Empirical relationships between numeracy and treatment decision making: A scoping review of the literature

Malloy-Weir, Leslie J; Schwartz, Lisa; Yost, Jennifer; McKibbon, K. Ann

doi:10.1016/j.pec.2015.10.002

Cited by 20 publications

(18 citation statements)

References 49 publications

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“…Two studies described addressing numeracy as part of the PtDA development process [ 59 , 83 ]; one study measured and reported participants’ baseline numeracy skills [ 74 ]. As reported in a recent study [ 98 ], numeracy and health literacy have largely been treated as separate concepts in the literature despite indications that PtDAs designed for patients with different levels of health literacy may not support the needs of patients with disparate numeracy skills. This is another important area for future research.…”

Section: Discussionmentioning

confidence: 99%

Are cancer-related decision aids appropriate for socially disadvantaged patients? A systematic review of US randomized controlled trials

Enard

Mullen²,

Kamath

et al. 2016

BMC Med Inform Decis Mak

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BackgroundShared decision-making (SDM) is considered a key component of high quality cancer care and may be supported by patient decision aids (PtDAs). Many patients, however, face multiple social disadvantages that may influence their ability to fully participate in SDM or to use PtDAs; additionally, these social disadvantages are among the determinants of health associated with greater cancer risk, unwarranted variations in care and worse outcomes. The purpose of this systematic review is to describe the extent to which disadvantaged social groups in the United States (US) have been included in trials of cancer-related PtDAs and to highlight strategies, lessons learned and future opportunities for developing and evaluating PtDAs that are appropriate for disadvantaged populations.MethodsWe selected cancer-related US studies from the Cochrane 2014 review of PtDAs and added RCTs meeting Cochrane criteria from searches of PubMed, CINAHL, PsycINFO (January 2010 to December 2013); and reference lists. Two reviewers independently screened titles/abstracts; three reviewers independently screened full text articles, performed data extraction and assessed: 1) inclusion of participants based on seven indicators of social disadvantage (limited education; female gender; uninsured or Medicaid status; non-U.S. nativity; non-White race or Hispanic ethnicity; limited English proficiency; low-literacy), and 2) attention to social disadvantage in the development or evaluation of PtDAs.ResultsTwenty-three of 39 eligible RCTs included participants from at least one disadvantaged subgroup, most frequently racial/ethnic minorities or individuals with limited education and/or low-literacy. Seventeen studies discussed strategies and lessons learned in attending to the needs of disadvantaged social groups in PtDA development; 14 studies targeted disadvantaged groups or addressed subgroup differences in PtDA evaluation.ConclusionsThe diversity of the US population is represented in a majority of cancer-related PtDA RCTs, but fewer studies have tailored PtDAs to address the multiple social disadvantages that may impact patients’ participation in SDM. More detailed attention to the comprehensive range of social factors that determine cancer risk, variations in care and outcomes is needed in the development and evaluation of PtDAs for disadvantaged populations.Trial registrationRegistered 24 October 2014 in PROSPERO International prospective register of systematic reviews (CRD42014014470).Electronic supplementary materialThe online version of this article (doi:10.1186/s12911-016-0303-6) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Are cancer-related decision aids appropriate for socially disadvantaged patients? A systematic review of US randomized controlled trials

Enard

Mullen²,

Kamath

et al. 2016

BMC Med Inform Decis Mak

View full text Add to dashboard Cite

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“…There is limited and inconsistent knowledge about the relationship between numeracy and the treatment decision-making process (e.g., choosing to enroll in a prevention program). 44 The intervention also had a differential effect on patient activation scores between the low and high numeracy groups, but interestingly favored the high numeracy group rather than the low numeracy group; and, in particular, the combined group of high numeracy and low literacy. There was no differential effect between the low versus high reading literacy groups alone.…”

