How numeracy influences risk comprehension and medical decision making

The relationship between numerical magnitude processing and math anxiety, and their joint effect on adult math performance, varied by indicators of numerical tasks

According to the hypothesis of Maloney et al. (Cognition 114(2):293-297, 2010. https://doi.org/10.1016/j.cognition.2009.09.013), math anxiety is related to deficits in numerical magnitude processing, which in turn compromises the development of advanced math skills. Because previous studies on this topic are contradictory, which may be due to methodological differences in the measurement of numerical magnitude processing, we tested Maloney et al.'s hypothesis using different tasks and their indicators: numerical magnitude processing (symbolic and non-symbolic comparison tasks: accuracy, reaction time, numerical ratio, distance and size effects, and Weber fraction; number line estimation task: estimation error), math anxiety (combined scores of learning, testing, math problem solving, and general math anxiety), and math performance. The results of our study conducted on 119 young adults mostly support the hypothesis proposed by Maloney et al. that deficiency in symbolic magnitude processing is related to math anxiety, but the relationship between non-symbolic processes and math anxiety was opposite to the assumptions. Moreover, the results indicate that estimation processes (but not comparison processes) and math anxiety are related to math performance in adults. Finally, high math anxiety moderated the relationship between reaction time in the symbolic comparison task, reaction time in the non-symbolic comparison task, numerical ratio effect in the symbolic comparison task, and math performance. Because the results of the joint effect of numerical magnitude processing and math anxiety on math performance were inconsistent, this part of the hypothesis is called into question.

Icon Arrays for Medical Risk Communication: Do Icon Type and Color Influence Cardiovascular Risk Perception and Recall?

BACKGROUND

Icon arrays have been shown to be an effective method for communicating medical risk information. However, in practice, icon arrays used to visualize personal risks often differ in the type and color of the icons. The aim of this study was to examine the influence of icon type and color on the perception and recall of cardiovascular risk, as little is known about how color affects the perception of icon arrays.

METHODS

A total of 866 participants aged 40 to 90 years representative of the German population in terms of gender and age completed an online experiment. Using a 2 × 2 between-subjects design, participants were randomly assigned to 1 of 4 experimental groups. They received their hypothetical 10-year cardiovascular risk using an icon array that varied by icon type (smiley v. person) and color (black/white v. red/yellow). We measured risk perception, emotional response, intentions of taking action to reduce the risk (e.g., increasing one's physical activity), risk recall, and graph evaluation/trustworthiness, as well as numeracy and graphical literacy.

RESULTS

Icon arrays using person icons were evaluated more positively. There was no effect of icons or color on risk perception, emotional response, intentions of taking action to reduce the risk, or trustworthiness of the graph. While more numerate/graphical literate participants were more likely to correctly recall the presented risk estimate, icon type and color did not influence the probability of correct recall.

CONCLUSIONS

Differences in the perception of the tested icon arrays were rather small, suggesting that they may be equally suitable for communicating medical risks. Further research on the robustness of these results across other colors, icons, and risk domains could add to guidelines on the design of visual aids.

HIGHLIGHTS

The use of different icons and colors did not influence the perception and the probability of recalling the 10-year cardiovascular risk, the emotional response, or the intentions to reduce the presented risk.Icon arrays with person icons were evaluated more positively.There was no evidence to suggest that the effectiveness of the studied icon arrays varied based on individuals' levels of numerical or graphical literacy, nor did it differ between people with or without a history of CVD or on medication for an increased CVD risk.

Factors influencing U.S. women's interest and preferences for breast cancer risk communication: a cross-sectional study from a large tertiary care breast imaging center

BACKGROUND

Breast imaging clinics in the United States (U.S.) are increasingly implementing breast cancer risk assessment (BCRA) to align with evolving guideline recommendations but with limited uptake of risk-reduction care. Effectively communicating risk information to women is central to implementation efforts, but remains understudied in the U.S. This study aims to characterize, and identify factors associated with women's interest in and preferences for breast cancer risk communication.

METHODS

This is a cross-sectional survey study of U.S. women presenting for a mammogram between January and March of 2021 at a large, tertiary breast imaging clinic. Survey items assessed women's interest in knowing their risk and preferences for risk communication if considered to be at high risk in hypothetical situations. Multivariable logistic regression modeling assessed factors associated with women's interest in knowing their personal risk and preferences for details around exact risk estimates.

RESULTS

Among 1119 women, 72.7% were interested in knowing their breast cancer risk. If at high risk, 77% preferred to receive their exact risk estimate and preferred verbal (52.9% phone/47% in-person) vs. written (26.5% online/19.5% letter) communications. Adjusted regression analyses found that those with a primary family history of breast cancer were significantly more interested in knowing their risk (OR 1.5, 95% CI 1.0, 2.1, p = 0.04), while those categorized as "more than one race or other" were significantly less interested in knowing their risk (OR 0.4, 95% CI 0.2, 0.9, p = 0.02). Women 60 + years of age were significantly less likely to prefer exact estimates of their risk (OR 0.6, 95% CI 0.5, 0.98, p < 0.01), while women with greater than a high school education were significantly more likely to prefer exact risk estimates (OR 2.5, 95% CI 1.5, 4.2, p < 0.001).

CONCLUSION

U.S. women in this study expressed strong interest in knowing their risk and preferred to receive exact risk estimates verbally if found to be at high risk. Sociodemographic and family history influenced women's interest and preferences for risk communication. Breast imaging centers implementing risk assessment should consider strategies tailored to women's preferences to increase interest in risk estimates and improve risk communication.

Gist Knowledge and Misinformation Acceptance: An Application of Fuzzy Trace Theory

Applying fuzzy trace theory to misinformation related to COVID-19, the present study (a) examines the roles of gist knowledge in predicting misinformation acceptance, and (b) further examines whether a gist cue in fact checking scales affects the level of gist knowledge. Study 1 (a survey) showed that categorical gist knowledge was negatively related to misinformation acceptance, whereas ordinal gist knowledge was not, when both types of knowledge were included in the model. In addition, Study 2 (an experiment) showed that fact checking scales containing a categorical gist cue resulted in greater categorical gist knowledge.

Diversity of spatial activities and parents' spatial talk complexity predict preschoolers' gains in spatial skills

Children's spatial activities and parental spatial talk were measured to examine their associations with variability in preschoolers' spatial skills (N = 113, Mage = 4 years, 4 months; 51% female; 80% White, 11% Black, and 9% other). Parents who reported more diversity in daily spatial activities and used longer spatial talk utterances during a spatial activity had children with greater gains in spatial skills from ages 4 to 5 (β = .17 and β = .40, respectively). Importantly, this study is the first to move beyond frequency counts of spatial input and investigate the links among the diversity of children's daily spatial activities, as well as the complexity of parents' spatial language across different contexts, and preschoolers' gains in spatial skills, an important predictor of later STEM success.

"R" you getting this? Factors contributing to the public's understanding, evaluation, and use of basic reproduction numbers for infectious diseases

BACKGROUND

We (1) examined the effects of evaluative labels and visual aids on people's understanding, evaluation, and use of the COVID-19 reproduction number (or "r-number"), (2) examined whether people's perceived susceptibility and (intended) adherence to preventive measures changed after being exposed to the r-number, and (3) explored whether these effects and changes depended on people's numeracy skills.

