Martin Tusler

Development and Testing of an Abbreviated Numeracy Scale: A Rasch Analysis Approach

ABSTRACT Research has demonstrated that individual differences in numeracy may have important consequences for decision making. In the present paper, we develop a shorter, psychometrically improved measure of numeracy—the ability to understand, manipulate, and use numerical information, including probabilities. Across two large independent samples that varied widely in age and educational level, participants completed 18 items from existing numeracy measures. In Study 1, we conducted a Rasch analysis on the item pool and created an eight‐item numeracy scale that assesses a broader range of difficulty than previous scales. In Study 2, we replicated this eight‐item scale in a separate Rasch analysis using data from an independent sample. We also found that the new Rasch‐based numeracy scale, compared with previous measures, could predict decision‐making preferences obtained in past studies, supporting its predictive validity. In Study, 3, we further established the predictive validity of the Rasch‐based numeracy scale. Specifically, we examined the associations between numeracy and risk judgments, compared with previous scales. Overall, we found that the Rasch‐based scale was a better linear predictor of risk judgments than prior measures. Moreover, this study is the first to present the psychometric properties of several popular numeracy measures across a diverse sample of ages and educational level. We discuss the usefulness and the advantages of the new scale, which we feel can be used in a wide range of subject populations, allowing for a more clear understanding of how numeracy is associated with decision processes. Copyright

Consumer Competencies and the Use of Comparative Quality Information It Isn't Just about Literacy

While consumers are increasingly expected to use complex health care information to make informed decisions, it is unclear how many have the skills to do so. In this investigation we examine health literacy, numeracy, and patient activation, assessing the contribution of each to the comprehension of comparative health care performance reports and their use in making an informed choice. A convenience sample of 303 employed-age adults participated in the study. The findings indicate that numeracy skill is the strongest predictor of comprehension, followed by health literacy. Higher activation helps those low in literacy and numeracy compensate for their lower skills and achieve higher levels of comprehension. In addition, making good choices, when trade-offs are necessary, is related to activation separate from comprehension. This is important as many real-life choices involve trade-offs. Results indicate that choice is not just about literacy or comprehension, it also has to do with activation.

Can Patients Be Part of the Solution? Views on Their Role in Preventing Medical Errors

Patients have the potential to play an important role in preventing medical errors. Yet little is known about how to effectively engage patients in this role as a “vigilant partner” in care. Respondents were asked to assess the perceived effectiveness of fourteen recommended actions for preventing medical errors. The findings indicate that most of the actions are viewed as effective. However, respondents also indicate that they are unlikely to engage in many of the recommended actions. Having a greater sense of self-efficacy in being able to prevent medical errors is significantly linked with a greater reported likelihood of engaging in preventive action.

Making Health Care Quality Reports Easier to Use

BACKGROUND Although there is evidence that consumers want comparative quality information, most studies indicate that consumers make limited use of the data in decision making. The reasons for the limited use appear to be the complexity of the information and the difficulty of processing and using the amount of information in reports. The purpose of this investigation was to determine whether there are approaches to reporting comparative information that make it easier for consumers to comprehend the information. Further, the degree to which consumers who have a low level of skill can accurately use that information when it is presented in a format that is easier to use was examined. METHODS The study used an experimental design to examine how different presentation approaches affect the use of information. Participants were randomly assigned to different conditions and were asked to review information and complete a decision task related to using comparative information and making health plan selections. Two separate convenience samples were used in the study: an elderly Medicare sample (N = 253), and a nonelderly sample (N = 239). RESULTS The findings indicate that there are data presentation approaches that help consumers who have lower skills use information more accurately. Some of these presentation strategies (for example, relative stars) improve comprehension among the lower skilled, and other strategies (for example, evaluative labels) appear to aid those in the midrange of comprehension skill. CONCLUSIONS Using these approaches in reporting would likely increase the use of the comparative information and increase the efficacy of reporting efforts.

Development of the Patient Activation Measure for Mental Health

Our objective was to adapt the physical health Patient Activation Measure (PAM) for use among people with mental health conditions (PAM-MH). Data came from three studies among people with chronic mental health conditions and were combined in Rasch analyses. The PAM-MH’s psychometric properties equal those of the original 13-item PAM. Test–retest reliability and concurrent validity were good, and the PAM-MH showed sensitivity to change. The PAM-MH appears to be a reliable and valid measure of patient activation among individuals with mental health problems. It appears to have potential for use in assessing change in activation.

Assessing activation stage and employing a "next steps" approach to supporting patient self-management.

