Health – Common European Numeracy Framework

Health and care

INTRODUCTION

Health and numeracy intersect in several key ways, highlighting important issues that impact individuals and communities. Addressing these key issues at the intersection of health and numeracy is essential for promoting better health outcomes and ensuring equitable access to healthcare resources.

KEY ISSUES

At the intersection of health and numeracy are the following key issues:

Medication Management: Numeracy skills are crucial for accurately dosing and administering medication, as errors can have serious health consequences.
Treatment Adherence: Numeracy influences a patient’s ability to follow treatment plans and understand the importance of medication adherence.
Health Literacy: Understanding numerical information in health materials, such as interpreting nutrition labels or medical test results, is essential for making informed health decisions.
Financial Burdens: Health costs often involve complex numerical calculations, and individuals with low numeracy skills may struggle to manage healthcare expenses.
Risk Assessment: Numeracy is vital for evaluating health risks, such as understanding statistics related to disease prevalence or vaccine effectiveness.
Healthcare Access: Limited numeracy can hinder one’s ability to navigate the healthcare system, making it harder to access necessary care and services.
Health Promotion: Numeracy is crucial for comprehending health promotion campaigns and understanding the quantitative benefits of healthy lifestyle choices.
Data Interpretation: Analyzing health data, like tracking vital signs or monitoring chronic conditions, requires numeracy skills for accurate interpretation.
Health Disparities: Numeracy disparities can exacerbate existing health disparities, as individuals with lower numeracy may struggle to advocate for their health needs.

Relationship to framework

Suggestions for PD meetings

Discussing personal experiences

Group discussion:

Discuss personal experiences with the health system and have the listeners try to find out when numeracy issues are involved. Try to relate the experiences with the key issues mentioned above.

Medical information

Discuss the following issue on providing medical information:

Challenges for providers of patient information

Providers of patient information often have a broad audience and face the problem that people have different preferences regarding the need and use of risk estimates. The meaning that is ascribed to such information varies greatly. While some express a clear need for risk estimates, others are confused by numbers and prefer to make decisions based on other types of information. Different preferences imply that using a combined verbal and numerical format may be the best compromise to suit various needs. This is also reflected in the current European Commission Guideline on readability from 2009 as well as the current EU template for patient leaflets (see below). Providing different information for different groups according to their preferences would be an option, but it may be difficult to direct patients to the information that best suits their needs.

Unfortunately, data on adverse effects are often poorly reported in trials and systematic reviews, which complicates the issue. Furthermore, there might still be a role for verbal terms in written information, for example for people with difficulties in understanding numbers, or when large amounts of numbers make information too difficult to comprehend. It is difficult to draw a clear recommendation for providers of patient information as it is unlikely that there is a one-size-fits-all approach. This will depend on many other factors such as the context and the target group of the information.

European Commission (EC) (2009). Guideline on the Readability of the Labelling and Package Leaflet of Medicinal Products for Human Use. http://ec.europa.eu/health/files/eudralex/vol-2/c/2009_01_12_readability_guideline_final_en.pdf

European Medicines Agency (EMA) (2022). Quality Review of Documents Human Product-information Annotated Template (English) Version 10.3. https://www.ema.europa.eu/documents/template-form/qrd-product-information-annotated-template-english-version-103_en.pdf

Package leaflets on medication

Collect package leaflets on medications (als called: Patient Information Leaflet). Select from them specific issues, for instance the risk on side effects and percentages or fractions. Or the prescribed dosages. Does everyone has the same mental picture when reading such information.
Alternative: Group study of medical information, for instance from medication package leaflets or information leaflets from the physician’s office or the hospital. Highlight where the numeracy issues are.
Alternative: Discuss the articles of Mühlbauer et al. (2018): Alternative package leaflets improve people’s understanding of drug side effects, and Schwappach et al. (2011) Is less more? Patients’ preferences for drug information leaflets.

Activity: Think, Pair, Share.

Background information

Literature

Büchter, R. B., Fechtelpeter, D., Knelangen, M., Ehrlich, M., & Waltering, A. (2014). Words or numbers? Communicating risk of adverse effects in written consumer health information: A systematic review and meta-analysis. BMC Medical Informatics and Decision Making, 14(1). https://doi.org/10.1186/1472-6947-14-76

Coben, D., Hall, C., Hutton, M., Rowe, D., Weeks, K., & Wolley, N. (2010). Benchmark assessment of numeracy for nursing: Medication dosage calculation at point of registration. NHS Education for Scotland.