Section: Discussionmentioning

confidence: 95%

Health Coaching Has Differential Effects on Veterans with Limited Health Literacy and Numeracy: a Secondary Analysis of ACTIVATE

et al. 2019

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BACKGROUND: Health coaching is an effective behavior change strategy. Understanding if there is a differential impact of health coaching on patients with low health literacy has not been well investigated. OBJECTIVE: To determine whether a telephone coaching intervention would result in similar improvements in enrollment in prevention programs and patient activation among Veterans with low versus high health literacy (specifically, reading literacy and numeracy). DESIGN: Secondary analysis of a randomized controlled trial. PARTICIPANTS: Four hundred seventeen Veterans with at least one modifiable risk factor: current smoker, BMI ≥ 30, or < 150 min of moderate physical activity weekly. METHODS: A single-item assessment of health literacy and a subjective numeracy scale were assessed at baseline. A logistic regression and general linear longitudinal models were used to examine the differential impact of the intervention compared to control on enrollment in prevention programs and changes in patient activation measures (PAM) scores among patients with low versus high health literacy. RESULTS: The coaching intervention resulted in higher enrollment in prevention programs and improvements in PAM scores compared to usual care regardless of baseline health literacy. The coaching intervention had a greater effect on the probability of enrollment in prevention programs for patients with low numeracy (intervention vs control difference of 0.31, 95% CI 0.18, 0.45) as compared to those with high numeracy (0.13, 95% CI − 0.01, 0.27); the low compared to high differential effect was clinically, but not statistically significant (0.18, 95% CI − 0.01, 0.38; p = 0.07). Among patients with high numeracy, the intervention group had greater increases in PAM as compared to the control group at 6 months (mean difference in improvement 4.8; 95% CI 1.7, 7.9; p = 0.003). This led to a clinically and statistically significant differential intervention effect for low vs high numeracy (− 4.6; 95% CI − 9.1, − 0.15; p = 0.04). CONCLUSIONS:We suggest that health coaching may be particularly beneficial in behavior change strategies in populations with low numeracy when interpretation of health risk information is part of the intervention. CLINICALTRIALS.GOV IDENTIFIER: NCT01828567KEY WORDS: telephone coaching; health risk assessment; health literacy; health numeracy.

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“…Difficulties with the comprehension of numerical information in a health context have been recognized as a problem a long time ago, and different approaches have been attempted to improve it [17]. There is evidence that numeracy plays an important role in decision making in medicine, separately from health literacy [18], and that numeracy of health professionals presents a separate issue to consider by developers of health messages when formatting the information for lay or expert populations. In Trial 2, we found that biomedical university students scored significantly higher compared to consumers both on the comprehension of treatment benefits and side effects.…”

Section: Discussionmentioning

confidence: 99%

Framing the numerical findings of Cochrane plain language summaries: two randomized controlled trials

Buljan

Tokalić

Roguljić

et al. 2020

BMC Med Res Methodol

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Background: Cochrane systematic review Plain language Summaries (CSR PLSs should serve as a tool for the evidence translation to non-medical population. However, the evidence of optimal type of numerical presentation in CSR PLSs is still scarce. The aim of this study was to investigate readers' comprehension and preferences for different presentation of findings, including framing and numerical data, in Cochrane systematic review Plain Language Summaries (CSR PLSs). Methods: We conducted a parallel randomized trial and a crossover randomized trial at the School of Medicine and family practice offices in Split, Croatia. The participants were students and consumers. We assessed possible differences in comprehension, measured by four questions on PLS content, of CSR PLSs depending on the positive or negative framing of results (n = 91) (Trial 1) or using percentages or frequencies for the presentation of results (n = 245) (Trial 2). The outcome measures were comprehension of PLS content, perceived effectiveness of the treatment and readiness to use the treatment (all on 1-10 scales). Results: In Trial 1 we found no difference in readers' perception of the effectiveness of the described treatment, desire that the treatment be offered by their family doctor, readiness to use the treatment, or comprehension when CSR PLS results were presented positively or negatively. In Trial 2 we found no difference in CSR PLS comprehension when results were presented as natural frequencies or percentages (BF 10 = 0.62, Bayesian t-test for independent samples). Conclusions: Numerical presentation and framing direction of results appear to have no significant impact on understanding of messages in CSR PLSs.

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Empirical relationships between numeracy and treatment decision making: A scoping review of the literature

Abstract: Decision aids designed for patients with different levels of health literacy may not meet the needs of patients with different levels of numeracy. The numeracy skills of health professionals require attention.

Cited by 20 publications

References 49 publications

Are cancer-related decision aids appropriate for socially disadvantaged patients? A systematic review of US randomized controlled trials

Are cancer-related decision aids appropriate for socially disadvantaged patients? A systematic review of US randomized controlled trials

Health Coaching Has Differential Effects on Veterans with Limited Health Literacy and Numeracy: a Secondary Analysis of ACTIVATE

Framing the numerical findings of Cochrane plain language summaries: two randomized controlled trials

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