How numeracy influences risk comprehension and medical decision making

The effects of presenting imprecise probabilities in intelligence forecasts

How to assess and present analytic uncertainty to policymakers has emerged as an important topic in risk and policy analysis. Due to the complexity and deep uncertainty present in many forecasting domains, these reports are often fraught with analytic uncertainty. In three studies, we explore the effect of presenting probability assessments and analytic uncertainty through probability ranges. Participants were presented with mock intelligence forecasts that include narrative evidence as well as numerical probability assessments. Participants were sensitive to the ambiguity communicated through the confidence range. The narrative appeared to have a smaller effect on judgments when accompanied by a probability range as opposed to a point assessment. In one study, participants also thought that the probability range was more useful for decision making at a higher probability whereas the point estimate was more useful at a lower probability. When evaluating a forecast in hindsight, decisionmakers tended to report lower levels of blame and higher levels of source credibility for forecasts that reported ranges as compared to point assessments. These findings suggest that decisionmakers are not necessarily "ambiguity averse" in the forecasting context. Presenting ranges of probability may have distinct advantages as a way to communicate probability and analytic confidence to decisionmakers.

Socioeconomic status, statistical confidence, and patient-provider communication: an analysis of the Health Information National Trends Survey (HINTS 2007)

The increasing trend of exposing patients seeking health advice to numerical information has the potential to adversely impact patient-provider relationships especially among individuals with low literacy and numeracy skills. We used the HINTS 2007 to provide the first large scale study linking statistical confidence (as a marker of subjective numeracy) to demographic variables and a health-related outcome (in this case the quality of patient-provider interactions). A cohort of 7,674 individuals answered sociodemographic questions, a question on how confident they were in understanding medical statistics, a question on preferences for words or numbers in risk communication, and a measure of patient-provider interaction quality. Over thirty-seven percent (37.4%) of individuals lacked confidence in their ability to understand medical statistics. This was particularly prevalent among the elderly, low income, low education, and non-White ethnic minority groups. Individuals who lacked statistical confidence demonstrated clear preferences for having risk-based information presented with words rather than numbers and were 67% more likely to experience a poor patient-provider interaction, after controlling for gender, ethnicity, insurance status, the presence of a regular health care professional, and the language of the telephone interview. We will discuss the implications of our findings for health care professionals.

A model of the influence of false-positive mammography screening results on subsequent screening

Decades of empirical research have demonstrated psychological and behavioural consequences of false-positive medical tests. To organise this literature and offer novel predictions, we propose a model of how false-positive mammography results affect return for subsequent mammography screening. We propose that false-positive mammography results alter how women think about themselves (e.g., increasing their perceived likelihood of getting breast cancer) and the screening test (e.g., believing mammography test results are less accurate). We further hypothesise that thoughts elicited by the false-positive experience will, in turn, affect future use of screening mammography. In addition, we discuss methodological considerations for statistical analyses of these mediational pathways and propose two classes of potential moderators. While our model focuses on mammography screening, it may be applicable to psychological and behavioural responses to other screening tests. The model is especially timely as false-positive medical test results are increasingly common, due to efforts to increase uptake of cancer screening, new technologies that improve existing tests' ability to detect disease at the cost of increased false alarms, and growing numbers of new medical tests.

The use of narrative evidence and explicit likelihood by decisionmakers varying in numeracy

Decisionmakers are often presented with explicit likelihood assessments (e.g., there is a 10% chance that an attack will occur over the next three months) and supporting narrative evidence in forecasting and risk communication domains. Decisionmakers are thought to rely on both numerical and narrative information to the extent that they perceive the information to be diagnostic, accurate, and trustworthy. In two studies, we explored how lay decisionmakers varying in numeracy evaluated and used likelihood assessments and narrative evidence in forecasts. Overall, the less numerate reported higher risk and likelihood perceptions. In simple probabilistic forecasts without narrative evidence, decisionmakers at all levels of numeracy were able to use the stated likelihood information, although risk perceptions of the less numerate were more affected by likelihood format. When a forecast includes narrative evidence, decisionmakers were better able to use stated likelihood in a percentage as compared to frequency or verbal formats. The more numerate used stated likelihood more in their evaluations whereas the less numerate focused more on the narrative evidence. These results have important implications for risk analysts and forecasters who need to report the results of their analyses to decisionmakers. Decisionmakers varying in numerical ability may evaluate forecasts in different ways depending on the types of information they find easiest to evaluate.