Can I Count on Getting Better? Association between Math Anxiety and Poorer Understanding of Medical Risk Reductions

Lower numerical ability is associated with poorer understanding of health statistics, such as risk reductions of medical treatment. For many people, despite good numeracy skills, math provokes anxiety that impedes an ability to evaluate numerical information. Math-anxious individuals also report less confidence in their ability to perform math tasks. We hypothesized that, independent of objective numeracy, math anxiety would be associated with poorer responding and lower confidence when calculating risk reductions of medical treatments. Methods. Objective numeracy was assessed using an 11-item objective numeracy scale. A 13-item self-report scale was used to assess math anxiety. In experiment 1, participants were asked to interpret the baseline risk of disease and risk reductions associated with treatment options. Participants in experiment 2 were additionally provided a graphical display designed to facilitate the processing of math information and alleviate effects of math anxiety. Confidence ratings were provided on a 7-point scale. Results. Individuals of higher objective numeracy were more likely to respond correctly to baseline risks and risk reductions associated with treatment options and were more confident in their interpretations. Individuals who scored high in math anxiety were instead less likely to correctly interpret the baseline risks and risk reductions and were less confident in their risk calculations as well as in their assessments of the effectiveness of treatment options. Math anxiety predicted confidence levels but not correct responding when controlling for objective numeracy. The graphical display was most effective in increasing confidence among math-anxious individuals. Conclusions. The findings suggest that math anxiety is associated with poorer medical risk interpretation but is more strongly related to confidence in interpretations

Biasing and debiasing health decisions with bar graphs: Costs and benefits of graph literacy

Bar graphs can improve risk communication in medicine and health. Unfortunately, recent research has revealed that bar graphs are associated with a robust bias that can lead to systematic judgement and decision-making errors. When people view bar graphs representing means, they tend to believe that data points located within bars are more likely to be part of the underlying distributions than equidistant points outside bars. In three experiments, we investigated potential consequences, key cognitive mechanisms, and generalisability of the within-the-bar bias in the medical domain. We also investigated the effectiveness of different interventions to reduce the effect of this bias and protect people from errors. Results revealed that the within-the-bar bias systematically affected participants’ judgements and decisions concerning treatments for controlling blood glucose, as well as their interpretations of ecological graphs designed to guide health policy decisions. Interestingly, individuals with higher graph literacy showed the largest biases. However, the use of dot plots to replace bars improved the accuracy of interpretations. Perceptual mechanisms underlying the within-the-bar bias and prescriptive implications for graph design are discussed

Injury Risk Estimation Expertise Assessing the ACL Injury Risk Estimation Quiz

Background: Available methods for screening anterior cruciate ligament (ACL) injury risk are effective but limited in application as they generally rely on expensive and time-consuming biomechanical movement analysis. A potential efficient alternative to biomechanical screening is skilled movement analysis via visual inspection (ie, having experts estimate injury risk factors based on observations of athletes’ movements). Purpose: To develop a brief, valid psychometric assessment of ACL injury risk factor estimation skill: the ACL Injury Risk Estimation Quiz (ACL-IQ). Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: A total of 660 individuals participated in various stages of the study, including athletes, physicians, physical therapists, athletic trainers, exercise science researchers/students, and members of the general public in the United States. The ACL-IQ was fully computerized and made available online (www.ACL-IQ.org). Item sampling/reduction, reliability analysis, cross-validation, and convergent/discriminant validity analysis were conducted to optimize the efficiency and validity of the assessment. Results: Psychometric optimization techniques identified a short (mean time, 2 min 24 s), robust, 5-item assessment with high reliability (test-retest: r = 0.90) and consistent discriminability (average difference of exercise science professionals vs general population: Cohen d = 1.98). Exercise science professionals and general population individuals scored 74% and 53% correct, respectively. Convergent and discriminant validity was demonstrated. Scores on the ACL-IQ were most associated with ACL knowledge and various cue utilities and were least associated with domain-general spatial/decision-making ability, personality, or other demographic variables. Overall, 23% of the total sample (40% exercise science professionals; 6% general population) performed better than or equal to the ACL nomogram. Conclusion: This study presents the results of a systematic approach to assess individual differences in ACL injury risk factor estimation skill; the assessment approach is efficient (ie, it can be completed in\3 min) and psychometrically robust. The results provide evidence that some individuals have the ability to visually estimate ACL injury risk factors more accurately than other instrument-based ACL risk estimation methods (ie, ACL nomogram). The ACL-IQ provides the foundation for assessing the efficacy of observational ACL injury risk factor assessment (ie, does simple skilled visual inspection reduce ACL injuries?). It also provides a representative task environment that can be used to increase our understanding of the perceptual-cognitive mechanisms underlying observational movement analysis and to improve injury risk assessment performance

Understanding the Effect of Information Presentation Order and Orientation on Information Search and Treatment Evaluation

Background. Past research finds that treatment evaluations are more negative when risks are presented after benefits. This study investigates this order effect: manipulating tabular orientation and order of risk–benefit information, and examining information search order and gaze duration via eye-tracking. Design. 108 (Study 1) and 44 (Study 2) participants viewed information about treatment risks and benefits, in either a horizontal (left-right) or vertical (above-below) orientation, with the benefits or risks presented first (left side or at top). For 4 scenarios, participants answered 6 treatment evaluation questions (1–7 scales) that were combined into overall evaluation scores. In addition, Study 2 collected eye-tracking data during the benefit–risk presentation. Results. Participants tended to read one set of information (i.e., all risks or all benefits) before transitioning to the other. Analysis of order of fixations showed this tendency was stronger in the vertical (standardized mean rank difference further from 0, M = ±.88) than horizontal orientation (M = ± 0.71). Approximately 50% of the time was spent reading benefits when benefits were shown first, but this was reduced to ~40% when risks were presented first (regression coefficient: B = −4.52, p <.001). Eye-tracking measures did not strongly predict treatment evaluations, although time percentage reading benefits positively predicted evaluation when holding other variables constant (B = 0.02, p =.023). Conclusion. These results highlight the impact of seemingly arbitrary design choices on inspection order. For instance, presenting risks where they will be seen first leads to relatively less time spent considering treatment benefits. Other research suggests these changes to inspection order can influence multi-option and multi-attribute choices, and represent an area for future research

