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Clinical Implications of Numeracy: Theory and Practice

  • Original Article
  • Published:
Annals of Behavioral Medicine

Abstract

Background

Low numeracy is pervasive and constrains informed patient choice, reduces medication compliance, limits access to treatments, impairs risk communication, and affects medical outcomes; therefore, it is incumbent upon providers to minimize its adverse effects.

Purpose

We provide an overview of research on health numeracy and discuss its implications in clinical contexts.

Conclusions

Low numeracy cannot be reliably inferred on the basis of patients’ education, intelligence, or other observable characteristics. Objective and subjective assessments of numeracy are available in short forms and could be used to tailor health communication. Low scorers on these assessments are subject to cognitive biases, irrelevant cues (e.g., mood), and sharper temporal discounting. Because prevention of the leading causes of death (e.g., cancer and cardiovascular disease) depends on taking action now to prevent serious consequences later, those low in numeracy are likely to require more explanation of risk to engage in prevention behaviors. Visual displays can be used to make numerical relations more transparent, and different types of displays have different effects (e.g., greater risk avoidance). Ironically, superior quantitative processing seems to be achieved by focusing on qualitative gist and affective meaning, which has important implications for empowering patients to take advantage of the evidence in evidence-based medicine.

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Acknowledgements

This work was based on a National Cancer Institute-sponsored symposium—Numeracy: A Critical (and Often Overlooked) Competence for Health Decision Making—presented at the Society of Behavioral Medicine Annual Meeting, Washington, D.C., USA, March 22, 2007. Dr. Reyna is supported by grants from the National Cancer Institute (R13CA126359) and the National Institute of Mental Health (MH-061211). Dr. Fagerlin is supported by an MREP early career award from the US Department of Veterans Affairs. Dr. Lipkus is supported by The Foundation for Informed Medical Decision Making. Dr. Peters is supported by a grant from the National Science Foundation (SES-0517770). We thank Nathan Dieckmann for his helpful literature review.

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Authors and Affiliations

  1. Basic and Biobehavioral Research Branch, DCCPS, National Cancer Institute, 6130 Executive Blvd., Bethesda, MD, 20892, USA

    Wendy Nelson Ph.D.

  2. Cornell University, Ithaca, NY, USA

    Valerie F. Reyna Ph.D.

  3. National Cancer Institute, Bethesda, MD, USA

    Valerie F. Reyna Ph.D.

  4. Ann Arbor VA HSR and D Center for Excellence Division of General Internal Medicine, University of Michigan, Ann Arbor, MI, USA

    Angela Fagerlin Ph.D.

  5. Center for Behavioral and Decision Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA

    Angela Fagerlin Ph.D.

  6. Duke University, Durham, NC, USA

    Isaac Lipkus Ph.D.

  7. Decision Research, Eugene, OR, USA

    Ellen Peters Ph.D.

  8. University of Oregon, Eugene, OR, USA

    Ellen Peters Ph.D.

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  1. Wendy Nelson Ph.D.
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  2. Valerie F. Reyna Ph.D.
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  3. Angela Fagerlin Ph.D.
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  4. Isaac Lipkus Ph.D.
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  5. Ellen Peters Ph.D.
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Correspondence to Wendy Nelson Ph.D..

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Nelson, W., Reyna, V.F., Fagerlin, A. et al. Clinical Implications of Numeracy: Theory and Practice. ann. behav. med. 35, 261–274 (2008). https://doi.org/10.1007/s12160-008-9037-8

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