Numeracy and Risk Literacy: What Have We Learned so Far?

Breast Cancer Knowledge Among Amish and Mennonite Women

Breast cancer is the most common cancer diagnosis for women in the USA and ranks second in cancer-related deaths. Disproportionately higher breast cancer rates can be found in rural and Appalachian regions due to several social drivers of health, including poverty, access to healthcare, and lack of culturally sensitive health education. Amish and Mennonite communities, religious groups with distinct cultural practices and beliefs, experience lower mammography screening and higher breast cancer mortality rates (among Amish women). This study focuses on knowledge about breast cancer and causes of cancer among Amish and Mennonite women. A total of 473 women participated in the study at 26 separate women's health clinics throughout Ohio, consisting of 348 Amish and 121 Mennonite women, the largest study conducted on breast cancer knowledge spanning dozens of communities. Statistically significant differences were found in total knowledge scores between Amish and Mennonite women (rpb = .178, n = 466, p = .007), with Amish women having lower scores and stronger beliefs in myths associated with breast cancer cause and symptoms (χ(1) = 7.558, p = .006). Both groups often provided scientifically accurate descriptions of cancer etiology. The majority of participants underestimated breast cancer risk, highlighting the need for culturally appropriate health education programs that consider numeracy and health literacy. By implementing targeted interventions and fostering partnerships with community stakeholders using a multifaceted approach that incorporates cultural sensitivity, community engagement, and collaboration, significant progress can be made towards reducing breast cancer disparities and improving health outcomes.

Not all information is informative: An exploration of educational content on recycled potable water knowledge and acceptance

As drought and water shortages threaten access to safe water supplies globally, finding ways to increase public acceptance of recycled water has become increasingly important. Educational interventions have often been explored as a potential method to help overcome public distaste for recycled water. However, in past research, the effects of educational interventions have tended to be modest, leading to some skepticism over the ability of public information campaigns to truly increase acceptance. We propose that, at least in part, these modest effects of education may be driven by differences in the ability of some types of educational content to increase recycled water knowledge and subsequent acceptance (e.g., some content may be too complex for a lay audience or may be insufficient to adequately address the concerns that drive one's apprehension towards recycled water). Thus, we developed and tested an educational video split into four distinct areas of educational content related to potable water reuse: (1) need for recycled water, (2) approaches to implementing recycled water (e.g., through direct, indirect, or de-facto reuse), (3) purification technology, and (4) locations and testimonials of actual implementation. In two experiments (Ns = 711, 385), we found that content illustrating approaches to implementing recycled water and locations using it led to medium to large increases in knowledge and acceptance. These results imply that given limited time and resources, brief information about these topics may increase acceptance better than alternative information. Moreover, these results underscore a need to more carefully consider the content used in educational campaigns, as not all information is equally likely to produce desired effects.

Motivated reasoning about climate change and the influence of Numeracy, Need for Cognition, and the Dark Factor of Personality

Human information processing is not always rational but influenced by prior attitudes, a phenomenon commonly known as motivated reasoning. We conducted two studies (N1 = 556, N2 = 1198; UK samples) investigating motivated reasoning in the context of climate change with a focus on individual differences as potential moderating factors. While previous research investigated motivated reasoning regarding the debate whether climate change is anthropogenic, we focused on current discourses about the effectiveness of different countermeasures. To this end, participants evaluated fictitious scientific data on the effectiveness of regulations to reduce CO2 emissions. In both studies, participants exhibited motivated reasoning as indicated by the observation that prior attitudes about CO2 reduction policies predicted evaluation of the scientific data. The degree of motivated reasoning was not related to individual difference variables, namely the ability to understand and reason with numbers (Numeracy), the willingness to show this ability (Need for Cognition), and the tendency to maximize one's individual utility (Dark Factor of Personality). However, numeracy was associated with a less biased interpretation of the presented information. Our research demonstrates that motivated reasoning is a general phenomenon, and points to numerical training as one way to improve reasoning.

'Symptom-free' when inflammatory bowel disease is in remission: Expectations raised by online resources

OBJECTIVES

Up to 60% of patients with inflammatory bowel disease (IBD) experience symptoms when in remission. Qualitative research suggests patients seldom feel they receive adequate explanations for these. This study explores how, and how often, ongoing symptoms during remission are represented on readily searchable patient websites.