METHODS

In an online experiment, participants from a large Dutch representative sample (N = 1,168) received information about the COVID-19 r-number displayed on the corona dashboard of the Dutch Ministry of Health, Welfare and Sport. The r-number was either presented with or without a categorical line display (i.e., evaluative label) and with or without an icon-based tree diagram (i.e., visual aid) explaining how the number works. Regarding people's use of the statistic, we measured perceived susceptibility to COVID-19 and adherence (intention) to five preventive measures before and after exposure to the r-number. After exposure, we also measured participants' understanding, perceived usefulness, affective and cognitive evaluation, and objective numeracy.

RESULTS

About 56% of participants correctly interpreted the r-number, with highly numerate people having better understanding than less numerate people. Information about the r-number was perceived as more useful when presented with a visual aid. There were no differences across experimental conditions in people's understanding, affective, and cognitive evaluations. Finally, independent of experimental conditions, intention to adhere to preventive measures was higher after seeing the r-number, but only among highly numerate people.

CONCLUSIONS

Although evaluative labels and visual aids did not facilitate people's understanding and evaluation of the r-number, our results show that the statistic is perceived as useful and may be used to stimulate adherence to preventive measures. Policy makers and public health communicators are advised to clearly explain why they are giving these numbers to - especially - the less numerate people, but also how people could use them for behavior change to combat the spread of virus during a pandemic.

Understanding Symptom Self-Monitoring Needs Among Postpartum Black Patients: Qualitative Interview Study

BACKGROUND

Pregnancy-related death is on the rise in the United States, and there are significant disparities in outcomes for Black patients. Most solutions that address pregnancy-related death are hospital based, which rely on patients recognizing symptoms and seeking care from a health system, an area where many Black patients have reported experiencing bias. There is a need for patient-centered solutions that support and encourage postpartum people to seek care for severe symptoms.

OBJECTIVE

We aimed to determine the design needs for a mobile health (mHealth) patient-reported outcomes and decision-support system to assist Black patients in assessing when to seek medical care for severe postpartum symptoms. These findings may also support different perinatal populations and minoritized groups in other clinical settings.

METHODS

We conducted semistructured interviews with 36 participants-15 (42%) obstetric health professionals, 10 (28%) mental health professionals, and 11 (31%) postpartum Black patients. The interview questions included the following: current practices for symptom monitoring, barriers to and facilitators of effective monitoring, and design requirements for an mHealth system that supports monitoring for severe symptoms. Interviews were audio recorded and transcribed. We analyzed transcripts using directed content analysis and the constant comparative process. We adopted a thematic analysis approach, eliciting themes deductively using conceptual frameworks from health behavior and human information processing, while also allowing new themes to inductively arise from the data. Our team involved multiple coders to promote reliability through a consensus process.

RESULTS

Our findings revealed considerations related to relevant symptom inputs for postpartum support, the drivers that may affect symptom processing, and the design needs for symptom self-monitoring and patient decision-support interventions. First, participants viewed both somatic and psychological symptom inputs as important to capture. Second, self-perception; previous experience; sociocultural, financial, environmental, and health systems-level factors were all perceived to impact how patients processed, made decisions about, and acted upon their symptoms. Third, participants provided recommendations for system design that involved allowing for user control and freedom. They also stressed the importance of careful wording of decision-support messages, such that messages that recommend them to seek care convey urgency but do not provoke anxiety. Alternatively, messages that recommend they may not need care should make the patient feel heard and reassured.

CONCLUSIONS

Future solutions for postpartum symptom monitoring should include both somatic and psychological symptoms, which may require combining existing measures to elicit symptoms in a nuanced manner. Solutions should allow for varied, safe interactions to suit individual needs. While mHealth or other apps may not be able to address all the social or financial needs of a person, they may at least provide information, so that patients can easily access other supportive resources.

Preliminary Evidence for a Positive Relation Between the COMT rs4680 Met/Met Genotype and Math Achievement

To identify if COMT polymorphisms interact with executive functions as predictors of math skills, we assessed 38 adolescents (mean age = 16.4 ± 0.80 years, IQ > 80) from a larger study of high-school students screened for their mathematical abilities. Adolescents were genotyped for the COMT Val158Met polymorphism (grouped as Met/Met or Val-carriers) and completed the WRAT math achievement test, working-memory, inhibitory-control, and shifting tasks. Met/Met-carriers achieved higher WRAT scores than the Val-carriers (W = 229, p = .009). Genotype group was a moderate-to-strong predictor of WRAT scores (β = 0.56 to 0.74). No genotype/executive-function interaction was detected. Our findings suggest that the rs4680 Met/Met genotype is positively associated with math achievement.

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.

Infographics on risks associated with COVID-19 and the willingness to get the AstraZeneca vaccine: two randomized online experiments

BACKGROUND

Germans hesitated to get vaccinated with AstraZeneca in the COVID-19 pandemic after reports of blood clots.

METHODS

In two preregistered online experiments with stratified randomization (Study 1 N = 824, Study 2: N = 1,056), we tested whether providing evidence-based benefit-risk information reduces the perceived risk of the AstraZeneca vaccine and the perceived probability of blood clots due to the AstraZeneca vaccine and increases the vaccination intention. In Study 1, participants saw no infographic (control) or one of two infographics (low vs. high exposure risk varied by the underlying incidence rates). Study 2 additionally varied the infographic design displaying the risk information (presented as table, circle icons, or manikin-like icons).

RESULTS

The infographic decreased the risk perception of the vaccine compared to no infographic (Study 1: Cohens d = 0.31, 95% CI [0.14, 0.48]; Study 2: Cohens d = 0.34, 95% CI [0.06, 0.62]), but it did not influence the perceived probability of blood clots due to the AstraZeneca vaccine (Study 2: Cohens d = 0.05, 95% CI [-0.23, 0.33]). Also, the infographic design did not affect the perceived probability of blood clots (Study 2). The vaccination intention was not affected by viewing the infographic (Study 1: Cohens d = 0.04, 95% CI [-0.13, 0.21]; Study 2: Cohens d = 0.04, 95% CI [-0.24, 0.32]) nor the presented infection rate (Study 1: Cohens d = 0.07, 95% CI [-0.09, 0.24], Study 2: Cohens d = 0.01, 95% CI [-0.12, 0.15]) but by risk perceptions, sociodemographic characteristics, confidence in the AstraZeneca vaccine, and preference for alternative vaccines.

CONCLUSIONS

The evidence-based benefit-risk information helped putting the risk of vaccinations into perspective. Nevertheless, objective risk information alone did not affect vaccination intention that was low due to the preexisting lacking vaccine confidence.

Anxiety about Mathematics and Reading in Preadolescents Is Domain-Specific

It was investigated whether test anxiety (TA), mathematics anxiety (MA), and reading anxiety (RA) can be traced back to some type of general academic anxiety or whether these are separable. A total of 776 fifth graders (Mage = 10.9 years) completed questionnaires on TA, MA, and RA, as well as a mathematics test. Also, mathematics and reading performance results from the National Tracking System were requested. The sample was randomly split into two halves. Confirmatory factor analyses showed that a three-factor model (factors: TA, MA, RA) had superior model fit compared with a one-factor model (factor: "Academic anxiety"), in both halves. The resulting anxiety factors were related to math performance measures using structural equation models. A scarcity of data on reading performance prevented the analysis of links between anxiety and reading performance. Anxiety-math performance relations were stronger for MA than for TA and MA. We concluded that TA, MA, and RA are separable constructs.

ChatGPT in medical school: how successful is AI in progress testing?

