Assessing values for health: numeracy matters

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Limited numeracy may be an important barrier to meaningfully assessing patients' values using the standard gamble and time trade-off techniques."><meta name="twitter:image" content="https://cdn.ncbi.nlm.nih.gov/pubmed/persistent/pubmed-meta-image-v2.jpg">  <link rel="search" type="application/opensearchdescription+xml" href="https://cdn.ncbi.nlm.nih.gov/pubmed/persistent/opensearch.xml" title="PubMed search">  <noscript> <link rel="stylesheet" type="text/css" href="https://cdn.ncbi.nlm.nih.gov/pubmed/14efe001-aebf-4097-9883-28c967333423/core/no-script.css"> </noscript> <meta name="citation_title" content="Assessing values for health: numeracy matters"> <meta name="citation_authors" content="Woloshin S;Schwartz LM;Moncur M;Gabriel S;Tosteson AN;"> <meta name="citation_date" content="2001 Sep-Oct"> <meta name="citation_publisher" content="Med Decis Making"> <meta name="citation_journal_title" content="Medical decision making : an international journal of the Society for Medical Decision Making"> <meta name="citation_pmid" content="11575488"> <meta name="citation_abstract_html_url" content="https://pubmed.ncbi.nlm.nih.gov/11575488/"> <meta name="citation_volume" content="21"> <meta name="citation_issue" content="5"> <meta name="citation_doi" content="10.1177/0272989X0102100505"> <meta name="citation_issn" content="0272-989X"> <link rel="canonical" href="https://pubmed.ncbi.nlm.nih.gov/11575488/" /> </head> <body > <noscript> <div class="no-script-banner" id="no-script-banner"> <div class="warning-message"> <div class="warning-message-text"> This site needs JavaScript to work properly. 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'Favorites' : 'non_favorites_collection'"> </select> <div class="collections-retry-load-on-error usa-input-error-message selection-validation-message"> Unable to load your collection due to an error<br> <a href="#">Please try again</a> </div> </div> </div> <div class="action-panel-actions"> <button class="action-panel-submit" type="submit" data-loading-label="Adding..." data-pinger-ignore data-ga-category="save_share" data-ga-action="collections" data-ga-label="add"> Add </button> <button class="action-panel-cancel" aria-label="Close 'Add to Collections' panel" ref="linksrc=close_collections_panel" aria-controls="collections-action-panel" aria-expanded="false" data-ga-category="save_share" data-ga-action="collections" data-ga-label="cancel"> Cancel </button> </div> </form> </div> </div> <div id="bibliography-action-panel" class="bibliography-action-panel action-panel in-progress-dots-panel" aria-hidden="true" data-bibliography-open-panel-enabled="false" 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type="radio" checked/> <label for="my-bibliography">My Bibliography</label> </li> </ul> </div> </div> <div class="bibliographies-retry-load-on-error usa-input-error-message selection-validation-message"> Unable to load your delegates due to an error<br> <a href="#">Please try again</a> </div> <div class="action-panel-actions"> <button class="action-panel-submit" type="submit" data-loading-label="Adding..." data-pinger-ignore> Add </button> <button class="action-panel-cancel" aria-label="Close 'Add to bibliography' panel" ref="linksrc=close_bibliography_panel" aria-controls="bibliography-action-panel" aria-expanded="false" data-ga-category="save_share" data-ga-action="mybib" data-ga-label="cancel"> Cancel </button> </div> </form> </div> </div> <div id="saved-search-action-panel" class="saved-search-action-panel action-panel " aria-hidden="true" data-saved-search-open-panel-enabled="false" data-saved-search-open-panel-url-hash="#open-saved-search-panel"> <div class="inner-wrap"> <h2 class="action-panel-heading"> Your saved search </h2> <form id="saved-search-action-panel-form" class="saved-search-action-panel-form action-panel-content action-form" data-create-saved-search-url="/create-saved-search/" data-try-search-terms-url="/try-search-term/" data-saved-search-root-url="https://www.ncbi.nlm.nih.gov/myncbi/searches/"> <input type="hidden" name="csrfmiddlewaretoken" value="yZ11dNiwCAW8fM6WoeEbsBPdZItbX2mAWxQSW3CnHsPQfcUUubIMk5ygkyGtBoQN"> <div