METHODS

Bing, Google, and Yahoo were searched for websites providing medical information about IBD. Thematic analysis was used to inductively explore themes around symptoms during quiescent IBD, followed by deductive content analysis to quantify core themes.

RESULTS

Results indicated that remission is commonly defined as "few or no symptoms" and that there is limited information available on symptoms during remission. 55.6% of IBD websites provided a definition of remission based on symptom control only, while 44.4% also incorporated inflammatory control. The few websites that mentioned that symptoms may continue during remission (21.7%) related these to IBS.

CONCLUSIONS

Current website information is predominantly biomedical and fails to adequately explain how symptoms may persist during remission and how IBS and IBD may be linked.

PRACTICE IMPLICATIONS

Lack of explanatory models of symptoms in remission may lead to distress and increase anxiety about symptoms. Clearer explanations of these symptoms are needed.

Picture this: Evaluating the efficacy of genetic counseling visual aids

Visual aids have been validated as effective tools for educating patients in a variety of medical settings. However, research exploring the efficacy and potential benefit of genetic counseling visual aids is lacking. To begin to address this gap, this study assessed participant knowledge of genetic counseling concepts after viewing either visual or non-visual educational content. Participants were recruited from the general population using the crowdsourcing platform Mechanical Turk. Wilcoxon rank-sum tests were carried out to evaluate differences in knowledge survey scores between the visual and non-visual groups, and Poisson regression models were fitted to evaluate these differences across a variety of demographic backgrounds. The visual group had equal or higher scores than the non-visual group across all analyses. The difference in group scores was statistically significant for autosomal recessive inheritance knowledge scores (p < 0.05). In addition, this difference was approaching significance for higher-level knowledge scores (p = 0.05) and total knowledge scores in individuals who have not completed post-secondary education (p = 0.05). These results indicate that visual aids improve knowledge of specific genetic counseling concepts such as inheritance patterns; the education of which is often integral to genetic counseling. These results also indicate that visual aids may facilitate a deeper understanding of genetic counseling concepts and may be particularly valuable for individuals with lower educational backgrounds. Together, the results of this study support the inclusion of visual aids in genetic counseling education to help improve patient understanding and the accessibility of genetic healthcare information.

The link between cognitive abilities and risk preference depends on measurement

Risk preference is an important construct for understanding individual differences in risk taking throughout the behavioral sciences. An active stream of research has focused on better understanding risk preference through its connection to other psychological constructs, in particular, cognitive abilities. Here, we examine two large-scale multimethod data sets and demonstrate that the method used to measure risk preference is an important moderator. In self-report measures, we found small but consistent positive correlations between working memory capacity/numeracy, facets of cognitive abilities, and risk tolerance. In behavioral measures, we found, on average, no correlation and large intermethod heterogeneity. This heterogeneity can be explained by the choice architecture that is created in behavioral methods-in particular, the relation between risk and reward and the impact of decision error in a task. Consequently, investigating how risk preference relates to psychological constructs such as cognitive abilities require a profound understanding of the choice architecture in measurements of risk preference and in the real world.

How Do People Process Different Representations of Statistical Information? Insights into Cognitive Effort, Representational Inconsistencies, and Individual Differences

BACKGROUND

Graphical representation formats (e.g., icon arrays) have been shown to lead to better understanding of the benefits and risks of treatments compared to numbers. We investigate the cognitive processes underlying the effects of format on understanding: how much cognitive effort is required to process numerical and graphical representations, how people process inconsistent representations, and how numeracy and graph literacy affect information processing.

METHODS

In a preregistered between-participants experiment, 665 participants answered questions about the relative frequencies of benefits and side effects of 6 medications. First, we manipulated whether the medical information was represented numerically, graphically (as icon arrays), or inconsistently (numerically for 3 medications and graphically for the other 3). Second, to examine cognitive effort, we manipulated whether there was time pressure or not. In an additional intervention condition, participants translated graphical information into numerical information before answering questions. We also assessed numeracy and graph literacy.

RESULTS

Processing icon arrays was more strongly affected by time pressure than processing numbers, suggesting that graphical formats required more cognitive effort. Understanding was lower when information was represented inconsistently (v. consistently) but not if there was a preceding intervention. Decisions based on inconsistent representations were biased toward graphically represented options. People with higher numeracy processed quantitative information more efficiently than people with lower numeracy did. Graph literacy was not related to processing efficiency.