BACKGROUND

As generative artificial intelligence (AI), ChatGPT provides easy access to a wide range of information, including factual knowledge in the field of medicine. Given that knowledge acquisition is a basic determinant of physicians' performance, teaching and testing different levels of medical knowledge is a central task of medical schools. To measure the factual knowledge level of the ChatGPT responses, we compared the performance of ChatGPT with that of medical students in a progress test.

METHODS

A total of 400 multiple-choice questions (MCQs) from the progress test in German-speaking countries were entered into ChatGPT's user interface to obtain the percentage of correctly answered questions. We calculated the correlations of the correctness of ChatGPT responses with behavior in terms of response time, word count, and difficulty of a progress test question.

RESULTS

Of the 395 responses evaluated, 65.5% of the progress test questions answered by ChatGPT were correct. On average, ChatGPT required 22.8 s (SD 17.5) for a complete response, containing 36.2 (SD 28.1) words. There was no correlation between the time used and word count with the accuracy of the ChatGPT response (correlation coefficient for time rho = -0.08, 95% CI [-0.18, 0.02], t(393) = -1.55, p = 0.121; for word count rho = -0.03, 95% CI [-0.13, 0.07], t(393) = -0.54, p = 0.592). There was a significant correlation between the difficulty index of the MCQs and the accuracy of the ChatGPT response (correlation coefficient for difficulty: rho = 0.16, 95% CI [0.06, 0.25], t(393) = 3.19, p = 0.002).

CONCLUSION

ChatGPT was able to correctly answer two-thirds of all MCQs at the German state licensing exam level in Progress Test Medicine and outperformed almost all medical students in years 1-3. The ChatGPT answers can be compared with the performance of medical students in the second half of their studies.

Cognitive Foundations of Early Mathematics: Investigating the Unique Contributions of Numerical, Executive Function, and Spatial Skills

There is an emerging consensus that numerical, executive function (EF), and spatial skills are foundational to children's mathematical learning and development. Moreover, each skill has been theorized to relate to mathematics for different reasons. Thus, it is possible that each cognitive construct is related to mathematics through distinct pathways. The present study tests this hypothesis. One-hundred and eighty 4- to 9-year-olds (Mage = 6.21) completed a battery of numerical, EF, spatial, and mathematics measures. Factor analyses revealed strong, but separable, relations between children's numerical, EF, and spatial skills. Moreover, the three-factor model (i.e., modelling numerical, EF, and spatial skills as separate latent variables) fit the data better than a general intelligence (g-factor) model. While EF skills were the only unique predictor of number line performance, spatial skills were the only unique predictor of arithmetic (addition) performance. Additionally, spatial skills were related to the use of more advanced addition strategies (e.g., composition/decomposition and retrieval), which in turn were related to children's overall arithmetic performance. That is, children's strategy use fully mediated the relation between spatial skills and arithmetic performance. Taken together, these findings provide new insights into the cognitive foundations of early mathematics, with implications for assessment and instruction moving forward.

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.

Rural adults' perceptions of nutrition recommendations for cancer prevention: Contradictory and conflicting messages

Despite robust evidence linking alcohol, processed meat, and red meat to colorectal cancer (CRC), public awareness of nutrition recommendations for CRC prevention is low. Marginalized populations, including those in rural areas, experience high CRC burden and may benefit from culturally tailored health information technologies. This study explored perceptions of web-based health messages iteratively in focus groups and interviews with 48 adults as part of a CRC prevention intervention. We analyzed transcripts for message perceptions and identified three main themes with subthemes: (1) Contradictory recommendations, between the intervention's nutrition risk messages and recommendations for other health conditions, from other sources, or based on cultural or personal diets; (2) reactions to nutrition risk messages, ranging from aversion (e.g., "avoid alcohol" considered "preachy") to appreciation, with suggestions for improving messages; and (3) information gaps. We discuss these themes, translational impact, and considerations for future research and communication strategies for delivering web-based cancer prevention messages.

Cognitive chicken or the emotional egg? How reconceptualizing decision-making by integrating cognition and emotion can improve task psychometrics and clinical utility

Decision-making is an executive function, tapping into cognitive, emotional, and personality-based components. This complexity, and the varying operational definitions of the construct, is reflected in the rich array of behavioral decision-making tasks available for use in research and clinical settings. In many cases, these tasks are "subfield-specific," with tasks developed by cognitive psychologists focusing on cognitive aspects of decision-making and tasks developed by clinical psychologists focusing on interactions between emotional and cognitive aspects. Critically, performance across different tasks does not consistently correlate, obfuscating the ability to compare scores between measures and detect changes over time. Differing theories as to what cognitive and/or emotional aspects affect decision-making likely contribute to this lack of consistency across measures. The low criterion-related validity among decision-making tasks and lack of consistent measurement of the construct presents challenges for emotion and decision-making scholars. In this perspective, we provide several recommendations for the field: (a) assess decision-making as a specific cognitive ability versus a taxonomy of cognitive abilities; (b) a renewed focus on convergent validity across tasks; (c) further assessment of test-retest reliability versus practice effects on tasks; and (d) reimagine future decision-making research to consider the research versus clinical implications. We discuss one example of decision-making research applied to clinical settings, acquired brain injury recovery, to demonstrate how some of these concerns and recommendations can affect the ability to track changes in decision-making across time.

The effects of communicating uncertainty around statistics, on public trust

Uncertainty around statistics is inevitable. However, communicators of uncertain statistics, particularly in high-stakes and potentially political circumstances, may be concerned that presenting uncertainties could undermine the perceived trustworthiness of the information or its source. In a large survey experiment (Study 1; N = 10 519), we report that communicating uncertainty around present COVID-19 statistics in the form of a numeric range (versus no uncertainty) may lead to slightly lower perceived trustworthiness of the number presented but has no impact on perceived trustworthiness of the source of the information. We also show that this minimal impact of numeric uncertainty on trustworthiness is also present when communicating future, projected COVID-19 statistics (Study 2; N = 2,309). Conversely, we find statements about the mere existence of uncertainty, without quantification, can reduce both perceived trustworthiness of the numbers and of their source. Our findings add to others suggesting that communicators can be transparent about statistical uncertainty without undermining their credibility as a source but should endeavour to provide a quantification, such as a numeric range, where possible.

Relative Contributions of g and Basic Domain-Specific Mathematics Skills to Complex Mathematics Competencies

Meta-analytic structural equation modeling was used to estimate the relative contributions of general cognitive ability or g (defined by executive functions, short-term memory, and intelligence) and basic domain-specific mathematical abilities to performance in more complex mathematics domains. The domain-specific abilities included mathematics fluency (e.g., speed of retrieving basic facts), computational skills (i.e., accuracy at solving multi-step arithmetic, algebra, or geometry problems), and word problems (i.e., mathematics problems presented in narrative form). The core analysis included 448 independent samples and 431,344 participants and revealed that g predicted performance in all three mathematics domains. Mathematics fluency contributed to the prediction of computational skills, and both mathematics fluency and computational skills predicted word problem performance, controlling g. The relative contribution of g was consistently larger than basic domain-specific abilities, although the latter may be underestimated. The patterns were similar across younger and older individuals, individuals with and without a disability (e.g., learning disability), concurrent and longitudinal assessments, and family socioeconomic status, and have implications for fostering mathematical development.

Statistical Literacy in Hand and Upper-Extremity Patients

Purpose

Statistical literacy is the ability of a patient to apply basic statistical concepts to their health care. Understanding statistics is a critical component of shared decision making. The purpose of this investigation was to define levels of statistical literacy in an upper-extremity (UE) patient population. We aimed to determine if patient demographics would be associated with statistical literacy.

