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Open Access Research article

Health numeracy in Japan: measures of basic numeracy account for framing bias in a highly numerate population

Masako Okamoto1*, Yasushi Kyutoku2, Manabu Sawada3, Lester Clowney2, Eiju Watanabe2, Ippeita Dan2 and Keiko Kawamoto1

Author Affiliations

1 Research Center for Animal Hygiene and Food Safety, Obihiro University of Agriculture & Veterinary Medicine, Inada-cho, Obihiro, Hokkaido 080-8555, Japan

2 Functional Brain Science Laboratory, Center for Development of Advanced Medical Technology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan

3 Department of Agro-Environmental Science, Obihiro University of Agriculture and Veterinary Medicine, Inada-cho, Obihiro, Hokkaido 080-8555, Japan

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BMC Medical Informatics and Decision Making 2012, 12:104  doi:10.1186/1472-6947-12-104

Published: 11 September 2012

Abstract

Background

Health numeracy is an important factor in how well people make decisions based on medical risk information. However, in many countries, including Japan, numeracy studies have been limited.

Methods

To fill this gap, we evaluated health numeracy levels in a sample of Japanese adults by translating two well-known scales that objectively measure basic understanding of math and probability: the 3-item numeracy scale developed by Schwartz and colleagues (the Schwartz scale) and its expanded version, the 11-item numeracy scale developed by Lipkus and colleagues (the Lipkus scale).

Results

Participants’ performances (n = 300) on the scales were much higher than in original studies conducted in the United States (80% average item-wise correct response rate for Schwartz-J, and 87% for Lipkus-J). This high performance resulted in a ceiling effect on the distributions of both scores, which made it difficult to apply parametric statistical analysis, and limited the interpretation of statistical results. Nevertheless, the data provided some evidence for the reliability and validity of these scales: The reliability of the Japanese versions (Schwartz-J and Lipkus-J) was comparable to the original in terms of their internal consistency (Cronbach’s α = 0.53 for Schwartz-J and 0.72 for Lipkus-J). Convergent validity was suggested by positive correlations with an existing Japanese health literacy measure (the Test for Ability to Interpret Medical Information developed by Takahashi and colleagues) that contains some items relevant to numeracy. Furthermore, as shown in the previous studies, health numeracy was still associated with framing bias with individuals whose Lipkus-J performance was below the median being significantly influenced by how probability was framed when they rated surgical risks. A significant association was also found using Schwartz-J, which consisted of only three items.

Conclusions

Despite relatively high levels of health numeracy according to these scales, numeracy measures are still important determinants underlying susceptibility to framing bias. This suggests that it is important in Japan to identify individuals with low numeracy skills so that risk information can be presented in a way that enables them to correctly understand it. Further investigation is required on effective numeracy measures for such an intervention in Japan.

Keywords:
Risk communications; Patient empowerment; Patient education; Risk perception; Decision making