Risk communication in tables versus text: a registered report randomized trial on 'fact boxes'.

identifying effective summary formats is fundamental to multiple fields including science communication, systematic reviews, evidence-based policy and medical decision-making. This study tested whether table or text-only formats lead to better comprehension of the potential harms and benefits of different options, here in a medical context. pre-registered, longitudinal experiment: between-subjects factorial 2 (message format) × 2 topic (therapeutic or preventative intervention) on comprehension and later recall (CONSORT-SPI 2018). longitudinal online survey experiment. 2305 census-matched UK residents recruited through the survey panel firm YouGov. comprehension of harms and benefits and knowledge recall after six weeks. fact boxes-simple tabular messages-led to more comprehension (d = 0.39) and slightly more knowledge recall after six weeks (d = 0.12) compared to the same information in text. These patterns of results were consistent between the two medical topics and across all levels of objective numeracy and education. Fact boxes were rated as more engaging than text, and there were no differences between formats in treatment decisions, feeling informed or trust. the brief table format of the fact box improved the comprehension of harms and benefits relative to the text-only control. Effective communication supports informed consent and decision-making and brings ethical and practical advantages. Fact boxes and other summary formats may be effective in a wide range of communication contexts

Does the cognitive reflection test measure cognitive reflection? A mathematical modeling approach

We used a mathematical modeling approach, based on a sample of 2,019 participants, to better understand what the cognitive reflection test (CRT; Frederick In Journal of Economic Perspectives, 19, 25–42, 2005) measures. This test, which is typically completed in less than 10 min, contains three problems and aims to measure the ability or disposition to resist reporting the response that first comes to mind. However, since the test contains three mathematically based problems, it is possible that the test only measures mathematical abilities, and not cognitive reflection. We found that the models that included an inhibition parameter (i.e., the probability of inhibiting an intuitive response), as well as a mathematical parameter (i.e., the probability of using an adequate mathematical procedure), fitted the data better than a model that only included a mathematical parameter. We also found that the inhibition parameter in males is best explained by both rational thinking ability and the disposition toward actively open-minded thinking, whereas in females this parameter was better explained by rational thinking only. With these findings, this study contributes to the understanding of the processes involved in solving the CRT, and will be particularly useful for researchers who are considering using this test in their research

The Illogicality of Stock-Brokers: Psychological Experiments on the Effects of Prior Knowledge and Belief Biases on Logical Reasoning in Stock Trading

BACKGROUND: Explanations for the current worldwide financial crisis are primarily provided by economists and politicians. However, in the present work we focus on the psychological-cognitive factors that most likely affect the thinking of people on the economic stage and thus might also have had an effect on the progression of the crises. One of these factors might be the effect of prior beliefs on reasoning and decision-making. So far, this question has been explored only to a limited extent. METHODS: We report two experiments on logical reasoning competences of nineteen stock-brokers with long-lasting vocational experiences at the stock market. The premises of reasoning problems concerned stock trading and the experiments varied whether or not their conclusions--a proposition which is reached after considering the premises--agreed with the brokers' prior beliefs. Half of the problems had a conclusion that was highly plausible for stock-brokers while the other half had a highly implausible conclusion. RESULTS: The data show a strong belief bias. Stock-brokers were strongly biased by their prior knowledge. Lowest performance was found for inferences in which the problems caused a conflict between logical validity and the experts' belief. In these cases, the stock-brokers tended to make logically invalid inferences rather than give up their existing beliefs. CONCLUSIONS: Our findings support the thesis that cognitive factors have an effect on the decision-making on the financial market. In the present study, stock-brokers were guided more by past experience and existing beliefs than by logical thinking and rational decision-making. They had difficulties to disengage themselves from vastly anchored thinking patterns. However, we believe, that it is wrong to accuse the brokers for their "malfunctions", because such hard-wired cognitive principles are difficult to suppress even if the person is aware of them

The effects of numeracy and presentation format on judgments of contingency

Covariation information can be used to infer whether a causal link plausibly exists between two dichotomous variables, and such judgments of contingency are central to many critical and everyday decisions. However, individuals do not always interpret and integrate covariation information effectively, an issue that may be compounded by limited numeracy skills, and they often resort to the use of heuristics, which can result in inaccurate judgments. This experiment investigated whether presenting covariation information in a composite bar chart increased accuracy of contingency judgments, and whether it can mitigate errors driven by low numeracy skills. Participants completed an online questionnaire, which consisted of an 11-item numeracy scale and three covariation problems that varied in level of difficulty, involving a fictitious fertilizer and its impact on whether a plant bloomed or not. Half received summary covariation information in a composite bar chart, and half in a 2 × 2 matrix that summarized event frequencies. Viewing the composite bar charts increased accuracy of individuals both high and low in numeracy, regardless of problem difficulty, resulted in more consistent judgments that were closer to the normatively correct value, and increased the likelihood of detecting the correct direction of association. Findings are consistent with prior work, suggesting that composite bar charts are an effective way to improve covariation judgment and have potential for use in the domain of health risk communication