The Meaning of Numbers in Health: Exploring Health Numeracy in a Mexican-American Population

Abstract

BACKGROUND: Health numeracy can be defined as the ability to use numeric information in the context of health. The interpretation and application of numbers in health may vary across cultural groups. OBJECTIVE: To explore the construct of health numeracy among persons who identify as Mexican American. DESIGN: Qualitative focus group study. Groups were stratified by preferred language and level of education. Audio-recordings were transcribed and Spanish groups (n=3) translated to English. An analysis was conducted using principles of grounded theory. PARTICIPANTS: A purposeful sample of participants from clinical and community sites in the Milwaukee and Chicago metropolitan areas. MAIN MEASURES: A theoretical framework of health numeracy was developed based upon categories and major themes that emerged from the analysis. KEY RESULTS: Six focus groups were conducted with 50 participants. Initial agreement in coding was 59-67% with 100% reached after reconciliation by the coding team. Three major themes emerged: 1) numeracy skills are applied to a broad range of communication and decision making tasks in health, 2) affective and cognitive responses to numeric information influence use of numbers in the health setting, and 3) there exists a strong desire to understand the meaning behind numbers used in health. The findings informed a theoretical framework of health numeracy. CONCLUSIONS: Numbers are important across a range of skills and applications in health in a sample of an urban Mexican-American population. This study expands previous work that strives to understand the application of numeric skills to medical decision making and health behaviors.

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“…Interpreting BP readings are difficult 28 and numbers have little meaning in the patient's day-to-day health experiences. 29 This may be compounded when there are multiple, meaningless numbers to track.…”

Development and Validation of the Spanish Numeracy Understanding in Medicine Instrument

“…42 Items were calibrated using data from the English respondents using BILOG software. 46 Qualitative studies 5,30 were conducted using both English and Spanish-speaking adults to develop items that would work in both Spanish-speaking and Englishspeaking and Hispanic and Non-Hispanic populations. Data used for psychometric analyses was initially obtained from English speakers, with 29 % of the sample identifying as being Hispanic.…”

“…[2][3][4][5]30 While there are health numeracy measures available, they vary in their area of focus and whether they assess knowledge, skills, and/or preference for use of numbers or the full range of skills an adult needs to understand and use numbers in decision making and medication administration. 11,15,16,[31][32][33][34][35][36][37] Relatively few health numeracy specific measures that have been translated into Spanish.…”

Impact of numeracy on parental self-efficacy and treatment outcome of children on complex diets.

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“…One such model, applied to persons of Mexican-American ethnicity, was developed based on a qualitative study using focus groups (M. Schapira et al, 2011). Reflecting the themes gleaned from interviews, the model showed affective and cognitive responses as two separate components influencing the application of numeracy skills in ten different health contexts, leading to health behaviors and outcomes.…”