Methods

An electronic survey was administered to a consecutive series of UE patients at a single institution. We recorded baseline demographics, Single Assessment Numeric Evaluation scores, the Berlin Numeracy Test (BNT), and General Health Numeracy Test. We also included a surgical risk question, which asked: "Approximately 3% of patients who get carpal tunnel surgery develop an infection. If 100 patients get this surgery, how many would you expect to develop an infection?" A covariate-controlled adjusted odds ratio reflecting the association between each statistical literacy outcome measure and patient characteristics was reported.

Results

A total 254 surveys were administered, 148 of which were completed and included. Fifty percent of respondents had a high-school education or less. For the BNT, 78% scored in the bottom quartile, and 52% incorrectly answered all questions. For the General Health Numeracy Test, 34% answered 0 or 1/6 questions correctly. For the surgical risk question, 24% of respondents answered incorrectly. Respondents who had a college or graduate degree had 2.62 times greater odds (95% confidence interval, 1.09-6.32) of achieving a BNT score in a higher quartile than patients who did not have a college or graduate degree.

Conclusions

Overall levels of statistical literacy are low for UE patients.

Clinical relevance

When engaging in management discussions and shared decision making, UE surgeons should assume low levels of statistical literacy. Consideration of alternative formats, such as frequencies, video-based materials, and pictographs, may be warranted when discussing outcomes and risks of surgical procedures.

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.

Surgeon's steering behaviour towards patients to participate in a cluster randomised trial on active surveillance for oesophageal cancer: A qualitative study

INTRODUCTION

Few studies have been conducted into how physicians use steering behaviour that may persuade patients to choose for a particular treatment, let alone to participate in a randomised trial. The aim of this study is to assess if and how surgeons use steering behaviour in their information provision to patients in their choice to participate in a stepped-wedge cluster randomised trial investigating an organ sparing treatment in (curable) oesophageal cancer (SANO trial).

MATERIALS AND METHODS

A qualitative study was performed. Thematic content analysis was applied to audiotaped and transcribed consultations of twenty patients with eight different oncological surgeons in three Dutch hospitals. Patients could choose to participate in a clinical trial in which an experimental treatment of 'active surveillance' (AS) was offered. Patients who did not want to participate underwent standard treatment: neoadjuvant chemoradiotherapy followed by oesophagectomy.

RESULTS

Surgeons used various techniques to steer patients towards one of the two options, mostly towards AS. The presentation of pros and cons of treatment options was imbalanced: positive framing of AS was used to steer patients towards the choice for AS, and negative framing of AS to make the choice for surgery more attractive. Further, steering language, i.e. suggestive language, was used, and surgeons seemed to use the timing of the introduction of the different treatment options, to put more focus on one of the treatment options.

CONCLUSION

Awareness of steering behaviour can help to guide physicians in more objectively informing patients on participation in future clinical trials.

The Lure of Beauty: People Select Representations of Statistical Information Largely Based on Attractiveness, Not Comprehensibility

OBJECTIVE

People differ in whether they understand graphical or numerical representations of statistical information better. However, assessing these skills is often not feasible when deciding which representation to select or use. This study investigates whether people choose the representation they understand better, whether this choice can improve risk comprehension, and whether results are influenced by participants' skills (graph literacy and numeracy).

METHODS

In an experiment, 160 participants received information about the benefits and side effects of painkillers using either a numerical or a graphical representation. In the "no choice" condition, the representation was randomly assigned to each participant. In the "choice" condition, participants could select the representation they would like to receive. The study assessed gist and verbatim knowledge (immediate comprehension and recall), accessibility of the information, attractiveness of the representation, as well as graph literacy and numeracy.

RESULTS

In the "choice" condition, most (62.5%) chose the graphical format, yet there was no difference in graph literacy or numeracy (nor age or gender) between people who chose the graphical or the numerical format. Whereas choice slightly increased verbatim knowledge, it did not improve gist or overall knowledge compared with random assignment. However, participants who chose a representation rated the representation as more attractive, and those who chose graphs rated them as more accessible than those without a choice.

LIMITATIONS

The sample consisted of highly educated undergraduate students with higher graph literacy than the general population. The task was inconsequential for participants in terms of their health.

CONCLUSIONS

When people can choose between representations, they fail to identify what they comprehend better but largely base that choice on how attractive the representation is for them.

HIGHLIGHTS

People differ systematically in whether they understand graphical or numerical representations of statistical information better. However, assessing these underlying skills to get the right representation to the right people is not feasible in practice. A simple and efficient method to achieve this could be to let people choose among representations themselves.However, our study showed that allowing participants to choose a representation (numerical v. graphical) did not improve overall or gist knowledge compared with determining the representation randomly, even though it did slightly improve verbatim knowledge.Rather, participants largely chose the representation they found more attractive. Most preferred the graphical representation, including those with low graph literacy.It would therefore be important to develop graphical representations that are not only attractive but also comprehensible even for people with low graph literacy.

Do colored cells in risk matrices affect decision-making and risk perception? Insights from randomized controlled studies

Risk matrices communicate the likelihood and potential impact of risks and are often used to inform decision-making around risk mitigations. The merits and demerits of risk matrices in general have been discussed extensively, yet little attention has been paid to the potential influence of color in risk matrices on their users. We draw from fuzzy-trace theory and hypothesize that when color is present, individuals are likely to place greater value on reducing risks that cross color boundaries (i.e., the boundary-crossing effect), leading to sub-optimal decision making. In two randomized controlled studies, employing forced-choice and willingness-to-pay measures to investigate the boundary-crossing effect in two different color formats for risk matrices, we find preliminary evidence to support our hypotheses that color can influence decision making. The evidence also suggests that the boundary-crossing effect is only present in, or is stronger for, higher numeracy individuals. We therefore recommend that designers should consider avoiding color in risk matrices, particularly in situations where these are likely to be used by highly numerate individuals, if the communication goal is to inform in an unbiased way.

Same Score, Different Audience, Different Message: Perceptions of Sex Offense Risk Depend on Static-99R Risk Level and Personality Factors of the Recipient

There are multiple ways to report risk scale results. Varela et al. (2014) found that Static-99R results were interpreted differently by prospective jurors based on risk level (high vs low) and an interaction between risk level and risk communication format (categorical, absolute estimate, and risk ratio). We adapted and extended Varela et al.'s (2014) study using updated Static-99R norms, recruiting a population-wide sample (n = 166), and adding variables assessing the personality factors 'cognitive motivation' (i.e., need for cognition) and 'attitudinal affect' (i.e., attitudes toward sex offenders, authoritarianism). We found a main effect of risk level and no effect of either communication format or the interaction between the two. Adding the personality variables increased explained variance from 9% to 34%, suggesting risk perception may be more about the personality of the person receiving the information than the information itself. We also found an interaction between attitudes toward sex offenders and risk level. Our results suggest risk perception might be better understood if personality factors are considered, particularly attitudes toward sex offenders. Because biases/personality of the person receiving the information are unknown in real world settings we argue that sharing multiple methods for communicating risk might be best and more inclusive.

