Numeracy Measures Research Articles

Commentary: Cognitive reflection vs. calculation in decision making.

Sinayev and Peters (2015; hereafter SP namely, that the propensity or disposition to think analytically plays an important role in CRT performance (Pennycook et al., 2015b). We discuss recent empirical evidence that supports the claim that the CRT is more than just a measure of numeracy or, more generally, cognitive ability.

Clinician Numeracy: The Development of an Assessment Measure for Doctors

Low numeracy in doctors poses serious risks to patient safety because inaccurate drug dose calculation may lead to under-treatment or overdose, while erroneous data interpretation affects medical decision making. Most research on numeracy in healthcare focuses on health numeracy in patients, while research on numeracy in doctors, “clinician numeracy”, is limited, partly due to the lack of a suitable assessment measure. We developed a new assessment, the Medical Interpretation and Numeracy Test (MINT), to assess clinician numeracy. The MINT tests computational, analytical and statistical constructs, using a combination of questions validated in other studies, and new test material specifically designed for doctors. We recruited 135 recently qualified doctors attending a teaching session on clinical decision making and risk communication to take our test. Psychometric analysis indicates that the MINT is a valid and reliable measure of clinician numeracy, with good internal-consistency reliability. Correlation with other numeracy/health numeracy tests varied greatly: this variation is understandable in view of the limited scope of many existing assessments that test only single constructs of numeracy/health numeracy. We conclude that the MINT provides a broad overview of clinician numeracy and can be a useful new assessment measure. Because of its important implications for patient safety, further research is needed to investigate clinician numeracy in doctors and other healthcare professionals, and to address and remediate deficiencies.

Gender, stock market participation and financial literacy

Women participate less than men in the stock market and score lower on financial literacy. We explore the link between this gender gap in stock market participation and financial literacy. Using survey data on a random sample of 1300 individuals that is representative of the Swedish population, we show that the estimated gender gap in stock market participation diminishes when we control for basic financial literacy, essentially a measure of numeracy. A gender gap in risk taking remains significant also when controlling for financial literacy.

The role of numeracy and approximate number system acuity in predicting value and probability distortion.

It is well documented that individuals distort outcome values and probabilities when making choices from descriptions, and there is evidence of systematic individual differences in distortion. In the present study, we investigated the relationship between individual differences in such distortions and two measures of numerical competence, numeracy and approximate number system (ANS) acuity. Participants indicated certainty equivalents for a series of simple monetary gambles, and data were used to estimate individual-level value and probability distortion, using a cumulative prospect theory framework. We found moderately strong negative correlations between numeracy and value and probability distortion, but only weak and non-statistically reliable correlations between ANS acuity and distortions. We conclude that low numeracy contributes to number distortion in decision making, but that approximate number system acuity might not underlie this relationship.

Towards an understanding of adult judgments of synergistic health benefits.

Numerous scientific studies show that certain combinations of dietary and/or lifestyle factors produce health benefits which are greater than the sum of the benefits associated with each factor alone. To address an existing knowledge gap, we assessed the extent to which individuals understand that certain combinations present these 'synergistic health benefits'. Health benefit judgments were obtained from lay adults for a range of dietary and/or lifestyle combinations that have been found to present synergistic benefits. Association between these judgments and socio-cognitive characteristics such as numeracy, education, and health interest (HI) were examined. Three hundred and fifty-two Swiss adults were presented with a description of one of eight synergistically beneficial combinations. Each participant provided a categorical benefit judgment (i.e., subadditive, additive, or synergistic) for the combination and explained the cognitive reasoning underlying their judgment. Participants completed measures of numeracy and HI. The proportion of combinations judged to present a synergistic benefit was modest for 'macro-level' combinations (e.g., diet and exercise), but low for 'micro-level' combinations (e.g., two phytochemicals). Cognitive reasoning data showed that a higher proportion of judgments for micro-level (cf. macro-level) combinations were based on greater subjective epistemic uncertainty. Higher interest in health was associated with a better understanding of synergistic benefits, but numeracy and education level were not. There is considerable scope to improve the extent to which lay adults understand that specific combination of diet and lifestyle behaviours can synergistically benefit their health. Our results enable us to make informed recommendations for public health interventions. What is already known on this subject? Combining certain dietary and/or lifestyle factors can result in synergistic health benefits. People could maintain/enhance their health by combining these synergistic combinations. No previous studies have assessed the extent to which people understand that certain factors produce synergistic health benefits. What does this study add? This is the first study to identify that lay awareness of synergistic health benefits could be substantially improved. Neither education level nor numeracy moderate judgments of synergistic benefits, but health interest does. Individuals better understand that broad lifestyle behaviours (cf. specific foods and phytochemicals) are synergistic.

