Numeracy and the Motivational Mind: The Power of Numeric Self-efficacy

Abstract

Background Objective numeracy appears to support better medical decisions and health outcomes. The more numerate generally understand and use numbers more and make better medical decisions, including more informed medical choices. Numeric self-efficacy—an aspect of subjective numeracy that is also known as numeric confidence—also relates to decision making via emotional reactions to and inferences from experienced difficulty with numbers and via persistence linked with numeric comprehension and healthier behaviors over time. Furthermore, it moderates the effects of objective numeracy on medical outcomes. Purpose We briefly review the numeracy and decision-making literature and then summarize more recent literature on 3 separable effects of numeric self-efficacy. Although dual-process theories can account for the generally superior decision making of the highly numerate, they have neglected effects of numeric self-efficacy. We discuss implications for medical decision-making (MDM) research and practice. Finally, we propose a modification to dual-process theories, adding a “motivational mind” to integrate the effects of numeric self-efficacy on decision-making processes (i.e., inferences from experienced difficulty with numbers, greater persistence, and greater use of objective-numeracy skills) important to high-quality MDM. Conclusions The power of numeric self-efficacy (confidence) has been little considered in MDM, but many medical decisions and behaviors require persistence to be successful over time (e.g., comprehension, medical-recommendation adherence). Including numeric self-efficacy in research and theorizing will increase understanding of MDM and promote development of better decision interventions. Highlights Research demonstrates that objective numeracy supports better medical decisions and health outcomes. The power of numeric self-efficacy (aka numeric confidence) has been little considered but appears critical to emotional reactions and inferences that patients and others make when encountering numeric information (e.g., in decision aids) and to greater persistence in medical decision-making tasks involving numbers. The present article proposes a novel modification to dual-process theory to account for newer findings and to describe how numeracy mechanisms can be better understood. Because being able to adapt interventions to improve medical decisions depends in part on having a good theory, future research should incorporate numeric self-efficacy into medical decision-making theories and interventions.

The Framing Dilemma: Quantitative Information, Shared Decision Making, and Nudging

“…Reyna and colleagues 2 present a convincing rejection of this approach: such a welter of information and framing could interfere with patients drawing any coherent gist at all. Peters and Shoots-Reinhard 3 do not mention the Framing Dilemma, but their conclusions also provide support for keeping the presentation simple. As they describe, studies show that less numerate patients may completely disengage from a decision if it seems to require complex quantitative reasoning.…”

“…As they describe, studies show that less numerate patients may completely disengage from a decision if it seems to require complex quantitative reasoning. 3 But if only one type of information or framing is to be presented, which one? Reyna and colleagues 2 suggest that the answer is to present information that will support an ''accurate'' gist impression, which they say ''goes beyond consistency with precise facts,'' (p. 742) and is supposed to ''distill its essential meaning'' (p. 742).…”

“…As they describe, studies show that less numerate patients may completely disengage from a decision if it seems to require complex quantitative reasoning. 3…”

Capitalizing on Opportunities to Integrate Theory and Practice in Medical Decision Making

“…The 3 articles in this issue's special section [3][4][5] offer an opportunity to consider this question. Working from different perspectives, each article grapples with a set of questions that involve navigating the interplay between testing principles regarding how people make medical decisions and pursuing opportunities to design and test strategies to improve medical decision making.…”

“…Whereas Resnicow and colleagues centered their analysis around a question about practice, Peters and Shoots-Reinhard 3 start with a theoretical question: how does perceived numerical self-efficacy (SE) affect medical decisions? They observe that when people are confident in their numerical skills, they are more likely to engage with numerical information and less likely to feel frustrated when working with numbers proves difficult; outcomes that are beneficial as long as people have sufficient numerical skills to capitalize on their persistence.…”