Visualizing risky situations induces a stronger neural response in brain areas associated with mental imagery and emotions than visualizing non-risky situations

In an fMRI study, we tested the prediction that visualizing risky situations induces a stronger neural response in brain areas associated with mental imagery and emotions than visualizing non-risky and more positive situations. We assumed that processing mental images that allow for "trying-out" the future has greater adaptive importance for risky than non-risky situations, because the former can generate severe negative outcomes. We identified several brain regions that were activated when participants produced images of risky situations and these regions overlap with brain areas engaged in visual, speech, and movement imagery. We also found that producing images of risky situations, in contrast to non-risky situations, was associated with increased neural activation in the insular cortex and cerebellum-the regions involved, among other functions, in emotional processing. Finally, we observed an increased BOLD signal in the cingulate gyrus associated with reward-based decision making and monitoring of decision outcomes. In summary, risky situations increased neural activation in brain areas involved in mental imagery, emotional processing, and decision making. These findings imply that the evaluation of everyday risky situations may be driven by emotional responses that result from mental imagery.

Evaluation of a decision support system using Bayesian network modeling in an applied Multi-INT surveillance environment

Sensemaking and decision-making are fundamental components of applied Intelligence, Surveillance, and Reconnaissance (ISR). Analysts acquire information from multiple sources over a period of hours, days, or even over the scale of months or years, that must be interpreted and integrated to predict future adversarial events. Sensemaking is essential for developing an appropriate mental model that will lead to accurate predictions sooner. Decision Support Systems (DSS) are one proposed solution to improve analyst decision-making outcomes by leveraging computers to conduct calculations that may be difficult for human operators and provide recommendations. In this study, we tested two simulated DSS that were informed by a Bayesian Network Model as a potential prediction-assistive tool. Participants completed a simulated multi-day, multi-source intelligence task and were asked to make predictions regarding five potential outcomes on each day. Participants in both DSS conditions were able to converge on the correct solution significantly faster than the control group, and between 36-44% more of the sample was able to reach the correct conclusion. Furthermore, we found that a DSS representing projected outcome probabilities as numerical, rather than using verbal ordinal labels, were better able to differentiate which outcomes were extremely unlikely than the control group or verbal-probability DSS.

Community focus groups about a COVID-19 individual risk assessment tool: access, understanding and usefulness

To make informed COVID-19 related decisions, individuals need information about their personal risks and how those risks may vary with specific demographic and health characteristics. The Fight COVID Milwaukee web-based risk assessment tool allows for assessment of COVID-19 mortality risk as a function of personal and neighborhood characteristics. The purpose of this study is to explore public understanding of this risk assessment tool and risk perception through community focus groups. Individuals were recruited from the general adult population in Milwaukee County, Wisconsin, USA, to participate in nine online focus groups where the risk assessment tool was presented for feedback. Three main themes were identified in the focus groups regarding the web-based risk assessment tool: some challenges in accessibility, variable ease of understanding, and personal usefulness but uncertain value for others. This paper explores how members of the community interpret individual risk assessments and life expectancy estimations, and how these vary with age, gender, race/ethnicity, socioeconomic status, and pre-existing comorbidities.

Bridging the ICT Revolution and Communication Inequality: Lessons for Cancer Survivors

The rapid development of information and communication technologies (ICTs) offers new opportunities for providing health information to patients. In this study, we examined the contrasting effects that communication innovation through ICTs can bring in the care of patients with chronic diseases and the health promotion of medical consumers. We also discussed how disparities in information technology usage, based on socioeconomic status, affect the information gap and health inequalities among medical consumers. ICTs have democratized health information, but the information gap persists and can deepen health inequality. Communication inequality manifests in access to technology, information processing, attention to health information, information seeking, and health outcomes. Significant differences in health communication behaviors exist according to social class. Social disparities in technology access and usage contribute to the information gap, which ultimately leads to different health levels. Communication innovation through ICT has both positive and negative effects on managing chronic diseases. Positively, it democratizes information generation and consumption, enabling patients to interact with healthcare providers and peers for support and advice. Negatively, an abundance of medical information can cause cognitive overload. To maximize benefits and minimize adverse effects, efforts should focus on promoting ICTs in healthcare, enhancing patients' decision-making abilities, and addressing communication inequality. Healthcare institutions must provide consistent, high-quality information, and governments should support underserved populations' access to information, ensuring that ICTs contribute to improved health outcomes.

Understanding the complexities of mathematical cognition: A multi-level framework

Mathematics skills are associated with future employment, well-being, and quality of life. However, many adults and children fail to learn the mathematics skills they require. To improve this situation, we need to have a better understanding of the processes of learning and performing mathematics. Over the past two decades, there has been a substantial growth in psychological research focusing on mathematics. However, to make further progress, we need to pay greater attention to the nature of, and multiple elements involved in, mathematical cognition. Mathematics is not a single construct; rather, overall mathematics achievement is comprised of proficiency with specific components of mathematics (e.g., number fact knowledge, algebraic thinking), which in turn recruit basic mathematical processes (e.g., magnitude comparison, pattern recognition). General cognitive skills and different learning experiences influence the development of each component of mathematics as well as the links between them. Here, I propose and provide evidence for a framework that structures how these components of mathematics fit together. This framework allows us to make sense of the proliferation of empirical findings concerning influences on mathematical cognition and can guide the questions we ask, identifying where we are missing both research evidence and models of specific mechanisms.

Image-Based Communication for Strengthening Patient Health Education in Rural and Underserved Settings

Effective communication is the cornerstone of efficient patient care. It is vital to obtain a thorough history, build the patient's trust, and ensure compliance to treatment. Image-based communication (IBC) using comic-like strips is better than the conventional verbal and written modes, as it is inexpensive, less human resource dependent, and diversity agnostic. Strips based on local and socioculturally relevant issues and characters grab readers' attention, are relatable and entertaining, and utilize a storyline that invigorates thinking. The medical advice delivered by an ideal IBC strip is easy to comprehend, has a better recall, and promotes patient adherence. With an idea that IBC strips can serve as a vital supportive tool in underserved and overburdened clinics, we have described the nuances of adapting them into the existing physician-patient experience. We utilize a prototype IBC of an elderly woman helping a family whose child developed acute fever, possibly malaria. Various elements of an IBC strip, namely, panels, gutters, background, characters, bubbles, captions, and visual effects, are illustrated, and their variations are described later. Once designed, an IBC strip must be critically evaluated for the accuracy of the educational message, and errors, if any, must be corrected. The images are then subjected to a series of local field tests to ensure that they serve their purpose and have the desired cultural competence. Once ready, IBC strips can be posted in public spaces and outside clinics or distributed to healthcare workers or patients. Here, they serve as educational and health literacy tools. The strips can significantly reduce caregiver-patient interaction time and improve the quality of communication, especially when patients are illiterate or understand a different language. It is easier to develop rapport and partnership with a patient when the communication is presented through a pictorial tool. An IBC strip can be used to train grassroot workers, who subsequently train patients, thereby serving a dual purpose. To obtain tangible clinical and epidemiologic benefits from IBC strips, rigorous evidence building and standardization are a crucial long-term goal.

Antenatal consultation and deliberation: adapting to parental preferences

OBJECTIVE

To analyze and compare perspectives on antenatal consultation and decision-making from participants with varying degrees of prematurity experience and clinician-experts.

STUDY DESIGN

Open-ended interviews structured around topics previously identified by recognized clinician-experts were conducted with participants having different levels of prematurity experience. Analysis used mixed methods (thematic and mental models analysis). Secondary sub-group comparisons were performed, based on degree of experience.