Proficiency of FPPI and objective numeracy in assessing breast cancer risk estimation

Two studies examined the effectiveness of the Fuzzy Processing Preference Index, (FPPI) an individual differences measure of base rate neglect/respect, and an objective numeracy scale in predicting subjective probabilities of the likelihood of breast cancer, BRCA mutations, and the conditional probability of breast cancer given BRCA mutations in medical risk scenarios. FPPI and objective numeracy independently predicted estimate accuracy for breast cancer and genetic mutation risk. Surprisingly, objective numeracy positively correlated with overestimating conditional probabilities across the board, as well as BRCA mutations and breast cancer risk for high-risk scenarios. FPPI was strongest in predictions for high-risk scenarios, but did not predict conditional probability estimates. FPPI uniquely predicts risk estimation accuracy controlling for objective numeracy suggesting the two measures assess distinct cognitive processes. We conclude that FPPI and other numeracy measures may be profitably used together, and FPPI appears better than traditional numeracy measures in some medical decision-making contexts.

Vocabulary from adolescence to middle age

The 1970 British Cohort Study (BCS70) is rich in cognitive measures taken during childhood and adolescence, and also includes adult measures of literacy and numeracy. The Age 42 survey in 2012 included a cognitive scale which had been used previously with the cohort in childhood – a vocabulary test first taken in 1986, when the cohort members were 16 years old. This paper asks how vocabulary scores changed between the ages of 16 and 42, taking account of early social background and childhood reading behaviour, but also examining the influence of educational and labour market attainment and reading for pleasure in mid-life. We find that both educational and occupational attainment, and reading habits in child-hood and adulthood, are linked to the development of vocabulary over time.

ABCs or 123s? The independent contributions of literacy and numeracy skills on health task performance among older adults

ObjectiveTo investigate the relationship between literacy and numeracy and their association with health task performance. MethodsOlder adults (n=304) completed commonly used measures of literacy and numeracy. Single factor literacy and numeracy scores were calculated and used to predict performance on an established set of health self-management tasks, including: (i) responding to spoken information; (ii) comprehension of print and (iii) multimedia information; and (iv) organizing and dosing medication. Total and sub-scale scores were calculated. ResultsLiteracy and numeracy measures were highly correlated (rs=0.68; ps<0.001). In multivariable models adjusted for age, gender, race, education, and comorbidity, lower literacy (β=0.44, p<0.001) and numeracy (β=0.44, p<0.001) were independently associated with worse overall task performance and all sub-scales (literacy range, β=0.23–0.45, ps<0.001; numeracy range, β=0.31–0.41, ps<0.001). Multivariable analyses with both constructs entered explained more variance in overall health task performance compared with separate literacy and numeracy models (8.2% and 10% respectively, ps<0.001). ConclusionLiteracy and numeracy were highly correlated, but independent predictors of health task performance. These skill sets are complementary and both are important for health self-management. Practice implicationsSelf-management interventions may be more effective if they consider both literacy and numeracy skills rather than focusing on one specific ability.

Validation of a Short, 3-Item Version of the Subjective Numeracy Scale.

