Health Literacy and Numeracy Workshop Summary (2014) / Chapter Skim
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4 Numeracy Demands, Assumptions, and Challenges for Communicators
4 Numeracy Demands, Assumptions, and Challenges for Communicators
Pages 47-66
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NUMERACY AND HEALTH JOURNALISM Marguerite Holloway, M.S. Columbia University Graduate School of Journalism Holloway said the issue of numeracy and health journalism is a vital one.
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It is clear from responses to news stories that many people get and use health information presented by the media and that media outlets respond to consumer demand by presenting health stories, particularly on personal health. In this context getting the numbers wrong or creating hype has the potential to have significant consequences, Holloway said.
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As an example of this, Holloway said studies about public perception of climate change information illustrate the difference between the experiential processing system and the analytical processing system. The tension between these two ways of processing information is another challenge for reporters covering health.
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As news organizations adapt to the new environment, there is more collaboration with statisticians and data experts in newsrooms. Holloway recommended that numbers be presented with transparency and in a variety of ways, and that journalists give both relative and absolute risk.
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It is difficult to absorb information that runs counter to expectations. When journalists tell stories of individual experience that are well supported by and help illustrate numerical data, the complexity and nuance of the issue can come to life.
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Center for Healthcare Informatics and Policy, Weill Cornell Medical College Ancker's presentation explored the ways in which numeracy issues relate to shared decision making and the concept of explaining risks and uncertainty. She began with an example of a patient decision that generated a number of headlines early in 2013, when Angelina Jolie publicly disclosed that she had tested positive for mutation at BRCA1 and chose a prophylactic bilateral mastectomy as a preventive measure.
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In shared decision making, the goal is to help people have a better understanding of their own risk for a certain disease or condition. As a result, a great deal of the public health risk communication literature focuses on nonquantitative ways of expressing risk, on framing, or on fear appeals and not quantitative risk communication.
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" There is no way to know without more information. In shared decision making, there is a strong preference for providing information numerically, Ancker said.
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The graphic on the left inflates the apparent difference and the graphic on the right somewhat minimizes it or at least places it in context. Another example from icon graphics illustrates the point further.
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Figure 4-2 shows two ways of expressing risk where the part-to-whole relationship is visible. Ancker said some good qualitative research suggests that the arrangement on the left does a better job of expressing the idea that anybody can be at risk, that risk is haphazard and random, and that anybody might be affected (Ancker et al., 2011a,b)
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There is a very clear visual analogy with the risk information. Icon graphics exploit people's ability to visually process sizes at an automatic level and rely somewhat less on learned information.
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Information in a bar graph may seem easier to understand just because there are fewer elements to the graphic. Finally, risk ladders or risk scales are a type of graphic that is not seen much in health risk communication, but is used more widely in environmental risk communication.
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Ancker conducted research in which she used an innovative game-like interaction to educate patients about their risk. Instead of merely telling people what their risk was, the game encouraged individuals to click on an icon graphic to uncover which figures in the graphic had the disease.
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First, there is serious research about public health information, the public understanding of science, and news coverage of science and health. A number of journals publish this research, such as the Journal of Health Communication, Science Communication, and Journalism and Mass Communication Quarterly.
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Rudd noted that the idea of health literacy arising from interactions rather than being embedded in an individual is a central point of the Institute of Medicine's 2004 report on health literacy.3 Patrick McGarry, roundtable member, asked whether any studies had been done on people's perceptions of case studies versus population-based statistics. He noted that although suicide is low prevalence, it is a very real problem.
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Holloway agreed and added there is some opportunity to work with professional associations and strengthen training in health communication for journalists. As a follow-up, Parker gave the example of the upcoming enrollment period for the health care insurance marketplaces opening under the ACA.
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Holloway added that within journalism, there is a growing emphasis on data visualization, and a great deal of work is being done on how to best present various types of information so they are easily understood by the reader. Benard Dreyer, roundtable member, asked the presenters about the best way to communicate risk and risk reduction to patients.
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Isham concluded that there are serious ethical issues around the topic of numeracy and health literacy and the responsibility of professionals to communicate ethically, and that those issues should be explored. Ancker agreed that there are ethical issues involved in whether a health communicator's job is to persuade or merely give information.
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2006. Developing a quality criteria framework for patient decision aids: Online international Delphi Consensus process.
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