class="action-panel-control-wrap"> <label for="saved-search-name" class="action-panel-label saved-search-name-label required-field-asterisk"> Name of saved search: </label> <input maxlength="200" type="text" name="saved-search-name" id="saved-search-name" class="saved-search-name" value="" required pattern="[^"&=<>\/]*" title="The following characters are not allowed in the Name field: "&=<>/"> </div> <div class="action-panel-control-wrap"> <label for="saved-search-term" class="action-panel-label required-field-asterisk"> Search terms: </label> <textarea name="saved-search-term" id="saved-search-term" class="saved-search-term" required></textarea> </div> <div class="test-search-term-wrap"> <a href="#" class="try-search-term">Test search terms</a> </div> <div class="choice-group action-panel-extra-margin-top"> <span class="action-panel-label" id="fieldset-label"> Would you like email updates of new search results? </span> <fieldset id="saved-search-alert" aria-describedby="fieldset-label"> <legend class="usa-sr-only">Saved Search Alert Radio Buttons</legend> <ul class="radio-group-items"> <li> <input type="radio" id="saved-search-alert-yes" class="saved-search-alert-yes" name="saved-search-alert" value="yes" checked> <label for="saved-search-alert-yes" class="action-panel-label">Yes</label> </li> <li> <input aria-label="No radio input" type="radio" id="saved-search-alert-no" class="saved-search-alert-no" name="saved-search-alert" value="no"> <label for="saved-search-alert-no" class="action-panel-label">No</label> </li> </ul> </fieldset> </div> <div class="alert-schedule-wrap"> <div class="action-panel-control-wrap"> <label class="action-panel-label"> Email: </label> <span aria-label="Email address" id="saved-search-email" class="action-panel-label"><span class="action-panel-label-bold"></span> (<a class="myncbi-account-settings" href="https://www.ncbi.nlm.nih.gov/account/settings/">change</a>)</span> </div> <div class="action-panel-control-wrap action-panel-extra-margin-top"> <label for="saved-search-frequency" class="action-panel-label"> Frequency: </label> <select id="saved-search-frequency" class="no-border-panel-selector saved-search-frequency"> <option value="monthly">Monthly</option> <option value="weekly">Weekly</option> <option value="daily">Daily</option> </select> </div> <div class="action-panel-control-wrap saved-search-monthly-additional"> <label for="saved-search-monthly-on-day" class="action-panel-label"> Which day? </label> <select 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value="100">100 items</option> <option value="200">200 items</option> </select> </div> <div> <input type="checkbox" id="saved-search-send-if-no-result" class="saved-search-send-if-no-result" name="saved-search-send-if-no-result"> <label for="saved-search-send-if-no-result" class="action-panel-label smaller-checkbox"> Send even when there aren't any new results </label> </div> <div class="action-panel-control-wrap option-text-in-email-wrap"> <label for="saved-search-email-text" class="action-panel-label"> Optional text in email: </label> <textarea name="saved-search-email-text" id="saved-search-email-text" class="saved-search-email-text"></textarea> </div> </div> <div class="action-panel-actions"> <button class="action-panel-submit" type="submit" data-loading-label="Saving..." data-ga-category="save_share" data-ga-action="alert" data-ga-label="save"> Save </button> <button class="action-panel-cancel" aria-label="Close 'Your saved search' panel" ref="linksrc=close_saved_search_panel" 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class="heading-title"> Assessing values for health: numeracy matters </h1> <div class="inline-authors"> <div class="authors"> <div class="authors-list"> <span class="authors-list-item "><a class="full-name" href="/?term=Woloshin+S&cauthor_id=11575488" ref="linksrc=author_name_link" data-ga-category="search" data-ga-action="author_link" data-ga-label="S Woloshin">S Woloshin</a><sup class="affiliation-links"><span class="author-sup-separator"> </span><a class="affiliation-link" title="VA Outcomes Group, White River Junction, Vermont 05009, USA." href="#full-view-affiliation-1" ref="linksrc=author_aff"> 1 </a></sup><span class="comma">, </span></span><span class="authors-list-item "><a class="full-name" href="/?term=Schwartz+LM&cauthor_id=11575488" ref="linksrc=author_name_link" data-ga-category="search" data-ga-action="author_link" data-ga-label="L M Schwartz">L M Schwartz</a><span class="comma">, </span></span><span class="authors-list-item "><a class="full-name" href="/?term=Moncur+M&cauthor_id=11575488" ref="linksrc=author_name_link" data-ga-category="search" data-ga-action="author_link" data-ga-label="M Moncur">M Moncur</a><span class="comma">, </span></span><span class="authors-list-item "><a class="full-name" href="/?term=Gabriel+S&cauthor_id=11575488" ref="linksrc=author_name_link" data-ga-category="search" data-ga-action="author_link" data-ga-label="S Gabriel">S Gabriel</a><span class="comma">, </span></span><span class="authors-list-item "><a class="full-name" href="/?term=Tosteson+AN&cauthor_id=11575488" ref="linksrc=author_name_link" data-ga-category="search" data-ga-action="author_link" data-ga-label="A N Tosteson">A N Tosteson</a></span> </div> </div> </div> <div class="short-article-details"> Affiliations <button class="more-details" id="toggle-authors" data-alt-text="Collapse" aria-controls="expanded-authors" aria-expanded="false" data-pinger-ignore data-fetch-url="/11575488/long-authors/" data-id-prefix=""> <span class="title"> 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class="expanded-authors" id="short-view-expanded-authors"> <div class="authors"> <h3 class="title"> Authors </h3> <div class="authors-list"> <span class="authors-list-item "><a class="full-name" href="/?term=Woloshin+S&cauthor_id=11575488" ref="linksrc=author_name_link" data-ga-category="search" data-ga-action="author_link" data-ga-label="S Woloshin">S Woloshin</a><sup class="affiliation-links"><span class="author-sup-separator"> </span><a class="affiliation-link" title="VA Outcomes Group, White River Junction, Vermont 05009, USA." href="#short-view-affiliation-1" ref="linksrc=author_aff"> 1 </a></sup><span class="comma">, </span></span><span class="authors-list-item "><a class="full-name" href="/?term=Schwartz+LM&cauthor_id=11575488" ref="linksrc=author_name_link" data-ga-category="search" data-ga-action="author_link" data-ga-label="L M Schwartz">L M Schwartz</a><span class="comma">, </span></span><span class="authors-list-item "><a class="full-name" href="/?term=Moncur+M&cauthor_id=11575488" ref="linksrc=author_name_link" data-ga-category="search" data-ga-action="author_link" data-ga-label="M Moncur">M Moncur</a><span class="comma">, </span></span><span class="authors-list-item "><a class="full-name" href="/?term=Gabriel+S&cauthor_id=11575488" ref="linksrc=author_name_link" data-ga-category="search" data-ga-action="author_link" data-ga-label="S Gabriel">S Gabriel</a><span class="comma">, </span></span><span class="authors-list-item "><a class="full-name" href="/?term=Tosteson+AN&cauthor_id=11575488" ref="linksrc=author_name_link" data-ga-category="search" data-ga-action="author_link" data-ga-label="A N Tosteson">A N Tosteson</a></span> </div> </div> <div class="affiliations"> <h3 class="title"> Affiliation </h3> <ul class="item-list"> <li data-affiliation-id="short-view-affiliation-1" id="short-view-affiliation-1" ><sup class="key">1</sup> VA Outcomes Group, White River Junction, Vermont 05009, USA.</li> </ul> </div> </div> <ul class="identifiers" id="short-view-identifiers"> <li> <span class="identifier pubmed"> <span class="id-label"> PMID: </span> <strong class="current-id" title="PubMed ID">11575488</strong> </span> </li> <li> <span class="identifier doi"> <span class="id-label"> DOI: </span> <a class="id-link" target="_blank" rel="noopener" ref="linksrc=article_id_link&article_id=10.1177/0272989X0102100505&id_type=DOI" href="https://doi.org/10.1177/0272989x0102100505" data-ga-category="full_text" data-ga-action="DOI" > 10.1177/0272989X0102100505 </a> </span> </li> </ul> <div class="in-clipboard-label " hidden> Item in Clipboard </div> </div> </div> </header> <div class="actions-buttons inline"><div class="inner-wrap"><button class="full-text-links-button full-text-links-dialog-trigger" title="Open dialog with full text links" ref="linksrc=full_text_links"> Full