Efficiency in scale design reduces respondent burden. A brief but reliable measure of numeracy may provide a useful research tool eligible for integration into large epidemiological studies or clinical trials. Our goal was to validate a 3-item version of the Subjective Numeracy Scale (SNS-3). We examined 7 separate cross-sectional data sets: patients in the emergency department (n = 208), clinic (n = 205), and hospital (n = 460; n = 2053) and patients with chronic kidney disease (n = 147), with diabetes (n = 318), and on hemodialysis (n = 143). Internal reliability of the SNS-3 was assessed with Cronbach's α. Criterion validity was determined by nonparametric correlations of the SNS-3 with SNS-8 and other measures of numeracy; construct validity was determined by correlations with measures of health literacy and education. The SNS-3 had good internal reliability (median Cronbach's α = 0.78) and correlated highly with the full SNS (median ρ = 0.91). The SNS-3 was significantly correlated with other measures of numeracy (e.g., median ρ = 0.57 with the Wide Range Achievement Test 4), health literacy (e.g., median ρ = 0.35 with the Shortened Test of Functional Health Literacy in Adults), and education (median ρ = 0.41), providing good evidence of criterion and construct validity. The SNS-3 is sufficiently reliable and valid to be used as a measure of subjective numeracy.

Early Numeracy and Literacy: Untangling the Relation Between Specific Components

Although it is evident that advanced aspects of numeracy are dependent on the successful acquisition of early skills, this developmental process does not occur in isolation from other academic factors. Early literacy skills are intertwined with the acquisition of early numeracy skills, particularly at the informal numeracy and numeral knowledge phases. However, the localization of these domains’ impact in early numeracy development is unclear. To address this issue, 180 preschool children 3.13 to 5.88 years (51.1% female, 66.7% Caucasian, 14.4% African-American, 4.4% Hispanic, 14.4% other race/ethnicity) were assessed on measures of print knowledge, vocabulary, informal numeracy, and numeral knowledge. Results indicated that the relation between language and numeral knowledge is fully mediated by informal numeracy skills and the relation between informal numeracy skills and numeral knowledge skills is partially mediated by print knowledge. Explanations of the findings, implications for mathematics education, and future directions are discussed.

The moderating role of objective and subjective numeracy in attribute framing.

Previous research has found that objective numeracy moderates framing effects: People who are less numerate were found to be more susceptible to goal-framing and attribute-framing effects than people who are highly numerate. This study examined the possibility that subjective numeracy likewise moderates attribute framing in contexts where participants are presented with percentages of success or failure. The results show that compared with highly numerate participants, less numerate participants were more susceptible to the effect of attribute framing. Interestingly, this moderating effect was revealed only when using objective numeracy measures, and not when subjective numeracy measures were used. Future research is suggested to replicate these findings, to establish the generalizability of numeracy as a moderator of other cognitive biases, and to examine several possible theoretical explanations for the differential moderation of attribute-framing bias.

A Swedish validation of the Berlin Numeracy Test.

Recent research has highlighted the importance of considering an individual's level of numeracy, that is their numerical abilities, in a vast variety of judgment and decision making tasks. To accurately evaluate the influence of numeracy requires good and valid measures of the construct. In the present study we validate a Swedish version of the Berlin Numeracy Test (Cokely, Galesic, Schulz, Ghazal & Garcia-Retamero, 2012). The validation was carried out on both a student sample and a sample representative of the Swedish population. The Swedish BNT showed sound psychometrical properties in both samples. Further, in both samples the BNT had satisfactory convergent and discriminant validity when correlating with other measures of numeracy, while not being significantly related to measures of personality. With respect to predictive validity the results indicated divergent patterns in the two samples. In the student sample, participants scoring highest on the BNT outperformed those in the other three levels, which did not differ in performance. In contrast, in the population sample participants scoring lowest on the BNT performed worse than those in the other three levels, which did not differ in performance. Taken together, however, the results suggest that the Swedish version of the BNT should be considered a valid measure of numeracy in both Swedish student and population representative samples.

