Age, numeracy, and cultural differences in Chinese and American adolescents' performance on the ratio bias task

Affective Distancing Associated with Second Language Use Influences Response to Health Information

Health care delivery depends on effective provider–patient communication. An important issue is whether and how this communication differs for second language (SL) patients. While understanding health information can be impaired by limited English proficiency, we examined a potential benefit of SL use. SL users may be “affectively distanced”, with weaker emotional reactions to content presented in a foreign versus native language (NL). This distancing may have important implications for understanding, and for making decisions and judgements about health information to the extent these processes involve affective responses. For example, patients may respond to diagnostic test results indicating risk of illness with less intense negative affect if the information is presented in their SL. Language differences in affective response may in turn attenuate risk perception for SL versus NL users, with perceived risk being lower while the objective risk associated with test results increases, as predicted by the ‘risk as feelings’ view of risk perception, where perceived risk is based on affective response to the information. On the other hand, risk perception may be more calibrated with objective risk for SL users to the extent that affective distancing encourages SL users to rely on deliberative rather than affective-based, intuitive processes related to risk perception. SL use may also influence attitudes toward and intentions to perform behaviors that address risk because these processes are driven in part by risk perception and memory for the risk information. These processes may also depend on numeracy, defined as the ability to make sense of and rationalize numbers, because it influences risk perception. We tested these predictions in the context of a simulated Electronic Health Record (EHR) patient portal, in which participants were presented diagnostic test results in English from fictional patients. Native English speakers (n = 25), and native Mandarin speakers with higher numeracy (n = 25) and lower numeracy (n = 28) participated in the study. Consistent with the ‘affective distancing’ effect, SL participants with either higher or lower numeracy demonstrated a flatter slope for positive and negative affective responses to the test results compared to NL participants. Moreover, SL participants reported greater perceived risk than NL participants did as objective risk rose. A similar pattern occurred for attitudes toward and intentions to perform behaviors that addressed this risk, especially for treatment health behaviors. On the other hand, language did not influence memory for risk-related information. Our findings extend the affective distancing effect associated with SL use to the health domain and show that this effect influences risk perception and behavioral intentions beyond memory recall and numeracy skills.