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This version was published on October
1, 2007
Medical Decision Making, Vol. 27, No. 5,
672-680 (2007)
DOI: 10.1177/0272989X07304449
Measuring Numeracy without a Math Test: Development of the Subjective Numeracy Scale
Angela Fagerlin, PhD
VA Health Services Research & Development Center for Practice Management and Outcomes Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, Center for Behavioral and Decision Sciences in Medicine, Ann Arbor, Michigan, Division of General Internal Medicine, University of Michigan, Ann Arbor, Michigan, fagerlin{at}med.umich.edu
Brian J. Zikmund-Fisher, PhD
VA Health Services Research & Development Center for Practice Management and Outcomes Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, Center for Behavioral and Decision Sciences in Medicine, Ann Arbor, Michigan, Division of General Internal Medicine, University of Michigan, Ann Arbor, Michigan
Peter A. Ubel, MD
VA Health Services Research & Development Center for Practice Management and Outcomes Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, Center for Behavioral and Decision Sciences in Medicine, Ann Arbor, Michigan, Division of General Internal Medicine, University of Michigan, Ann Arbor, Michigan, Department of Psychology, University of Michigan, Ann Arbor, Michigan
Aleksandra Jankovic, MS
Center for Behavioral and Decision Sciences in Medicine, Ann Arbor, Michigan
Holly A. Derry, MPH
Center for Behavioral and Decision Sciences in Medicine, Ann Arbor, Michigan
Dylan M. Smith, PhD
VA Health Services Research & Development Center for Practice Management and Outcomes Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, Center for Behavioral and Decision Sciences in Medicine, Ann Arbor, Michigan, Division of General Internal Medicine, University of Michigan, Ann Arbor, Michigan
Background. Basic numeracy skills are necessary before patients can understand the risks of medical treatments. Previous research has used objective measures, similar to mathematics tests, to evaluate numeracy. Objectives. To design a subjective measure (i.e., self-assessment) of quantitative ability that distinguishes low- and high-numerate individuals yet is less aversive, quicker to administer, and more useable for telephone and Internet surveys than existing numeracy measures. Research Design. Paper-and-pencil questionnaires. Subjects. The general public (N = 703) surveyed at 2 hospitals. Measures. Forty-nine subjective numeracy questions were compared to measures of objective numeracy. Results. An 8-item measure, the Subjective Numeracy Scale (SNS), was developed through several rounds of testing. Four items measure people's beliefs about their skill in performing various mathematical operations, and 4 measure people's preferences regarding the presentation of numerical information. The SNS was significantly correlated with Lipkus and others' objective numeracy scale (correlations: 0.63—0.68) yet was completed in less time (24 s/item v. 31 s/item, P < 0.05) and was perceived as less stressful (1.62 v. 2.69, P < 0.01) and less frustrating (1.92 v. 2.88, P < 0.01). Fifty percent of participants who completed the SNS volunteered to participate in another study, whereas only 8% of those who completed the Lipkus and others scale similarly volunteered (odds ratio = 11.00, 95% confidence interval = 2.14—56.65). Conclusions. The SNS correlates well with mathematical test measures of objective numeracy but can be administered in less time and with less burden. In addition, it is much more likely to leave participants willing to participate in additional research and shows much lower rates of missing or incomplete data.
Key Words: numeracy • risk communication • decision making • literacy • measurement. (Med Decis Making 2007 • 27:672—680)
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