Associations between early shared music activities in the home and later child outcomes: Findings from the Longitudinal Study of Australian Children

The benefits of early shared book reading between parents and children have long been established, yet the same cannot be said for early shared music activities in the home. This study investigated the parent–child home music activities in a sample of 3031 Australian children participating in Growing Up in Australia: The Longitudinal Study of Australian Children (LSAC) study. Frequency of shared home music activities was reported by parents when children were 2–3 years and a range of social, emotional, and cognitive outcomes were measured by parent and teacher report and direct testing two years later when children were 4–5 years old. A series of regression analyses (controlling for a set of important socio-demographic variables) found frequency of shared home music activities to have a small significant partial association with measures of children's vocabulary, numeracy, attentional and emotional regulation, and prosocial skills. We then included both book reading and shared home music activities in the same models and found that frequency of shared home music activities maintained small partial associations with measures of prosocial skills, attentional regulation, and numeracy. Our findings suggest there may be a role for parent-child home music activities in supporting children's development.

Improved self-management skills in Chinese diabetes patients through a comprehensive health literacy strategy: study protocol of a cluster randomized controlled trial.

BackgroundDiabetes self-management often involves the interpretation and application of oral, written, or quantitative information. Numerous diabetes patients in China have limited health literacy, which likely leads to poorer clinical outcomes. This study is designed to examine the efficacy and cost-effectiveness of addressing health literacy to improve self-management skills and glycemic control in Chinese diabetes patients.Methods/designThis is a cluster randomized controlled trial (RCT) conducted in 20 community healthcare sites in Shanghai, China. Overall, 800 diabetes patients will be randomized into intervention and control arms and will have a baseline hemoglobin A1c (HbA1c) assay and undergo a baseline survey which includes measures of health literacy and diabetes numeracy using revised Chinese versions of the Health Literacy Management Scale and Diabetes Numeracy Test Scale. During the 1-year period of intervention, while the control group will receive usual care, the intervention group will be supplemented with a comprehensive health literacy strategy which includes i) training healthcare providers in effective health communication skills that address issues related to low literacy, and ii) use of an interactive Diabetes Education Toolkit to improve patient understanding and behaviors. Assessments will be conducted at both patient and healthcare provider levels, and will take place upon admission and after 3, 6, 12, and 24 months of intervention. The primary outcome will be the improvement in HbA1c between Intervention group and Control group patients. Secondary outcomes at the patient level will include improvement in i) clinical outcomes (blood pressure, fasting lipids, body mass index, weight, smoking status), ii) patient reported self-management behaviors, and iii) patient-reported self-efficacy. Outcomes at the provider level will include: i) provider satisfaction and ii) intensity and type of care provided. The effects of the intervention will be examined in multivariable general linear models. Both cost-effectiveness and cost-utility analyses will be performed.DiscussionThe main strengths of this study are its large sample size and RCT design, involvement of both patients and healthcare providers, and the long term follow-up (24-months). This project will help to demonstrate the value of addressing health literacy and health communication to improve self-management and clinical outcomes among Chinese diabetes patients.Trial registrationISRCTN76130594, Registration date: Sept 22, 2014.Electronic supplementary materialThe online version of this article (doi:10.1186/1745-6215-15-498) contains supplementary material, which is available to authorized users.

"Thinking about numbers is not my idea of fun": need for cognition mediates age differences in numeracy performance.

Numeracy refers to people's ability to use numbers. Low numeracy has been associated with difficulties in understanding risk-benefit information and making health decisions. Older adults tend to perform worse than younger adults on measures of numeracy, but some theories of aging suggest that older adults may lack motivation for such tasks. We therefore test whether age differences in numeracy performance are mediated by a reduced motivation to think hard about complex problems-as measured by need for cognition. We recruited an age-diverse convenience sample of 306 UK adults. They completed measures of numeracy and need for cognition. They self-reported their educational attainment and other demographics. Older age was related to lower numeracy and lower need for cognition. The negative relationship between age and numeracy was mediated by need for cognition. These findings held after we controlled for educational attainment and other demographic factors. Older adults may show lower numeracy performance due to lack of motivation. We discuss strategies for improving people's motivation to complete numeracy measures and other numerical tasks.

