Health Literacy and Numeracy Workshop Summary (2014) / Chapter Skim
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3 Numeracy Demands, Assumptions, and Challenges for Consumers
3 Numeracy Demands, Assumptions, and Challenges for Consumers
Pages 29-46
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Senior Policy Analyst, Consumers Union Consumers Union carried out consumer testing of the new health insurance disclosure requirements in the Patient Protection and Affordable Care Act (ACA) , Quincy said.
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In addition, consumer testing showed that people have little trust in health insurance companies, another source of stress in the process. Consumers Union research showed that the primary reason why people cannot determine which plan is best for them is that they are confused by the cost-sharing terms, Quincy said.
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1 The Consumers' Checkbook Guide to Health Plans for Federal Employees and Annuitants is an online tool that allows federal employees and retirees to compare health insurance plans offered under the Federal Employees Health Benefits Program.
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Patients encounter all of the concepts involved in numeracy when they receive care, follow treatment plans, and pay for medical care. Much of chronic disease care is based on informing patients about prevention and risk, which requires an understanding of statistics and probability, Apter said.
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Apter added that patients must also participate in the development of a chronic disease management plan, which is often complicated and involves a variety of numeracy skills. Such skills are also needed to follow the management plan; for example, patients must monitor their symptoms.
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34 FIGURE 3-1 Asthma Action Plan from the National Heart, Lung, and Blood Institute. SOURCE: Apter, 2013.
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It can be difficult for many people to understand these concepts and use them in making health care decisions. To conduct research into the numeracy skills of asthma patients and whether it affected their asthma care, Apter and colleagues developed the Asthma Numeracy Questionnaire, a four-question survey on common concepts in the national asthma guidelines, and administered the survey to patients in English or Spanish (see Box 3-2)
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The patient will never develop bone loss ANQ Question 3 You have a peak flow meter. Your Danger or Red Zone is 50% of your best reading.
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Apter said she would focus on what clinicians can do to overcome the negative consequences of low numeracy skills. Apter suggested that clinicians should focus their efforts in two areas -- first to decrease the demand on the patients and second to increase clinician communication skills.
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Apter hypothesized that determining where a piece of information fits into the matrix and then working to simplify the information so that it would move up and to the left on the matrix would make the information easier for the patient to understand. For example, using the issue of the number of 5 milligram prednisone tablets to take to achieve a 30 milligram dose, the clinician could instead instruct the patient to take six pills in the morning, thereby moving the communication up and to the left on the matrix.
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Poor numeracy is associated with poor health outcomes, and limited numeracy can impair the ability to communicate and understand health information and to participate in shared decision making. It is essential to equalize and enhance educational opportunities, but clinicians must also understand and account for limited educational opportunities and limited numeracy in patients to ensure adequate access to health care and effective communication, Apter said.
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He said the example from Apter's presentation is confusing for parents, particularly for those who do not speak English or have low literacy skills. His practice has made the decision to eliminate peak flow measurements from its asthma action plan because it is so confusing.
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She said that she and two colleagues, Michael Wolf and Sarah Shoemaker, have developed a patient education materials assessment tool, which is a tool that assesses whether materials are understandable and actionable. Brach asked if there are any strategies to help people who are writing and designing patient information materials to determine what is not essential.
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Lindsey Robinson, roundtable member, asked if Apter knew of any asthma action plan that included information on the impact of asthma medications on oral health. Apter answered that oral health in general is not considered enough in medical education and medical treatment, and is not generally mentioned in asthma treatment.
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Quincy said the state and federal insurance exchanges operating under the ACA provide a good research opportunity because they each display and present information to the consumer a little differently. She added that in her coverage example, it was important for the consumer to know the total cost of breast cancer treatment because that knowledge provided motivation to buy insurance.
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Helen Osborne, audience member, said that after hearing the morning's presentations, she was excited and enthusiastic about possible solutions to the problem of low numeracy skills. She wondered if the challenges could be reframed to fit with the Apple store analogy offered earlier by Terry Davis.
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Answering questions about these types of basic human processes can advance health literacy research and improve people's health. Jessica Ancker, a presenter scheduled for the afternoon session, noted that much of the morning's presentations had been about costs and the difficulty of estimating medical costs.
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