LIMITATIONS

Our study was conducted with a nonpatient sample, and the medical information was hypothetical.

CONCLUSIONS

Although graphical (v. numerical) formats have previously been found to lead to better understanding, they may require more cognitive effort. Therefore, the goal of risk communication may play an important role when choosing how to communicate medical information.

HIGHLIGHTS

This article investigates the cognitive processes underlying the effects of representation format on the understanding of statistical information and individual differences therein.Processing icon arrays required more cognitive effort than processing numbers did.When information was represented inconsistently (i.e., partly numerically and partly graphically), understanding was lower than with consistent representation, and decisions were biased toward the graphically represented options.People with higher numeracy processed quantitative information more efficiently than people with lower numeracy did.

Numeracy, gist, literal thinking and the value of nothing in decision making

The onus on the average person is greater than ever before to make sense of large amounts of readily accessible quantitative information, but the ability and confidence to do so are frequently lacking. Many people lack practical mathematical skills that are essential for evaluating risks, probabilities and numerical outcomes such as survival rates for medical treatments, income from retirement savings plans or monetary damages in civil trials. In this Review, we integrate research on objective and subjective numeracy, focusing on cognitive and metacognitive factors that distort human perceptions and foment systematic biases in judgement and decision making. Paradoxically, an important implication of this research is that a literal focus on objective numbers and mechanical number crunching is misguided. Numbers can be a matter of life and death but a person who uses rote strategies (verbatim representations) cannot take advantage of the information contained in the numbers because 'rote' strategies are, by definition, processing without meaning. Verbatim representations (verbatim is only surface form, not meaning) treat numbers as data as opposed to information. We highlight a contrasting approach of gist extraction: organizing numbers meaningfully, interpreting them qualitatively and making meaningful inferences about them. Efforts to improve numerical cognition and its practical applications can benefit from emphasizing the qualitative meaning of numbers in context - the gist - building on the strengths of humans as intuitive mathematicians. Thus, we conclude by reviewing evidence that gist training facilitates transfer to new contexts and, because it is more durable, longer-lasting improvements in decision making.

Taking the Shortcut: Simplifying Heuristics in Discrete Choice Experiments

Health-related discrete choice experiments (DCEs) information can be used to inform decision-making on the development, authorisation, reimbursement and marketing of drugs and devices as well as treatments in clinical practice. Discrete choice experiment is a stated preference method based on random utility theory (RUT), which imposes strong assumptions on respondent choice behaviour. However, respondents may use choice processes that do not adhere to the normative rationality assumptions implied by RUT, applying simplifying decision rules that are more selective in the amount and type of processed information (i.e., simplifying heuristics). An overview of commonly detected simplifying heuristics in health-related DCEs is lacking, making it unclear how to identify and deal with these heuristics; more specifically, how researchers might alter DCE design and modelling strategies to accommodate for the effects of heuristics. Therefore, the aim of this paper is three-fold: (1) provide an overview of common simplifying heuristics in health-related DCEs, (2) describe how choice task design and context as well as target population selection might impact the use of heuristics, (3) outline DCE design strategies that recognise the use of simplifying heuristics and develop modelling strategies to demonstrate the detection and impact of simplifying heuristics in DCE study outcomes.

Measuring feelings about choices and risks: The Berlin Emotional Responses to Risk Instrument (BERRI)

We introduce a brief instrument specifically validated for measuring positive and negative feelings about risks-the Berlin Emotional Responses to Risk Instrument (BERRI). Based on seven studies involving diverse adults from three countries (n = 2120), the BERRI was found to robustly estimate anticipatory affective reactions derived from subjective evaluations of positive (i.e., assured, hopeful, and relieved) and negative emotions (i.e., anxious, afraid, and worried). The brief BERRI outperformed a 14-item assessment, uniquely tracking costs/benefits associated with cancer screening among men and women (Studies 1 and 2). Predictive validity was further documented in paradigmatic risky choice studies wherein options varied over probabilities and severities across six contexts (health, social, financial, technological, ethical, and environmental; Study 3). Studies 4-6, conducted during the Ebola epidemic and COVID-19 pandemic, indicated BERRI responses were sensitive to subtle effects caused by emotion-related framing manipulations presented in different cultures and languages (the United States, Spain, and Poland). Study 7 indicated BERRI responses remained stable for 2 weeks. Although the BERRI can provide an estimate of overall affect, choices were generally better explained by the unique influences of positive and negative affect. Overall, results suggest the novel, brief instrument can be an efficient tool for high-stakes research on decision making and risk communication.