Dulam, T., & Hoogland, K. (2021). The relationship between self-rated health and proficiency in numeracy and technological problem solving in OECD-countries. In L. Heilmann & D. Kaye (Eds.), Proceedings of the 28th International Conference of Adults Learning Mathematics: A Research Forum. ALM. https://alm-online.net/wp-content/uploads/2022/03/ALM28Proceedings-final.pdf

Golbeck, A. L., Ahlers-Schmidt, C. R., Paschal, A. M., & Dismuke, S. E. (2005). A Definition and Operational Framework for Health Numeracy. American Journal of Preventive Medicine, 29(4), 375–376. https://doi.org/10.1016/j.amepre.2005.06.012

Heilmann, L. (2020). Health and numeracy: the role of numeracy skills in health satisfaction and health-related behaviour. ZDM, 52(3), 407–418. https://doi.org/10.1007/s11858-019-01106-z

Hutton, M., Coben, D., Hall, C., Rowe, D., Sabin, M., Weeks, K., & Woolley, N. (2010). Numeracy for nursing, report of a pilot study to compare outcomes of two practical simulation tools–An online medication dosage assessment and practical assessment in the style of objective structured clinical examination. Nurse Education Today, 30(7), 608–614.

Lau, N. T. T., Wilkey, E. D., Soltanlou, M., Cusiac, R. L., Peters, L., Tremblay, P., Goffin, C., Alves, I. S., Ribner, A. D., Thompson, C., van Hoof, J., Bahnmueller, J., Alvarez, A., Bellon, E., Coolen, I., Ollivier, F., & Ansari, D. (2022). Numeracy and COVID-19: Examining interrelationships between numeracy, health numeracy and behaviour. Royal Society Open Science, 9(3). https://doi.org/10.1098/rsos.201303

Mühlbauer, V., Prinz, R., Mühlhauser, I., Wegwarth, O. (2018) Alternative package leaflets improve people’s understanding of drug side effects—A randomized controlled exploratory survey. https://doi.org/10.1371/journal.pone.0203800

Neiva Pantuzza, L. L., Nascimento, E. do, Crepalde-Ribeiro, K., Botelho, S. F., Parreiras Martins, M. A., Camila de Souza Groia Veloso, R., Gonzaga do Nascimento, M. M., Vieira, L. B., & Moreira Reis, A. M. (2022). Medication literacy: A conceptual model. Research in Social and Administrative Pharmacy, 18(4), 2675–2682. https://doi.org/10.1016/j.sapharm.2021.06.003

Peters, E., Hibbard, J., Slovic, P., & Dieckmann, N. (2007). Numeracy skill and the communication, comprehension, and use of risk-benefit information. Health Affairs, 26(3), 741–748. https://www.healthaffairs.org/toc/hlthaff/26/3

Rodgers, J., Kakarmath, S., Denis, V., Encinas-Martin, M., & Subramanian, S. v. (2019). Association between numeracy and self-rated poor health in 33 high- and upper middle- income countries. Preventive Medicine, 129(September 2018), 105872. https://doi.org/10.1016/j.ypmed.2019.105872

Rolison, J. J., Morsanyi, K., & Peters, E. (2020). Understanding Health Risk Comprehension: The Role of Math Anxiety, Subjective Numeracy, and Objective Numeracy. Medical Decision Making, 40(2). https://doi.org/10.1177/0272989X20904725

Raynor, D. K., Blenkinsopp, A., Knapp, P., Grime, J., Nicolson, D. J., Pollock, K., Dorer, G., Gilbody, S., Dickinson, D., & Spoor, P. (2007). A systematic review of quantitative and qualitative research on the role and effectiveness of written information available to patients about individual medicines HTA Health Technology Assessment NHS R&D HTA Programme www.hta.ac.uk. Health Technology Assessment, 11(5). http://www.hta.ac.uk

Schapira, M. M., Fletcher, K. E., Gilligan, M. A., King, T. K., Laud, P. W., Matthews, B. A., Neuner, J. M., & Hayes, E. (2008). A Framework for Health Numeracy: How Patients Use Quantitative Skills in Health Care. Journal of Health Communication, 13(5), 501–517. https://doi.org/10.1080/1081073080220216

Schwappach, D.L.B., Mülders, M., Simic D., Wilm, S., Thürmann, P.A. (2011) Is less more? Patients’ preferences for drug information leaflets. https://doi.org/10.1002/pds.2212

Systematic Reviews

Mafruhah, O. R., Huang, Y. M., Shiyanbola, O. O., Shen, G. L., & Lin, H. W. (2021). Ideal instruments used to measure health literacy related to medication use: A systematic review. In Research in Social and Administrative Pharmacy (Vol. 17, Issue 10, pp. 1663–1672). Elsevier Inc. https://doi.org/10.1016/j.sapharm.2021.01.017