An Individualized Numeracy Curriculum for Children with Intellectual Disabilities: A Single Blind Pilot Randomized Controlled Trial

Research investigating structured, comprehensive numeracy curricula appropriate for children with Intellectual Disabilities (ID) is limited. We conducted a pilot study focused on an adaptation of the Maths Recovery program. Twenty four elementary school children with severe ID or autism were randomly allocated into the intervention and control groups. For 12 weeks, children in the intervention group received individualized numeracy teaching based on the adapted Maths Recovery curriculum, whereas children in the control group received “mathematics as usual” teaching. Pre- and post- intervention tests on standardized numeracy measures were conducted. Children were successfully recruited into the study, parents were willing for their child to be randomised to one of the arms of the study, and the vast majority of children were retained to follow-up. Analysis of data from outcome measures indicated that the Maths Recovery group made improvements at post-intervention in comparison to the control group. A follow-up test showed that gains were maintained 7 months after the end of the intervention. These pilot results support the case for a definitive research trial of the adapted Maths Recovery intervention.

Understanding of BRCA1/2 genetic tests results: the importance of objective and subjective numeracy.

The majority of women (71%) who undergo BRCA1/2 testing-designed to identify genetic mutations associated with increased risk of cancer-receive results that are termed 'ambiguous' or 'uninformative negative'. How women interpret these results and the association with numerical ability was examined. In this study, 477 women at increased risk for breast and ovarian cancer were recruited via the Cancer Genetics Network. They were presented with information about the four different possible BRCA1/2 test results-positive, true negative, ambiguous and uninformative negative-and asked to indicate which of six options represents the best response. Participants were then asked which treatment options they thought a woman receiving the results should discuss with her doctor. Finally, participants completed measures of objective and subjective numeracy. Almost all of the participants correctly interpreted the positive and negative BRCA1/2 genetic test results. However, they encountered difficulties interpreting the uninformative and ambiguous BRCA1/2 genetic test results. Participants were almost equally likely to think either that the woman had learned nothing from the test result or that she was as likely to develop cancer as the average woman. Highly numerate participants were more likely to correctly interpret inconclusive test results (ambiguous, OR = 1.62; 95% CI [1.28, 2.07]; p < 0.001; uninformative, OR = 1.40; 95% CI [1.10, 1.80]). Given the medical and psychological ramifications of genetic testing, healthcare professionals should consider devoting extra effort to ensuring proper comprehension of ambiguous and uninformative negative test results by women.

Does Numeracy Correlate With Measures of Health Literacy in the Emergency Department?