The association between experience-based risky choice and mathematical ability

Mathematical ability has always been considered an important influencing factor in description-based risky choices. Experience-based risky choices, which occur frequently in daily life, are very different from description-based risky choices. The association between experience-based risky choice and mathematical ability remains unknown. This study adopts the feedback paradigm for experience-based risky choice to explore the association between multiple mathematical abilities and experience-based risky choice. The results show that, in experience-based risky choice, mathematical ability did not influence the decision to pursue higher expected value, but it did influence preference for risky. Thus, our study contributes to a more comprehensive view of mathematical ability and risky choice.

Cocreation with Dutch patients of decision-relevant information to support shared decision-making about adjuvant treatment in breast cancer care

BACKGROUND

To support patients in shared decision-making about treatment options, patient decision aids (PtDAs) usually provide benefit/harm information and value clarification methods (VCMs). Recently, personalized risk information from prediction models is also being integrated into PtDAs. This study aimed to design decision-relevant information (i.e., personalized survival rates, harm information and VCMs) about adjuvant breast cancer treatment in cocreation with patients, in a way that suits their needs and is easily understandable.

METHODS

Three cocreation sessions with breast cancer patients (N = 7-10; of whom N = 5 low health literate) were performed. Participants completed creative assignments and evaluated prototypes of benefit/harm information and VCMs. Prototypes were further explored through user testing with patients (N = 10) and healthcare providers (N = 10). The researchers interpreted the collected data, for example, creative and homework assignments, and participants' presentations, to identify key themes. User tests were transcribed and analysed using ATLAS.ti to assess the understanding of the prototypes.

RESULTS

Important information needs were: (a) need for overview/structure of information directly after diagnosis and; (b) need for transparent benefit/harm information for all treatment options, including detailed harm information. Regarding VCMs, patients stressed the importance of a summary/conclusion. A bar graph seemed the most appropriate way of displaying personalized survival rates; the impact of most other formats was perceived as too distressful. The concept of 'personalization' was not understood by multiple patients.

CONCLUSIONS

A PtDA about adjuvant breast cancer treatment should provide patients with an overview of the steps and treatment options, with layers for detailed information. Transparent information about the likelihood of benefits and harm should be provided. Given the current lack of information on the likelihood of side effects/late effects, efforts should be made to collect and share these data with patients. Further quantitative studies are needed to validate the results and to investigate how the concept of 'personalization' can be communicated.

PATIENT OR PUBLIC CONTRIBUTION

Ten breast cancer patients participated in three cocreation sessions to develop decision-relevant information. Subsequent user testing included 10 patients. The Dutch Breast Cancer Association (BVN) was involved as an advisor in the general study design.

Assessing numerical reasoning provides insight into financial literacy

Financial literacy is linked to financial well-being and decision making. While financial literacy and numeracy skills are strongly related, the relevance of different aspects of numeracy (mental arithmetic, math achievement, and numerical reasoning) for financial literacy has not yet been examined. Data were collected from 88 cognitively healthy adults, mean age = 50 years (SD = 15); mean education = 15 years (SD = 2); 61% females; with 56% Caucasian, 36% Black, and 90% non-Hispanic. Financial literacy was measured with the widely used Big Three scale, and numeracy was measured with the Wechsler Adult Intelligence Scale-III, Arithmetic subtest; the Wide Range Achievement Test-IV, Math Computation subtest; and the Weller's Abbreviated Numeracy Scale (WANS). Regressions analyses were conducted with financial literacy as the outcome variable and each numeracy measure along with demographics (age, sex, and education) as the predictors. In all the models, only the numeracy measures were significant as individual predictors, with numerical reasoning holding the strongest association with financial literacy, followed by mental arithmetic and math achievement. The current study supports the existing literature that numeracy is important for financial literacy, and provides empirical evidence for the specific contributions of individual numeracy measures that clinicians may use to garner impressions about financial skills.

