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  1. 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.


    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.


    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 timemore »(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.


    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.

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    Free, publicly-accessible full text available May 18, 2023
  2. Abstract

    Climate change poses a multifaceted, complex, and existential threat to human health and well-being, but efforts to communicate these threats to the public lag behind what we know how to do in communication research. Effective communication about climate change’s health risks can improve a wide variety of individual and population health-related outcomes by: (1) helping people better make the connection between climate change and health risks and (2) empowering them to act on that newfound knowledge and understanding. The aim of this manuscript is to highlight communication methods that have received empirical support for improving knowledge uptake and/or driving higher-quality decision making and healthier behaviors and to recommend how to apply them at the intersection of climate change and health. This expert consensus about effective communication methods can be used by healthcare professionals, decision makers, governments, the general public, and other stakeholders including sectors outside of health. In particular, we argue for the use of 11 theory-based, evidence-supported communication strategies and practices. These methods range from leveraging social networks to making careful choices about the use of language, narratives, emotions, visual images, and statistics. Message testing with appropriate groups is also key. When implemented properly, these approaches are likelymore »to improve the outcomes of climate change and health communication efforts.

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  3. Free, publicly-accessible full text available July 21, 2023
  4. Four studies demonstrate that the public’s understanding of government budgetary expenditures is hampered by difficulty in representing large numerical magnitudes. Despite orders of magnitude difference between millions and billions, study participants struggle with the budgetary magnitudes of government programs. When numerical values are rescaled as smaller magnitudes (in the thousands or lower), lay understanding improves, as indicated by greater sensitivity to numerical ratios and more accurate rank ordering of expenses. A robust benefit of numerical rescaling is demonstrated across a variety of experimental designs, including policy relevant choices and incentive-compatible accuracy measures. This improved sensitivity ultimately impacts funding choices and public perception of respective budgets, indicating the importance of numerical cognition for good citizenship.
    Free, publicly-accessible full text available July 12, 2023
  5. Free, publicly-accessible full text available July 1, 2023
  6. Free, publicly-accessible full text available July 1, 2023
  7. Free, publicly-accessible full text available May 1, 2023
  8. Luciano, Michelle (Ed.)
    Objective numeracy, the ability to understand and use mathematical concepts, has been related to superior decisions and life outcomes. Unknown is whether it relates to greater satisfaction in life. We investigated numeracy’s relations with income satisfaction and overall life satisfaction in a diverse sample of 5,525 American adults. First, more numerate individuals had higher incomes; for every one point higher on the eight-item numeracy test, individuals reported $4,062 more in annual income, controlling for education and verbal intelligence. Combined, numeracy, education, and verbal intelligence explained 25% of the variance in income while Big-5 personality traits explained less than 4%. Further, the higher incomes associated with greater numeracy were related to more positive life evaluations (income and life satisfaction). Second, extant research also has indicated that the highly numerate compare numbers more than the less numerate. Consistent with numeracy-related income comparisons, numeracy moderated the relation between income and life evaluations, meaning that the same income was valued differently by those better and worse at math. Specifically, among those with lower incomes, the highly numerate were less satisfied than the less numerate; this effect reversed among those with higher incomes as if the highly numerate were aware of and made comparisons tomore »others’ incomes. Further, no clear income satiation point was seen among those highest in numeracy, and satiation among the least numerate appeared to occur at a point below $50,000. Third, both education and verbal intelligence related to income evaluations in similar ways, and numeracy’s relations held when controlling for these other relations. Although causal claims cannot be made from cross-sectional data, these novel results indicate that numeracy may be an important factor underlying life evaluations and especially for evaluations concerning numbers such as incomes. Finally, this study adds to our understanding of education and intelligence effects in life satisfaction and happiness.« less
  9. Background Decision aid developers have to convey complex task-specific numeric information in a way that minimizes bias and promotes understanding of the options available within a particular decision. Whereas our companion paper summarizes fundamental issues, this article focuses on more complex, task-specific aspects of presenting numeric information in patient decision aids. Methods As part of the International Patient Decision Aids Standards third evidence update, we gathered an expert panel of 9 international experts who revised and expanded the topics covered in the 2013 review working in groups of 2 to 3 to update the evidence, based on their expertise and targeted searches of the literature. The full panel then reviewed and provided additional revisions, reaching consensus on the final version. Results Five of the 10 topics addressed more complex task-specific issues. We found strong evidence for using independent event rates and/or incremental absolute risk differences for the effect size of test and screening outcomes. Simple visual formats can help to reduce common judgment biases and enhance comprehension but can be misleading if not well designed. Graph literacy can moderate the effectiveness of visual formats and hence should be considered in tool design. There is less evidence supporting the inclusion ofmore »personalized and interactive risk estimates. Discussion More complex numeric information. such as the size of the benefits and harms for decision options, can be better understood by using incremental absolute risk differences alongside well-designed visual formats that consider the graph literacy of the intended audience. More research is needed into when and how to use personalized and/or interactive risk estimates because their complexity and accessibility may affect their feasibility in clinical practice.« less
  10. Background Shared decision making requires evidence to be conveyed to the patient in a way they can easily understand and compare. Patient decision aids facilitate this process. This article reviews the current evidence for how to present numerical probabilities within patient decision aids. Methods Following the 2013 review method, we assembled a group of 9 international experts on risk communication across Australia, Germany, the Netherlands, the United Kingdom, and the United States. We expanded the topics covered in the first review to reflect emerging areas of research. Groups of 2 to 3 authors reviewed the relevant literature based on their expertise and wrote each section before review by the full authorship team. Results Of 10 topics identified, we present 5 fundamental issues in this article. Although some topics resulted in clear guidance (presenting the chance an event will occur, addressing numerical skills), other topics (context/evaluative labels, conveying uncertainty, risk over time) continue to have evolving knowledge bases. We recommend presenting numbers over a set time period with a clear denominator, using consistent formats between outcomes and interventions to enable unbiased comparisons, and interpreting the numbers for the reader to meet the needs of varying numeracy. Discussion Understanding how different numericalmore »formats can bias risk perception will help decision aid developers communicate risks in a balanced, comprehensible manner and avoid accidental “nudging” toward a particular option. Decisions between probability formats need to consider the available evidence and user skills. The review may be useful for other areas of science communication in which unbiased presentation of probabilities is important.« less