The objective was to quantify the correlation between general numeracy and health literacy in an emergency department (ED) setting. This was a prospective cross-sectional convenience sample study of adult patients in an urban, academic ED with 97,000 annual visits. General numeracy was evaluated using four validated questions and health literacy using three commonly used validated screening tools (Short Test of Functional Health Literacy in Adults [S-TOFHLA], Rapid Estimate of Adult Literacy in Medicine-Revised [REALM-R], and the Newest Vital Sign [NVS]). Scores were dichotomized for health literacy tests to limited (low or marginal) versus adequate health literacy, and the proportion of patients answering all numeracy questions correctly was calculated with the mean proportion of correct responses in these groups. The correlation between numeracy scores and scores on the health literacy screening tools was evaluated using Spearman's correlation. A total of 446 patients were enrolled. Performance on questions evaluating general numeracy was universally poor. Only 18 patients (4%) answered all numeracy questions correctly, 88 patients (20%) answered zero questions correctly, and overall the median number of correct answers was one (interquartile range [IQR]= 1 to 2). Among patients with limited health literacy (LHL) by any of the three screening tools used, the mean number of correct numeracy answers was approximately half that of patients with adequate health literacy. However, even among those with adequate health literacy, the average number of correct answers to numeracy questions ranged from 1.6 to 2.4 depending on the screening test used. When dichotomized into those who answered ≤50% versus >50% of numeracy questions correctly, there was a significant difference between those with LHL and those who scored ≤50% on numeracy. Health literacy screening results were correlated with general numeracy in the low to moderate range: S-TOFHLA rs =0.428 (p<0.0001); REALM, rs =0.400 (p<0.0001); and NVS, rs =0.498 (p<0.0001). Correlations between measures of general numeracy and measures of health literacy are in the low to moderate range. Performance on numeracy testing was nearly universally poor, even among patients performing well on health literacy screens, with a substantial proportion of the latter patients unable to answer half of the numeracy items correctly. Insofar as numeracy is considered a subset of health literacy, these results suggest that commonly used health literacy screening tools in ED-based studies inadequately evaluate and overestimate numeracy. This suggests the potential need for separate numeracy screening when these skills are important for health outcomes of interest. Providers should be sensitive to potential numeracy deficits among those who may otherwise have normal health literacy.

Numeracy and Health Numeracy Among Chinese and Kenyan Immigrants to Canada

Mathematics self-efficacy plays an important role in the performance of quantitative tasks. The objective of this study was to examine the role of mathematics self-efficacy in numeracy and health numeracy among immigrants (60 Mandarin-speaking and 60 Kikuyu-speaking immigrants to Canada) for whom English was a second language (ESL). Two French Kit numeracy tasks (the addition, and the addition and subtraction correction tasks) constituted objective measures of numeracy, and the numeracy component of a health literacy instrument (The Short Test of Functional Health Literacy for Adults [S-TOFHLA]) constituted the health numeracy measure. We measured math self-efficacy using the Mathematics Self-Efficacy Scale (MSES) and the Subjective Numeracy Scale (SNS). All measures were presented in English. Kikuyu speakers had lower math self-efficacy ( p &lt; .05) compared with Mandarin speakers ( p &lt; .05). Mandarin speakers outperformed Kikuyu speakers in numeracy ( p &lt; .001) and health numeracy ( p &lt; .023) skills. In multiple regression analyses, 32% to 57 % of the variance in objective numeracy was explained by language, residency in Canada, and self-efficacy, adjusting for the other predictor variables; self-efficacy and format of numeric health information (numbers only vs. numbers with detailed text) consistently predicted health numeracy. Mathematics self-efficacy may be an important factor in numeracy, but not as important in health numeracy for Kikuyu- and Mandarin-speaking immigrants for whom English is a second language. Factors contributing to low numeracy may differ from those explaining low health numeracy in ESL immigrants.

Health numeracy: the importance of domain in assessing numeracy.

Existing research concludes that measures of general numeracy can be used to predict individuals' ability to assess health risks. We posit that the domain in which questions are posed affects the ability to perform mathematical tasks, raising the possibility of a separate construct of "health numeracy" that is distinct from general numeracy. The objective was to determine whether older adults' ability to perform simple math depends on domain. Community-based participants completed 4 math questions posed in 3 different domains: a health domain, a financial domain, and a pure math domain. Participants were 962 individuals aged 55 and older, representative of the community-dwelling US population over age 54. We found that respondents performed significantly worse when questions were posed in the health domain (54% correct) than in either the pure math domain (66% correct) or the financial domain (63% correct). Our experimental measure of numeracy consisted of only 4 questions, and it is possible that the apparent effect of domain is specific to the mathematical tasks that these questions require. These results suggest that health numeracy is strongly related to general numeracy but that the 2 constructs may not be the same. Further research is needed into how different aspects of general numeracy and health numeracy translate into actual medical decisions.