Which vaccine attributes foster vaccine uptake? A cross-country conjoint experiment

Why do people prefer one particular COVID-19 vaccine over another? We conducted a pre-registered conjoint experiment (n = 5,432) in France, Germany, and Sweden in which respondents rated the favorability of and chose between pairs of hypothetical COVID-19 vaccines. Differences in effectiveness and the prevalence of side-effects had the largest effects on vaccine preferences. Factors with smaller effects include country of origin (respondents are less favorable to vaccines of Chinese and Russian origin), and vaccine technology (respondents exhibited a small preference for hypothetical mRNA vaccines). The general public also exhibits sensitivity to additional factors (e.g. how expensive the vaccines are). Our data show that vaccine attributes are more important for vaccine preferences among those with higher vaccine favorability and higher risk tolerance. In our conjoint design, vaccine attributes–including effectiveness and side-effect prevalence–appear to have more muted effects among the most vaccine hesitant respondents. The prevalence of side-effects, effectiveness, country of origin and vaccine technology (e.g., mRNA vaccines) determine vaccine acceptance, but they matter little among the vaccine hesitant. Vaccine hesitant people do not find a vaccine more attractive even if it has the most favorable attributes. While the communication of vaccine attributes is important, it is unlikely to convince those who are most vaccine hesitant to get vaccinated.

[A new understanding of risk communication in public health emergencies]

Die Risikokommunikation öffentlicher Institutionen soll die Bevölkerung im Falle bestehender Risiken bei der Entscheidungsfindung unterstützen. In gesundheitlichen Notlagen wie der Coronavirus(SARS-CoV-2)-Pandemie spielt sie eine besonders wichtige Rolle. Bereits nach dem SARS-Ausbruch im Jahr 2003 hat die Weltgesundheitsorganisation (WHO) ihre Internationalen Gesundheitsvorschriften (IHR 2005) überarbeitet und gefordert, Risikokommunikation in allen Mitgliedsländern als einen Kernbereich in der Gesundheitspolitik zu etablieren. Während der gesundheitspolitische Akzent begrüßt wurde, konnten die Möglichkeiten der Risikokommunikation in diesem Bereich bisher nicht voll ausgeschöpft werden. Gründe sind u. a. Unstimmigkeiten im Begriffsverständnis der Risikokommunikation und die Vielzahl zur Verfügung stehender Methoden.

Der vorliegende Diskussionsartikel soll dazu beitragen, ein neues Verständnis von Risikokommunikation in Public-Health-Notlagen (Emergency Risk Communication – ERC) zu etablieren. Es wird vorgeschlagen, neben den Risiken die Chancen der Krise stärker einzubeziehen und Risikokommunikation noch mehr als einen kontinuierlichen Prozess zu begreifen, der an verschiedenen Stellen optimierbar ist. Der Earlier-Faster-Smoother-Smarter-Ansatz und hierbei insbesondere die frühere Erkennung von Gesundheitsgefahren (Earlier) könnten das Management von Public-Health-Notlagen zukünftig unterstützen.

BRCA1/2 testing for genetic susceptibility to cancer after 25 years: A scoping review and a primer on ethical implications

BACKGROUND

Mutations in the genes called BRCA1 and BRCA2 are associated with significantly elevated lifetime risk of developing breast and ovarian cancer. This year marks 25 years since genetic tests for BRCA1/2 mutations became available to the public. Currently, comprehensive guidelines exist regarding BRCA1/2 testing and preventive measures in mutation carriers. As such, BRCA1/2 testing represents a precedent not only in genetic testing and management of genetic cancer risk, but also in bioethics. The goal of the current research was to offer a review and an ethical primer of the main ethical challenges related to BRCA testing.

METHOD

A systematic scoping review was undertaken following the PRISMA Extension for Scoping Reviews (PRISMA-ScR). Four databases were searched and 18 articles that met the inclusion criteria were synthetized narratively into a conceptual map.

RESULTS

Ethical discussions revolved around the BRCA1/2 gene discovery, how tests are distributed for clinical use, the choice to undergo testing, unresolved issues in receiving and disclosing test results, reproductive decision-making, and culture-specific ethics. Several unique properties of the latest developments in testing circumstances (e.g., incorporation of BRCA1/2 testing in multi-gene or whole genome sequence panels and tests sold directly to consumers) significantly raised the complexity of ethical debates.

CONCLUSIONS

Multidisciplinary ethical discussion is necessary to guide not only individual decision making but also societal practices and medical guidelines in light of the new technologies available and the latest results regarding psychological, social, and health outcomes in cancer previvors and survivors affected by BRCA mutations.