RESULTS

Non-clinician participants' (n = 80) perspectives differed regarding: amount and content of information desired, decision-making strategies, and who - parent or clinician - should direct consultations. Most wanted to retain decisional authority, all recognized their emotional limitations and many advocated for deliberation support. Participants worried parents' would regret choosing palliative care contrary to clinicians. Bereaved parents often saw issues differently.

CONCLUSIONS

Parents approach risk and decision-making for extremely premature infants in a personal fashion. They need personalized support tailored to their unique circumstances, decision-making preferences, and emotions.

Coconut oil: an overview of cardiometabolic effects and the public health burden of misinformation

Recent data from meta-analyses of randomized clinical trials (RCTs) suggest that dietary intake of coconut oil, rich in saturated fatty acids, does not result in cardiometabolic benefits, nor in improvements in anthropometric, lipid, glycemic, and subclinical inflammation parameters. Nevertheless, its consumption has surged in recent years all over the world, a phenomenon which can possibly be explained by an increasing belief among health professionals that this oil is as healthy as, or perhaps even healthier than, other oils, in addition to social network misinformation spread. The objective of this review is to present nutritional and epidemiological aspects related to coconut oil, its relationship with metabolic and cardiovascular health, as well as possible hypotheses to explain its high rate of consumption, in spite of the most recent data regarding its actual effects.

Effect of Presenting Survival Information as Text or Pictograph During Periviable Birth Counseling: A Randomized, Controlled Trial

OBJECTIVES

To examine whether presenting a 30% or a 60% chance of survival in different survival information formats would influence hypothetical periviable birth treatment choice and whether treatment choice would be associated with participants' recall or their intuitive beliefs about the chances of survival.

STUDY DESIGN

An internet sample of women (n = 1052) were randomized to view a vignette with either a 30% or 60% chance of survival with intensive care during the periviable period. Participants were randomized to survival information presented as text-only, in a static pictograph, or in an iterative pictograph. Participants chose intensive care or palliative care and reported their recall of the chance of survival and their intuitive beliefs about their infant's chance of survival.

RESULTS

There was no difference in treatment choice by presentation with a 30% vs 60% chance of survival (P = .48), by survival information format (P = .80), or their interaction (P = .18). However, participants' intuitive beliefs about chance of survival significantly predicted treatment choice (P < .001) and had the most explanatory power of any participant characteristic. Intuitive beliefs were optimistic and did not differ by presentation of a 30% or 60% chance of survival (P = .65), even among those with accurate recall of the chance of survival (P = .09).

CONCLUSIONS

Physicians should recognize that parents may use more than outcome data to make treatment choices and in forming their own, often-optimistic, intuitive beliefs about their infant's chance of survival.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT04859114.

Low parental numeracy and severe asthma exacerbations in a prospective study of Puerto Rican youth

BACKGROUND

Numeracy is the mathematical knowledge required to understand and act on instructions from health care providers. Whether persistently low parental numeracy is linked to childhood asthma exacerbations is unknown.

OBJECTIVE

To evaluate whether low parental numeracy at 2 time points is associated with asthma exacerbations and worse lung function in Puerto Rican youth.

METHODS

Prospective study of 225 youth with asthma in San Juan (PR) who participated in 2 visits approximately 5.3 years apart, with the first at ages 6 to 14 years and the second at ages 9 to 20 years. Parental numeracy was assessed with a modified version of the Asthma Numeracy Questionnaire (score range = 0-3 points), and persistently low parental numeracy was defined as a score less than or equal to 1 point at both visits. Asthma exacerbation outcomes included more than or equal to 1 emergency department (ED) visit, more than or equal to 1 hospitalization, and more than or equal to 1 severe exacerbation (≥1 ED visit or ≥1 hospitalization) for asthma in the year before the second visit. Spirometry was conducted using an EasyOne spirometer (NDD Medical Technologies, Andover, Massachusetts).

RESULTS

In an analysis adjusting for age, sex, parental education, use of inhaled corticosteroids, and the time between study visits, persistently low parental numeracy was associated with more than or equal to 1 ED visit for asthma (odds ratio [ORs], 2.17; 95% confidence interval [CI], 1.10-4.26), more than or equal to 1 hospitalization for asthma (OR, 3.92; 95% CI, 1.42-10.84), and more than or equal to 1 severe asthma exacerbation (OR, 1.99; 95% CI, 1.01-3.87) in the year before the follow-up visit. Persistently low parental numeracy was not significantly associated with change in lung function measures.

CONCLUSION

Persistently low parental numeracy is associated with asthma exacerbation outcomes in Puerto Rican youth.

Co-Creation of Breast Cancer Risk Communication Tools and an Assessment of Risk Factor Awareness: A Qualitative Study of Patients and the Public in India

BACKGROUND

Low awareness of BC and its associated risk factors causes delays in diagnosis and impacts survival. It is critical to communicate BC risk to patients in a format that they are easily able to understand. Our study aim was to develop easy-to-follow transmedia prototypes to communicate BC risk and evaluate user preferences, alongside exploring awareness of BC and its risk factors.

METHODS

Prototypes of transmedia tools for risk communication were developed with multidisciplinary input. A qualitative in-depth online interview study was undertaken using a pre-defined topic guide of BC patients (7), their relatives (6), the general public (6), and health professionals (6). Interviews were analyzed using a thematic approach.

FINDINGS

Most participants preferred pictographic representations (frequency format) of lifetime risk and risk factors and storytelling using short animations and comic strips (infographics) for communicating genetic risk and testing: "In a short time, they explained it very well, and I liked it". Suggestions included minimizing technical terminology, decreasing the delivery speed, "two-way dialogue", and using local "language for different locations". There was low awareness of BC, with some understanding of age and hereditary risk factors but limited knowledge of reproductive factors.

INTERPRETATION

Our findings support use of multiple context-specific multimedia tools in communicating cancer risk in an easy-to-understand way. The preference for storytelling using animations and infographics is a novel finding and should be more widely explored.

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.

Cardiovascular disease risk perception among community adults in South China: a latent profile analysis

Objective

Risk perception, a critical psychological construct, influences health behavior modification and maintenance of individuals with cardiovascular disease (CVD) risk. Little is known about CVD risk perception among Chinese adults. This research examined the profiles of CVD risk perception of community adults in South China, and explored the characteristics and factors that influence their perception of CVD risk.

Method

This cross-sectional study was conducted in Hangzhou, Zhejiang Province, in South China from March to July 2022 and included 692 participants. Risk perception was assessed using the Chinese version of the Attitude and Beliefs about Cardiovascular Disease Risk Questionnaire. Latent profile analysis (LPA) was performed to extract latent classes of CVD risk perception. These classes of CVD risk perception were compared with 10-year CVD risk categories to define correctness of estimation. Chi-square tests and multinomial regression analyses were used to identify differences between these categories.

Results

Three CVD risk perception classes were identified by LPA: low risk perception (14.2% of participants), moderate risk perception (46.8%), high risk perception (39.0%). Individuals who were aged with 40-60 year (OR = 6.94, 95% CI = 1.86-25.84), diabetes (OR = 6.26, 95% CI = 1.34-29.17), married (OR = 4.52, 95% CI = 2.30-8.90), better subjective health status (OR = 3.23, 95% CI = 1.15-9.10) and perceived benefits and intention to change physical activity (OR = 1.16, 95% CI = 1.05-1.27) were more likely to be in the high-risk perception class. Compared to absolute 10-year CVD risk based on China-PAR, a third of participants (30.1%) correctly estimated their CVD risk, 63.3% overestimated it and 6.6% underestimated it. CVD risk underestimation was associated with hypertension (OR = 3.91, 95% CI = 1.79-8.54), drinking (OR = 3.05, 95% CI = 1.22-7.64), better subjective health status (OR = 2.67, 95% CI = 1.18-6.03).

