A Framework for Health Numeracy: How Patients Use Quantitative Skills in Health Care

Our objective of this study is to develop a conceptual framework for the construct of health numeracy based on patient perceptions, using a cross-sectional, qualitative design. Interested participants (n = 59) meeting eligibility criteria (age 40–74, English speaking) were assigned to one of six focus groups stratified by gender and educational level (low, medium, high). Fifty-three percent were male, and 47% were female. Sixty-one percent were white non-Hispanic, and 39% were of minority race or ethnicity. Participants were randomly selected from three primary care sites associated with an academic medical center. Focus group discussions were held in May 2004 and focused on how numbers are used in the health care setting. Data were presented from clinical trials to further explore how quantitative information is used in health communication and decision making. Focus groups were audio and videotaped; verbatim transcripts were prepared and analyzed. A framework of health numeracy was developed to reflect the themes that emerged. Three broad conceptual domains for health numeracy were identified: primary numeric skills, applied health numeracy, and interpretive health numeracy. Across domains, results suggested that numeracy contains an emotional component, with both positive and negative affect reflected in patient numeracy statements. We conclude that health numeracy is a multifaceted construct that includes applied and interpretive components and is influenced by patient affect.

[1]  S. Flocke,et al.  Facilitating Participatory Decision-Making: What Happens in Real-World Community Practice? , 2000, Medical care.

[2]  S. Thorne,et al.  Hope and Probability: Patient Perspectives of the Meaning of Numerical Information in Cancer Communication , 2006, Qualitative health research.

[3]  Anselm L. Strauss,et al.  Basics of qualitative research : techniques and procedures for developing grounded theory , 1998 .

[4]  Dianne Davis,et al.  Patient understanding of food labels: the role of literacy and numeracy. , 2006, American journal of preventive medicine.

[5]  Lisa M. Schwartz,et al.  Patients and medical statistics , 2005 .

[6]  M. Ruffin,et al.  Patients' interpretation of qualitative probability statements. , 1994, Archives of family medicine.

[7]  M. Schapira,et al.  Agreement Between Scales in the Measurement of Breast Cancer Risk Perceptions , 2004, Risk analysis : an official publication of the Society for Risk Analysis.

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

[9]  Suzanne M. Miller,et al.  Decision making about prophylactic oophorectomy among at-risk women: psychological influences and implications. , 1999, Gynecologic oncology.

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

[11]  Stacey L Sheridan,et al.  Shared decision making about screening and chemoprevention. a suggested approach from the U.S. Preventive Services Task Force. , 2004, American journal of preventive medicine.

[12]  B. Rimer,et al.  Methods and Strategies to Recruit African Americans into Cancer Prevention Surveillance Studies , 2005, Cancer Epidemiology Biomarkers & Prevention.

[13]  Lisa J. Evered,et al.  Innumeracy: Mathematical Illiteracy and its Consequences. , 1990 .

[14]  Nancy Darcovich.  Literacy skills for the knowledge society: further results from the International Adult Literacy Survey , 1997 .

[15]  D. Morgan.  Focus groups for qualitative research. , 1988, Hospital guest relations report.

[16]  Thomas Bodenheimer,et al.  Improving primary care for patients with chronic illness. , 2002, JAMA.

[17]  Junji Otaki,et al.  Interpretation of and preference for probability expressions among Japanese patients and physicians. , 2002, Family practice.

[18]  T R Fleming,et al.  Levamisole and fluorouracil for adjuvant therapy of resected colon carcinoma. , 1990, The New England journal of medicine.

[19]  C. McHorney,et al.  Frequency or Probability? A Qualitative Study of Risk Communication Formats Used in Health Care , 2001, Medical decision making : an international journal of the Society for Medical Decision Making.

[20]  Steven Woloshin,et al.  Can Patients Interpret Health Information? An Assessment of the Medical Data Interpretation Test , 2005, Medical decision making : an international journal of the Society for Medical Decision Making.

[21]  Lisa M. Schwartz,et al.  Patients and medical statistics. Interest, confidence, and ability. , 2005, Journal of general internal medicine.

[22]  D. Nutbeam.  Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century , 2000 .

[23]  K. Xu.  The combined effects of participatory styles of elderly patients and their physicians on satisfaction. , 2004, Health services research.

[24]  John Schneider,et al.  Better physician-patient relationships are associated with higher reported adherence to antiretroviral therapy in patients with HIV infection , 2004, Journal of General Internal Medicine.

[25]  T. Bodenheimer,et al.  Patient self-management of chronic disease in primary care. , 2002, JAMA.

[26]  Matthew B. Miles,et al.  Qualitative Data Analysis: An Expanded Sourcebook , 1994 .

[27]  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.

[28]  David H. Wilson,et al.  Participatory Decision Making, Asthma Action Plans, and Use of Asthma Medication: A Population Survey , 2005, The Journal of asthma : official journal of the Association for the Care of Asthma.

[29]  G. McCloskey.  Wide Range Achievement Test-Revised , 1987 .

[30]  Amanda L Golbeck,et al.  A definition and operational framework for health numeracy. , 2005, American journal of preventive medicine.

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

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

[33]  I. Kickbusch,et al.  Health literacy: addressing the health and education divide. , 2001, Health promotion international.

[34]  C R Gallistel,et al.  Language and the Origin of Numerical Concepts , 2004, Science.

[35]  Sheida White,et al.  Assessing the nation's health literacy : key concepts and findings of the National Assessment of Adult Literacy (NAAL) , 2008 .

[36]  Margaret Holmes-Rovner,et al.  Patient comprehension of information for shared treatment decision making: state of the art and future directions. , 2003, Patient education and counseling.

[37]  Andrew Pleasant,et al.  Understanding health literacy: an expanded model. , 2005, Health promotion international.

[38]  PhD Dr. Dennis J. Mazur MD,et al.  Patients’ interpretations of probability terms , 2007, Journal of General Internal Medicine.

[39]  T. Church,et al.  Colorectal cancer mortality: effectiveness of biennial screening for fecal occult blood. , 1999, Journal of the National Cancer Institute.

[40]  Thomas Bodenheimer,et al.  Improving primary care for patients with chronic illness: the chronic care model, Part 2. , 2002, JAMA.

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

[42]  Garnet L Anderson,et al.  The Women's Health Initiative recruitment methods and results. , 2003, Annals of epidemiology.

[43]  R. Hamm,et al.  Interpretation of prostate cancer screening events and outcomes: a focus group study. , 2003, Patient education and counseling.

[44]  L. Lingard,et al.  Making sense of grounded theory in medical education , 2006, Medical education.

[45]  W. Burgin,et al.  Prognosis and decision making in severe stroke. , 2005, JAMA.

[46]  G. Lussier,et al.  Sex and Mathematical Background as Predictors of Anxiety and Self-Efficacy in Mathematics , 1996, Psychological reports.

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

[48]  P. Gordon.  Numerical Cognition Without Words: Evidence from Amazonia , 2004, Science.

[49]  P. Liamputtong.  Qualitative Research Methods , 2005 .