The role of motivated science reception and numeracy in the context of the COVID-19 pandemic

The successful management of the COVID-19 pandemic depends on individuals accepting the current state of research and adhering to the preventive behaviors that follow from it. However, the processing of scientific results is not always rational, but influenced by prior attitudes as well as the ability to understand statistical data. Against this background, this study investigated the role of motivated reasoning and numeracy in the context of the current pandemic. To this end, participants (N = 417; US sample) evaluated two fictitious studies, one indicating that mask mandates in schools are an effective intervention to contain the spread of SARS-CoV-2, and one indicating that mask mandates in schools are counterproductive. Participants evaluated the studies in line with their prior attitude toward mask mandates. In addition, higher numeracy was associated with decreased bias, demonstrating that the ability to reason with numbers can lead to more accurate processing of statistical information.

Revisiting the Open Sampling format: Improving risky choices through a novel graphical representation

When making risky choices, people often fall short of the norm of expected value (EV) maximization. Previous research has shown that presenting options in the Open Sampling (OSa) format, a 10-by-10 matrix of randomly arranged outcomes, can improve choices and reduce decision times. First, the current research aims to replicate and extend the findings on the OSa format. To this end, we compare OSa to the common description-based format as well as further graphical representations, and investigate the resulting accordance with EV maximization and decision time. Second, we study whether people lower (vs. higher) in numeracy, the ability to use probabilistic and mathematical concepts, particularly benefit from a graphical representation of options. We conducted five high-powered studies (total N = 1,575) in which participants chose repeatedly between two risky gambles, using different populations and gamble-problem sets. Overall, we could not find a benefit of the OSa format in terms of EV accordance in any of the five studies. However, three studies also tested a novel variant of the OSa format with grouped outcomes and found that it consistently improved EV accordance compared with all other formats. All graphical formats led to faster decisions without harming decision quality. The effects of presentation format were not moderated by numeracy in three of the four studies that assessed numeracy. In conclusion, our research introduces a new presentation format which consistently improves risky choices and can also be used to communicate risks in applied contexts such as medical decision making.

Understanding of Numerical Information during the COVID-19 Pandemic

Media news during the Coronavirus Disease 2019 (COVID-19) pandemic often entail complex numerical concepts such as exponential increase or reproduction number. This study investigated whether people have difficulties in understanding such information and whether these difficulties are related to numerical competence, reflective thinking, and risk proneness. One hundred sixty-three participants provided answers to a numeracy scale focusing on complex numerical concepts relevant to COVID-19 (COV Numeracy Scale). They also provided responses to well-established objective and subjective scales, questions about affective states, and questions about the COVID-19 pandemic. Higher scores on the COV Numeracy Scale correlated with higher scores on the Health Numeracy Scale, in the Cognitive Reflection Test (CRT), and in self-assessments of verbal comprehension, mathematical intelligence, and subjective numeracy. Interestingly, scores on the COV Numeracy Scale also positively correlated with the number of consulted information sources about COVID-19. Accuracy in the CRT emerged as a significant predictor, explaining ca. 14% of variance on the COV Numeracy Scale. The results suggest that people with lower reflective thinking skills and lower subjective and objective numerical competence can be more at disadvantage when confronted with COVID-related numerical information in everyday life. These findings advise caution in the communication of relevant public health information that entails complex numerical concepts.

Age differences in COVID-19 risk-taking, and the relationship with risk attitude and numerical ability

This study aimed to investigate age differences in risk-taking concerning the coronavirus pandemic, while disentangling the contribution of risk attitude, objective risk and numeracy. We tested (i) whether older and younger adults differed in taking coronavirus-related health risks, (ii) whether there are age differences in coronavirus risk, risk attitude and numerical ability and (iii) whether these age differences in coronavirus risk, attitude and numerical ability are related to coronavirus risk-taking. The study was observational, with measures presented to all participants in random order. A sample of 469 participants reported their coronavirus-related risk-taking behaviour, objective risk, risk attitude towards health and safety risks, numerical ability and risk perception. Our findings show that age was significantly related to coronavirus risk-taking, with younger adults taking more risk, and that this was partially mediated by higher numeracy, but not objective risk or risk attitude. Exploratory analyses suggest that risk perception for self and others partially mediated age differences in coronavirus risk-taking. The findings of this study may better our understanding of why age groups differ in their adoption of protective behaviours during a pandemic and contribute to the debate whether age differences in risk-taking occur due to decline in abilities or changes in risk attitude.