Conclusions

Most adults in South China possess a moderate level of CVD risk perception. Advanced age, higher monthly income, diabetes and better health status were significantly related to higher perceived CVD risk. Individuals with hypertension, drinking and better subjective health status were associated with CVD risk underestimation. Healthcare professionals should pay attention to the indicators for different classes and identify underestimation group as early as possible.

Context Matters: Emotional Sensitivity to Probabilities and the Bias for Action in Cancer Treatment Decisions

BACKGROUND

Past studies have shown a commission bias for cancer treatment, a tendency to choose active treatment even when watchful waiting is less risky. This bias suggests motivations for action beyond mortality statistics, but recent evidence suggests that individuals differ in their emotional sensitivity to probabilities (ESP), the tendency to calibrate emotional reactions to probability. The current study aims to examine the role of ESP in the commission bias, specifically whether those higher in ESP are more likely to choose watchful waiting when risk probabilities align with that choice.

METHODS

Participants (N = 1,055) read a scenario describing a hypothetical cancer diagnosis and chose between surgery and watchful waiting, with random assignment between versions where the mortality rate was either lower for surgery or for watchful waiting. We modeled choice using the Possibility Probability Questionnaire (PPQ), a measure of ESP, and several other individual differences in a logistic regression.

RESULTS

We observed a commission bias as in past studies with most participants choosing surgery both when surgery was optimal (71%) and when watchful waiting was optimal (58%). An ESP × Condition interaction indicated that the predictive role of ESP depended on condition. Those higher in ESP were more likely to choose surgery when probabilities favored surgery, β = 0.57, P < 0.001, but when probabilities favored watchful waiting, ESP had a near-zero relationship with choice, β = 0.05, P < 0.99.

CONCLUSIONS

The role of ESP in decision making is context specific. Higher levels of ESP predict choosing action when that action is warranted but do not predict a shift away from surgery when watchful waiting offers better chances of survival. ESP does not overcome the commission bias.

HIGHLIGHTS

Past studies have identified a "commission bias," a tendency to choose active treatment over watchful waiting, even when mortality rate is lower for waiting.Evaluation of risk probabilities is related to individual differences in emotional sensitivity to probabilities (ESP) and has been shown to predict reactions to and decisions about health risk situations.ESP appears to be selectively factored into decision making. ESP was a robust predictor of choosing surgery when probability information supported surgery but did not predict decisions when probability information supported watchful waiting.Those who are most emotionally attuned to probabilities are just as susceptible to the commission bias as those who are less attuned.

Communicating uncertainty in national security intelligence: Expert and nonexpert interpretations of and preferences for verbal and numeric formats

Organizations in several domains including national security intelligence communicate judgments under uncertainty using verbal probabilities (e.g., likely) instead of numeric probabilities (e.g., 75% chance), despite research indicating that the former have variable meanings across individuals. In the intelligence domain, uncertainty is also communicated using terms such as low, moderate, or high to describe the analyst's confidence level. However, little research has examined how intelligence professionals interpret these terms and whether they prefer them to numeric uncertainty quantifiers. In two experiments (N = 481 and 624, respectively), uncertainty communication preferences of expert (n = 41 intelligence analysts in Experiment 1) and nonexpert intelligence consumers were elicited. We examined which format participants judged to be more informative and simpler to process. We further tested whether participants treated verbal probability and confidence terms as independent constructs and whether participants provided coherent numeric probability translations of verbal probabilities. Results showed that although most nonexperts favored the numeric format, experts were about equally split, and most participants in both samples regarded the numeric format as more informative. Experts and nonexperts consistently conflated probability and confidence. For instance, confidence intervals inferred from verbal confidence terms had a greater effect on the location of the estimate than the width of the estimate, contrary to normative expectation. Approximately one-fourth of experts and over one-half of nonexperts provided incoherent numeric probability translations for the terms likely and unlikely when the elicitation of best estimates and lower and upper bounds were briefly spaced by intervening tasks.

Reliability and Validity of the Inpatient Rehabilitation Facility Discharge Mobility and Self-Care Quality Measures

OBJECTIVE

To describe the reliability and validity of the publicly reported facility-level quality measures Inpatient Rehabilitation Facility (IRF) Discharge Mobility Score for Medical Rehabilitation Patients ("Discharge mobility score") and IRF Discharge Self-Care Score for Medical Rehabilitation Patients ("Discharge self-care score").

DESIGN

Observational study using standardized patient assessment data to examine facility-level split-half reliability and construct validity of quality measure scores.

SETTING AND PARTICIPANTS

All IRFs (n = 1117) in the United States with at least 20 Medicare stays. Facility-level quality measure scores were calculated from 2017 data on 428,192 Medicare (fee-for-service and Medicare Advantage) IRF patient stays.

METHODS

Using clinician-reported assessment data, we calculated facility-level mobility and self-care quality measure scores and examined reliability of these scores using split-half analysis and Pearson product-moment correlations, Spearman rank correlations, and intraclass correlation coefficients (ICC_2,1). We examined construct validity of these scores by comparing facility-level quality measure scores by facility stroke disease-specific certification status.

RESULTS

Reported as percentages meeting or exceeding expectations, IRF quality measure scores ranged from 8.3% to 90.1% for mobility and 9.0% to 90.3% for self-care. IRF scores, when split in half to examine reliability, showed strong, positive correlations for the mobility (Pearson = 0.898, Spearman = 0.898, ICC = 0.898) and self-care (Pearson = 0.886, Spearman = 0.874, ICC = 0.886) scores. When stratified by provider volume, ICCs remained strong. Construct validity analyses showed IRFs with stroke disease-specific certification had higher mean and median scores than IRFs without certification, and a greater proportion of IRFs that were certified had higher scores.

CONCLUSION AND IMPLICATIONS

Our results support the reliability and construct validity of the IRF quality measures Discharge mobility and Discharge self-care scores. Reported as percentages meeting or exceeding expectations, these quality measures are designed to be more consumer-friendly compared to change scores.

What do patients on methotrexate need and expect at the clinic? An online patient survey

To verify, via a survey, the experience and needs of patients receiving methotrexate (MTX), their general management and the quality of the information provided by the rheumatologist. We conducted a 51-item online survey between May and July 2020 addressed to persons diagnosed with an immune-mediated disease and treated with MTX (regardless of the route of administration). Recruitment was done via Twitter. We obtained 294 responses, of which 283 were complete and could be analysed. Almost 82% of the respondents were women, 80% resided in Spain, 75% were between 31 and 60 years old, and 57% were active workers. Diseases included psoriasis (41%), lupus, Sjögren's or vasculitides (33%), and rheumatoid arthritis (16%), among others. Eighty per cent had read the leaflet inserted in the package, of whom 62% found it helpful. Only 15% of the respondents reported having been offered additional written material, which was considered barely functional (33 out of 100). Most patients (88%) responded that they had not received advice on any reliable sources to consult on the internet, and those who received it considered it unhelpful (24 out of 100). Patients receiving MTX due to an autoimmune disease demand more and better-quality written or web-based information than what is currently offered at their clinics.