text links </button><button class="citation-button citation-dialog-trigger" aria-label="Open dialog with citation text in different styles" 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id="inline-actions-display-format"><option value="abstract">Abstract</option><option value="pubmed">PubMed</option><option value="pmid">PMID</option></select></div></div></div></div></div></div> <div class="abstract" id="abstract"> <h2 class="title"> Abstract </h2> <div class="abstract-content selected" id="eng-abstract"> <p> <strong class="sub-title"> Background: </strong> Patients' values are fundamental to decision models, cost-effectiveness analyses, and pharmacoeconomic analyses. The standard methods used to assess how patients value different health states are inherently quantitative. People without strong quantitative skills (i.e., low numeracy) may not be able to complete these tasks in a meaningful way. </p> <p> <strong class="sub-title"> Methods: </strong> To determine whether the validity of utility assessments depends on the respondent's level of numeracy, the authors conducted in-person interviews and written surveys and assessed utility for the current health for 96 women volunteers. Numeracy was measured using a previously validated 3-item scale. The authors examined the correlation between self-reported health and utility for current health (assessed using the standard gamble, time trade-off, and visual analog techniques) across levels of numeracy. For half of the women, the authors also assessed standard gamble utility for 3 imagined health states (breast cancer, heart disease, and osteoporosis) and asked how much the women feared each disease. </p> <p> <strong class="sub-title"> Results: </strong> Respondent ages ranged from 50 to 79 years (mean = 63), all were high school graduates, and 52% had a college or postgraduate degree. Twenty-six percent answered 0 or only 1 of the numeracy questions correctly, 37% answered 2 correctly, and 37% answered all 3 correctly. Among women with the lowest level of numeracy, the correlation between utility for current health and self-reported health was in the wrong direction (i.e., worse health valued higher than better health): for standard gamble, Spearman r=-0.16, P = 0.44;for time trade-off, Spearman r=-0.13, P=0.54. Among the most numerate women, the authors observed a fair to moderate positive correlation with both standard gamble (Spearman r=0.22, P=0.19) and time trade-off (Spearman r=0.50, P=0.002). In contrast, using the visual analog scale, the authors observed a substantial correlation in the expected direction at all levels of numeracy (Spearman r= 0.82, 0.50, and 0.60 for women answering 0-1, 2, and 3 numeracy questions, respectively; all Ps < or = 0.003). With regard to the imagined health states, the most feared disease had the lowest utility for 35% of the women with the lowest numeracy compared to 76% of the women with the highest numeracy (P=0.03). </p> <p> <strong class="sub-title"> Conclusions: </strong> The validity of standard utility assessments is related to the subject's facility with numbers. 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class="title">Actions</div><div class="content"><ul class="keyword-actions-links"><li><a class="search-in-pubmed-link dropdown-block-link" href="/?term=%22Quality+of+Life%22%5BMAJR%5D&sort=date&sort_order=desc" data-href="/?term=%22Quality+of+Life%22%5BMAJR%5D&sort=date&sort_order=desc" ref="linksrc=search_in_pubmed_keyword_link&mesh="Quality of Life"[MAJR]" data-ga-category="search" data-ga-action="mesh_term" data-ga-label="Quality of Life*"> Search in PubMed </a></li><li><a class="search-in-mesh-link dropdown-block-link" ref="linksrc=search_in_mesh_link" href="https://www.ncbi.nlm.nih.gov/mesh?term=Quality+of+Life" data-ga-category="search_mesh" data-ga-action="mesh_term_link" data-ga-label="Quality of Life*"> Search in MeSH </a></li><li><a class="add-to-search-link dropdown-block-link" ref="linksrc=add_to_search_link" role="button" data-search-term=""Quality of Life"[MAJR]" data-ga-category="search" data-ga-action="add_to_search" data-ga-label=""Quality of Life"[MAJR]" href="#"> Add 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