Pairing facts with imagined consequences improves pandemic-related risk perception

The COVID-19 pandemic reached staggering new peaks during a global resurgence more than a year after the crisis began. Although public health guidelines initially helped to slow the spread of disease, widespread pandemic fatigue and prolonged harm to financial stability and mental well-being contributed to this resurgence. In the late stage of the pandemic, it became clear that new interventions were needed to support long-term behavior change. Here, we examined subjective perceived risk about COVID-19 and the relationship between perceived risk and engagement in risky behaviors. In study 1 (n = 303), we found that subjective perceived risk was likely inaccurate but predicted compliance with public health guidelines. In study 2 (n = 735), we developed a multifaceted intervention designed to realign perceived risk with actual risk. Participants completed an episodic simulation task; we expected that imagining a COVID-related scenario would increase the salience of risk information and enhance behavior change. Immediately following the episodic simulation, participants completed a risk estimation task with individualized feedback about local viral prevalence. We found that information prediction error, a measure of surprise, drove beneficial change in perceived risk and willingness to engage in risky activities. Imagining a COVID-related scenario beforehand enhanced the effect of prediction error on learning. Importantly, our intervention produced lasting effects that persisted after a 1- to 3-wk delay. Overall, we describe a fast and feasible online intervention that effectively changed beliefs and intentions about risky behaviors.

Effects of communicating uncertainty descriptions in hazard identification, risk characterization, and risk protection

Uncertainty is a crucial issue for any risk assessment. Consequently, it also poses crucial challenges for risk communications. Many guidebooks advise reporting uncertainties in risk assessments, expecting that the audience will appreciate this disclosure. However, the empirical evidence about the effects of uncertainty reporting is sparse and inconclusive. Therefore, based on examples of potential health risks of electromagnetic fields (EMF), three experiments were conducted analysing the effects of communicating uncertainties separately for hazard identification, risk characterisation and risk protection. The setups aimed to explore how reporting and how explaining of uncertainty affects dependent variables such as risk perception, perceived competence of the risk assessors, and trust in risk management. Each of the three experiments used a 2x2 design with a first factor presenting uncertainty descriptions (as used in public controversies on EMF related health effects) or describing a certainty conditions; and a second factor explaining the causes of uncertainties (by pointing at knowledge gaps) or not explaining them. The study results indicate that qualitative uncertainty descriptions regarding hazard identification reduce the confidence in the professional competencies of the assessors. In contrast, a quantitative uncertainty description in risk characterisation-regarding the magnitude of the risk-does not affect any of the dependent variables. Concerning risk protection, trust in exposure limit values is not affected by qualitative uncertainty information. However, the qualitative description of uncertainty regarding the adequacy of protection amplifies fears. Furthermore, explaining this uncertainty results in lower text understandability.

Parental Risk Literacy is Related to Quality of Life in Spanish Families of Children with Autism Spectrum Disorder

Families of children with autism spectrum disorder (ASD) often experience much more negative perceptions of their family quality of life (FQoL). To investigate key factors that may shape these experiences, we conducted a case-control study of sixty-one Spanish families (29 with a child with ASD) using a broad psychosocial assessment (e.g., ASD severity, social support, demographics), including the first direct test of the relationship between FQoL and parental risk literacy (i.e., the ability to evaluate and understand risk, as measured by numeracy). Results revealed that numeracy was associated with differences in perceived FQoL among families of children with ASD (R² = .10), a finding that held across several models statistically controlling for the influence of other variables. Findings suggest that parental risk literacy skills may generally be associated with differences in decision making vulnerabilities (e.g., risk evaluation and interpretation) that influence family outcomes including FQoL.

Informed consent in inflammatory bowel disease: a necessity in real-world clinical practice

In modern medicine, any medical intervention has to be supported by a patient's informed consent. Challenges to this process include the specificity and complexity of medical information being provided, the patient's ability to comprehend the information, the medical uncertainty of the outcomes, and the physician's legal concerns. Important elements of the consent process are respect for the patient's autonomy and self-determination, appropriate disclosure and verification of their understanding, and voluntariness. In inflammatory bowel disease (IBD), pharmaceutical treatment carries significant risks, making discussion and illustration of the treatment critical for decision making. This review aims to emphasize the importance of the informed consent process in routine IBD clinical practice, and suggests an appropriate way of informing patients about the medical treatment on offer. The information that has to be comprehensively presented before consent includes: i) treatment goal; ii) basic characteristics of treatment (route and timetable of drug administration, drug efficacy, adverse events); and iii) consequences of staying untreated. The IBD physician's main concerns must include ensuring not only that the information being provided is detailed and objective, but also that the decision-making process is shared with the patient. Ultimately, the process of obtaining informed consent in real-world clinical practice is undoubtedly of great importance, for both upholding the principles of medical ethics and avoiding legal conflicts.