Current approaches to chronic illness care seek to engage the patient as part of the care team. Yet, finding effective ways to engage patients in their own care and support patient self-management has been challenging. Instead of pushing patients to immediately adopt all recommended behavioral changes, many programs encourage small steps while working toward a larger goal. A strategy that first assessed the level of mastery, and then encouraged “next step” behaviors, may be more effective as the recommended steps would be calibrated to the patients level of competency. In this analysis, we build on the previous research to determine whether there are behaviors that are more or less likely to be adopted at different stages of activation.

Why Worry? Worry, risk perceptions, and willingness to act to reduce medical errors

Through the domain of medical errors, the role of worry and perceived risk in precautionary behaviors was examined in a convenience sample (N = 195, mean age = 42 years, 71% female). Worry was linked to fatality estimates. A model of the antecedents and consequences of worry also was tested. Risk characteristics such as dread and preventability, negative reactivity, and vulnerability to medical errors appeared to motivate worry about medical errors. Worry about medical errors was a better predictor of intentions to take precautionary actions than were risk perceptions. An understanding of how worry influences preventive efforts will help in building communication strategies to the public and in effectively engaging patients in the role of vigilant partner in care.

It Isn't Just about Choice: The Potential of a Public Performance Report to Affect the Public Image of Hospitals

Can a well-designed public performance report affect the public image of hospitals? Using a pre/postdesign and telephone interviews, consumer views and reports of their use of public hospital report are examined. The findings show that the report did influence consumer views about the quality of individual hospitals in the community 2 to 4 months after the release of the report.

Numbers matter to informed patient choices: a randomized design across age and numeracy levels.

Background. How drug adverse events (AEs) are communicated in the United States may mislead consumers and result in low adherence. Requiring written information to include numeric AE-likelihood information might lessen these effects, but providing numbers may disadvantage less skilled populations. The objective was to determine risk comprehension and willingness to use a medication when presented with numeric or nonnumeric AE-likelihood information across age, numeracy, and cholesterol-lowering drug-use groups. Methods. In a cross-sectional Internet survey (N = 905; American Life Panel, 15 May 2008 to 18 June 2008), respondents were presented with a hypothetical prescription medication for high cholesterol. AE likelihoods were described using 1 of 6 formats (nonnumeric: consumer medication information (CMI)–like list, risk labels; numeric: percentage, frequency, risk labels + percentage, risk labels + frequency). Main outcome measures were risk comprehension (recoded to indicate presence/absence of risk overestimation and underestimation), willingness to use the medication (7-point scale; not likely = 0, very likely = 6), and main reason for willingness (chosen from 8 predefined reasons). Results. Individuals given nonnumeric information were more likely to overestimate risk, were less willing to take the medication, and gave different reasons than those provided numeric information across numeracy and age groups (e.g., among the less numerate, 69% and 18% overestimated risks in nonnumeric and numeric formats, respectively; among the more numerate, these same proportions were 66% and 6%). Less numerate middle-aged and older adults, however, showed less influence of numeric format on willingness to take the medication. It is unclear whether differences are clinically meaningful, although some differences are large. Conclusions. Providing numeric AE-likelihood information (compared with nonnumeric) is likely to increase risk comprehension across numeracy and age levels. Its effects on uptake and adherence of prescribed drugs should be similar across the population, except perhaps in older, less numerate individuals.

How do People with Different Levels of Activation Self-Manage their Chronic Conditions?

AbstractBackground: People with chronic conditions are better able to self-manage if they are more engaged, informed, and confident. Healthcare providers are increasingly offering support for self-management, and there is interest in improving the efficacy of these efforts by tailoring them to a person’s knowledge, skill, and confidence to self-manage — so-called ‘activation.’ Objective: To explore how people with chronic conditions at different levels of ‘activation’ (as measured by the Patient Activation Measure) understand successful self-management, what barriers to self-management they face, and what strategies they employ to manage their condition and to cope with stress. Methods: Face-to-face semi-structured interviews were conducted with a stratified convenience sample of respondents with at least one chronic condition (n = 27) who were non-faculty staff at the University of Oregon (Eugene, OR, USA). Stratification was performed using the level of patient activation. Interviews took place in February and March 2006 in a private office on the university campus. Results: Those people lower in activation tended to see successful self-management as compliance whereas those at higher activation levels saw it as being in control. People with lower activation levels indicated that lack of knowledge and lack of confidence were barriers for them. Both the high and low activated could be derailed by stress. People with lower activation levels talked about a more limited number of strategies for coping but both the high and low activated had learned strategies from professionals and by trial and error. Conclusions: Some aspects of self-management support may need to be tailored for people at different levels of activation to ensure that differences in their understanding, knowledge, and confidence are addressed. However, there are also likely to be some types of self-management support such as stress-coping strategies and problem-solving skills that are beneficial for all patients with chronic conditions regardless of activation level.