult Learning and Literacy , 2006 .

[19]  Seymour Epstein,et al.  The relation of rational and experiential information processing styles to personality, basic beliefs, and the ratio-bias phenomenon. , 1999 .

[20]  R F Nease,et al.  Perceptions of breast cancer risk and screening effectiveness in women younger than 50 years of age. , 1995, Journal of the National Cancer Institute.

[21]  Andrew F. Simon,et al.  Decision framing: moderating effects of individual differences and cognitive processing , 2004 .

[22]  David A. Kindig,et al.  Health literacy : a prescription to end confusion , 2004 .

[23]  Anthony Lutkus,et al.  The Nation's Report Card. NAEP 2004 Trends in Academic Progress: Three Decades of Student Performance in Reading, 1971-2004 and Mathematics, 1973-2004. NCES 2005?464. , 2005 .

[24]  Mark A. Kutner,et al.  The Health Literacy of America's Adults: Results from the 2003 National Assessment of Adult Literacy. NCES 2006-483. , 2006 .

[25]  L Sachs,et al.  The meaning of 6.8: numeracy and normality in health information talks. , 1996, Social science & medicine.

[26]  Charles J. Brainerd,et al.  The origins of probability judgment: A review of data and theories. , 1994 .

[27]  J. Piaget,et al.  The Origin of the Idea of Chance in Children , 1975 .

[28]  V. Reyna,et al.  Numeracy, Ratio Bias, and Denominator Neglect in Judgments of Risk and Probability. , 2008 .

[29]  John Allen Paulos,et al.  Innumeracy: Mathematical Illiteracy and Its Consequences , 1988 .

[30]  A. Tversky,et al.  Judgment under Uncertainty: Heuristics and Biases , 1974, Science.

[31]  S. Epstein Integration of the cognitive and the psychodynamic unconscious. , 1994, The American psychologist.

[32]  V. Reyna,et al.  Fuzzy-trace theory and children's acquisition of mathematical and scientific concepts , 1991 .

[33]  V. Reyna,et al.  Fuzzy-trace theory and framing effects in choice: Gist extraction, truncation, and conversion , 1991 .

[34]  J. Cacioppo,et al.  DISPOSITIONAL DIFFERENCES IN COGNITIVE MOTIVATION : THE LIFE AND TIMES OF INDIVIDUALS VARYING IN NEED FOR COGNITION , 1996 .

[35]  B. Rimer,et al.  General Performance on a Numeracy Scale among Highly Educated Samples , 2001, Medical decision making : an international journal of the Society for Medical Decision Making.

[36]  C. K. Mertz,et al.  PSYCHOLOGICAL SCIENCE Research Article Numeracy and Decision Making , 2022 .

[37]  Steven A Hecht,et al.  Sources of individual differences in fraction skills. , 2003, Journal of experimental child psychology.

[38]  V. Reyna,et al.  Chapter 3 Fuzzy Memory and Mathematics in The Classroom , 1993 .

[39]  V. Reyna,et al.  Fuzzy-trace theory: An interim synthesis , 1995 .

[40]  Mark V. Williams,et al.  Test of Functional Health Literacy in Adults , 2016 .

[41]  C. K. Mertz,et al.  Less Is More in Presenting Quality Information to Consumers , 2007, Medical care research and review : MCRR.

[42]  Sheida White,et al.  Key Concepts and Features of the 2003 National Assessment of Adult Literacy. NCES 2006-471. , 2005 .

[43]  D. Baker,et al.  Development of a brief test to measure functional health literacy. , 1999, Patient education and counseling.

[44]  Keith E. Stanovich,et al.  Individual differences in framing and conjunction effects , 1998 .

[45]  V. Reyna CURRENT DIRECTIONS IN PSYCHOLOGICAL SCIENCE How People Make Decisions That Involve Risk A Dual-Processes Approach , 2022 .

[46]  V. Reyna Class inclusion, the conjunction fallacy, and other cognitive illusions , 1991 .

[47]  D. Baker The meaning and the measure of health literacy , 2006, Journal of general internal medicine.

[48]  Khan Mk,et al.  Health literacy: report of the Council on Scientific Affairs. Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs, American Medical Association. , 1999, JAMA.

[49]  V. Reyna,et al.  A web exercise in evidence-based medicine using cognitive theory , 2001, Journal of General Internal Medicine.

[50]  Lisa M. Schwartz,et al.  Assessing Values for Health: Numeracy Matters , 2001, Medical decision making : an international journal of the Society for Medical Decision Making.

[51]  Improvement,et al.  Adult literacy in America : a first look at the results of the National Adult Literacy Survey , 1993 .

[52]  Gerd Gigerenzer,et al.  How to Improve Bayesian Reasoning Without Instruction: Frequency Formats , 1995 .

[53]  R. Rudd,et al.  Health and Literacy: A Review of Medical and Public Health Literature , 1999 .

[54]  David Kastberg,et al.  Highlights from the Trends in International Mathematics and Science Study (TIMSS), 2003. NCES 2005-005. , 2004 .

[55]  Bruce M. Ross,et al.  Children’s Concepts of Chance and Probability , 1982 .