Dark Triad and COVID-19 vaccine hesitancy: the role of conspiracy beliefs and risk perception

With the spread of the Coronavirus Disease-2019 (COVID-19) pandemic, the mass vaccination plan represents the primary weapon to control the infection curve. Unfortunately, vaccine hesitancy also spread out worldwide. This led to exploring the critical factors that prevent vaccination from improving the efficacy of vaccine campaigns. In the present study, the role of the Dark Triad (psychopathy, Machiavellianism, and narcissism) in vaccine hesitancy was investigated, considering the sequential mediating effects of conspiracy beliefs and risk perception. Via a cross-sectional design, the study was conducted with 210 participants surveyed using an online questionnaire to assess the Dark Triad, vaccine hesitancy, conspiracy beliefs, risk perception, and a set of demographic and socio-cultural control variables. Results showed that conspiracy beliefs and risk perception fully mediated the association between the Dark Triad and vaccine hesitancy. This finding suggested that albeit personality accounts for individual differences in human behaviour, vaccine hesitancy is also affected by irrational and false beliefs that, in turn, weaken the risk perception associated with COVID-19. Implications and future research directions were discussed.

Does anxiety explain why math-anxious people underperform in math?

Math-anxious people consistently underperform in math. The most widely accepted explanation for why this underperformance occurs is that math-anxious people experience heightened anxiety when faced with math, and this in-the-moment anxiety interferes with performance. Surprisingly, this explanation has not been tested directly. Here, using both self-report and physiological indices of anxiety, we directly test how much in-the-moment anxiety explains math-anxious underperformance. Results indicate that in-the-moment anxiety indeed explains why math-anxious people underperform-but only partially, suggesting a need to seriously consider alternative mechanisms. Results also showed that while some highly math-anxious individuals-those with high levels of heart rate variability-experienced less in-the-moment anxiety, they nevertheless performed no better at math. For these individuals, math-anxious underperformance must occur for reasons unrelated to in-the-moment anxiety. More broadly, our findings point to substantial individual heterogeneity in the mechanisms underlying math-anxious underperformance. Accounting for this mechanistic heterogeneity may prove vital for optimally boosting math performance in math-anxious individuals.

Overlapping but separate number representations in the intraparietal sulcus – probing format- and modality-independence in sighted Braille readers

The Triple-Code Model stipulates that numerical information from different formats and modalities converges on a common magnitude representation in the Intraparietal Sulcus (IPS). To what extent the representations of all numerosity forms overlap remains unsolved. It has been postulated that the representation of symbolic numerosities (for example, Arabic digits) is sparser and grounded in an existing representation that codes for non-symbolic numerosity information (i.e., sets of objects). Other theories argue that numerical symbols represent a separate number category that emerges only during education. Here, we tested a unique group of sighted tactile Braille readers with numerosities 2, 4, 6 and 8 in three number notations: Arabic digits, sets of dots, tactile Braille numbers. Using univariate methods, we showed a consistent overlap in activations evoked by these three number notations. This result shows that all three used notations are represented in the IPS, which may suggest at least a partial overlap between the representations of the three notations used in this experiment. Using MVPA, we found that only non-automatized number information (Braille and sets of dots) allowed successful number classification. However, the numerosity of one notation could not be predicted above chance from the brain activation patterns evoked by another notation (no cross-classification). These results show that the IPS may host independent number codes in overlapping cortical circuits. In addition, they suggest that the level of training in encoding a given type of number information is an important factor that determines the amount of exploitable information and needs to be controlled for in order to identify the neural code underlying numerical information per se.

Individual differences in numerical representations of risk in health decision making: A fuzzy-trace theory approach

Fuzzy-trace theory predicts that decisionmakers process numerical information about risk at multiple levels in parallel: the simplest level, nominal (categorical some-none) gist, and at more fine-grained levels, involving relative comparison (ordinal less-more gist) and exact quantities (verbatim representations). However, little is known about how individual differences in these numerical representations relate to judgments and decisions, especially involving health tradeoffs and relative risks. To investigate these differences, we administered measures of categorical and ordinal gist representations of number, objective numeracy, and intelligence in two studies (Ns = 978 and 956). In both studies, categorical and ordinal gist representations of number predicted risk judgments and decisions beyond objective numeracy and intelligence. Participants with higher scores in categorical gist were more likely to choose options to avoid cancer recurrence risks; those who were higher in ordinal gist of numbers were more likely to discriminate relative risk of skin cancer; and those with higher scores in objective numeracy were more likely to choose options that were numerically superior overall in terms of relative risk of skin cancer and of genetic risks of breast cancer (e.g., lower numerical probability of cancer). Results support parallel-processing models that assume multiple representations of numerical information about risk, which vary in precision, and illustrate how individual differences in numerical representations are relevant to tradeoffs and risk comparisons in health decisions. These representations cannot be reduced to one another and explain psychological variations in risk processing that go beyond low versus high levels of objective numeracy.

Links between repeating and growing pattern knowledge and math outcomes in children and adults

This study examined repeating and growing pattern knowledge and their associations with procedural and conceptual arithmetic knowledge in a sample of U.S. children (N = 185; M_age  = 79.5 months; 55% female; 88% White) and adults (N = 93; M_age  = 19.5 years; 62% female; 66% White) from 2019 to 2020. Three key findings emerged: (1) repeating pattern tasks were easier than growing pattern tasks, (2) repeating pattern knowledge robustly predicted procedural calculation skills over and above growing pattern knowledge and covariates, and (3) growing pattern knowledge modestly predicted procedural and conceptual math outcomes over and above repeating pattern knowledge and covariates. We expand existing theoretical models to incorporate these specific links and discuss implications for supporting math knowledge.

Cognitive and Behavioral Factors Predicting the Decision to Vaccinate against COVID-19 in Clinical Psychiatric Population-A Cross-Sectional Survey

The spread of the COVID-19 virus created more than a medical crisis, while it also negatively affected the mental health of the general population. This context increased the vulnerability of the psychiatric population. While research interest highly targeted vaccine hesitancy and acceptance, many studies focused on trust issues-both in vaccine efficacy and in communication with authorities. Less is known about the psychological underpinnings of the COVID vaccination decision, specifically in the high-uncertainty circumstances due to the novelty of the virus. In a cross-sectional study, we investigated the predictive value of several cognitive (perceived risk, vulnerability, uncertainty, and trust in one's decision) and behavioral (previous vaccinations, social media use, and practicing preventive behavior) factors, for the vaccination decision against COVID-19, for 252 psychiatric inpatients (data collected between September 2021 and February 2022). Demographics and diagnostics were also considered. We found a significant relationship between the "Perceived risk of vaccination" and the choice of vaccination (χ²(2, N = 252) = 58.59, p ≤ 0.001), and between the "Trust in own decision to vaccinate" and the decision to vaccinate (χ²(2, N = 252) = 31,5, p ≤ 0.001). The overall regression model was statistically significant (χ² (9, N = 252) = 97.1, p < 0.001), with between 30% and 45% of the variance in the odds of a positive decision explained by the predictor set. The model coefficients analysis showed that an individual with a psychiatric disorder but with higher confidence in their decision had significant (p < 0.001) increased odds of the decision to vaccinate against COVID-19 by 893%. A former voluntary vaccination did not significantly associate with the decision to vaccinate against COVID-19 (χ²(1, N = 252) = 2.74, p > 0.05) in this special population. No other behavioral factors, diagnosis, or demographics were significant as predictors, for the clinical psychiatric population surveyed, except the educational level. Implications for future vaccination acceptance of this special population are discussed.