Worry, Risk Perception, and Controllability Predict Intentions Toward COVID-19 Preventive Behaviors

The ongoing pandemic of COVID-19 has already had serious worldwide health, socio-economic, political, and educational consequences. In the present study, we investigated what factors can motivate young adults to comply with the recommended preventive measures against coronavirus infection. Even though young people are less likely to suffer severe medical consequences from the virus, they can still transmit it to more vulnerable individuals. Surprisingly, we found no significant effects of previously successful experimental manipulations (e.g., enhancing self-efficacy, and visual aids) that aimed to improve risk understanding and impact COVID-19 related behavioral intentions. Instead, intentions toward preventive behaviors were predicted by self-reported worry, perceived controllability of the pandemic, and risk perception. Interestingly, worry about health, and worry about restricting personal freedom predicted behavioral intentions in diverging directions. In particular, participants who were worried about health, were more willing to obey strict hygiene and social distancing restrictions. In contrast, participants who were worried about personal restrictions, were less ready to adopt these preventive actions.

Effects of Cognitive Functioning and Education on Later-Life Health Numeracy

INTRODUCTION

Previous studies have shown an association between a high health numeracy and good cognitive functioning.

OBJECTIVE

To investigate the moderation effect of education on this relationship and which brain structures support health numeracy.

METHODS

We examined 70 healthy older persons (66% females; mean ± SD: age, 75.73 ± 4.52 years; education, 12.21 ± 2.94 years). The participants underwent a T1-weighted 3-T MRI and a neuropsychological assessment including a health numeracy task. Statistical parametric mapping was applied to identify focal changes in cortical thickness throughout the entire brain and to correlate image parameters with behavioral measures.

RESULTS

Executive functions and mental calculation emerged as predictors of health numeracy (B = 0.22, p < 0.05, and B = 0.38, p < 0.01). An interaction was found between education and executive functions (B = -0.16, p = 0.01) and between education and mental calculation (B = -0.11, p < 0.05). Executive functions and mental calculation had an impact on health numeracy in participants with a low to intermediate edu-cation (≤12 years) but not in those with a higher education (>12 years). Health numeracy scores were associated with cortical thickness in the right dorsomedial prefrontal cortex and the right superior temporal gyrus (p = 0.01).

CONCLUSIONS

Older people with a higher education perform better in health numeracy tasks than those with a lower education. They have access to previously acquired knowledge about ratio concepts and do not need to rely on executive functions and computational skills. This is highly relevant when decisions about health care have to be made.

Recognizing a Heart Attack: Patients' Knowledge of Cardiovascular Risk Factors and Its Relation to Prehospital Decision Delay in Acute Coronary Syndrome

In acute coronary syndromes (ACSs), longer decision delay - the time patients wait before seeking medical attention after symptoms have started - increases the risk of complications and death. However, many patients wait much longer than recommended and research is needed investigating how patient decision delay can be reduced. In a cross-sectional study of 120 ACS survivors, we investigated the relationship between knowledge of cardiovascular risk factors and decision delay. Several days after the onset of a cardiac event, patients completed a questionnaire measuring demographics, decision delay, objective knowledge of cardiovascular risks factors and of ACS symptoms, and subjective perceptions of symptoms during the cardiac episode. Relevant clinical data were extracted from patients' medical records. In a multiple linear regression analysis, controlling for demographic and clinical factors, objective knowledge of cardiovascular risk factors and ACS symptoms, and subjective attributions of symptoms to a cardiac cause were related to shorter decision delays. Among patients with relatively high knowledge of risk factors, only 5% waited more than 1 h to seek help, compared to 22% among patients with relatively low knowledge. These results suggest that knowledge of the factors that increase the risk of developing cardiovascular disease could play a role in patient decision making during an acute cardiac event. We discuss methodological issues and potential underlying mechanisms related to decision heuristics and biases, which can inform future research.