Numerate decision makers don’t use more effortful strategies unless it pays: A process tracing investigation of skilled and adaptive strategy selection in risky decision making

The present study investigated skilled and adaptive strategy selection in risky decision making. We proposed that people with high objective numeracy, a strong predictor of general decision making skill, would have a broad repertoire of choice strategies and adaptively select these strategies depending on the importance of the decision. Thus more objectively numerate people would maximize their effort (e.g., invest more time) in important, high-payoff decisions and switch to a simple, fast heuristic strategy in trivial decisions. Subjective numeracy would, by contrast, be more closely related to interest in problem solving for its own sake and would not yield such an effect of importance. Participants made twelve high-payoff choices and twelve low-payoff choices in binary two-outcome gambles framed as gains. We measured objective and subjective numeracy using standard measures. Results showed that people with high subjective numeracy generally maximized the expected value (EV) in all decisions. In contrast, participants with high objective numeracy maximized EV only when choice problems were meaningful (i.e., they could result in high payoffs). When choice problems were trivial (i.e., choosing the normatively better option would not result in a large payoff), more objectively numerate participants made choices consistent with faster, more frugal heuristic strategies.National Science Centre, Poland under grant 2015/17/D/HS6/00703Foundation for Polish Science (FNP) under grant START (111.2016)Ministerio de Economía y Competitividad (Spain) (PSI2014-51842-R)Juan de la Cierva Fellowship (FJCI-2016-28279) from the Spanish Ministry of Economy, Industry, and Competitivenes

Cancer awareness in older adults: Results from the Spanish Onco-barometer cross-sectional survey

Background: About half of all cancers are diagnosed in adults older than 65, making them the age group at highest risk of developing this disease. Nurses from different specialties can support individuals and communities in the prevention and early detection of cancer and should be aware of the common knowledge gaps and perceived bar riers among older adults. Objectives: The goal of the current research was to investigate personal characteristics, perceived barriers, and be liefs related to cancer awareness in older adults, with a special focus on perceptions about the influence of cancer risk factors, knowledge of cancer symptoms, and anticipated help-seeking. Design: Descriptive cross-sectional study. Participants: Participants were 1213 older adults (≥65 years old) from the representative national Onco barometer survey conducted in 2020 in Spain. Methods: Questions on the perceived influence of cancer risk factors, knowledge of cancer symptoms, and the Span ish version of the Awareness and Beliefs about Cancer (ABC) questionnaire were administered in computer-assisted telephone interviews. Results: Knowledge of cancer risk factors and symptoms was strongly related to personal characteristics and was lim ited among males and older individuals. Respondents from lower socio-economic background recognized fewer can cer symptoms. Having personal or family history of cancer had opposite effects on cancer awareness: It was related to more accurate symptom knowledge but also to lower perceptions about the influence of risk factors and more delayed help-seeking. Anticipated help-seeking times were strongly influenced by perceived barriers to help-seeking and be liefs about cancer. Worry about wasting the doctor's time (48% increase, 95% CI [25%–75%]), about what the doctor might find (21% increase [3%–43%]) and not having enough time to go to the doctor (30% increase [5%–60%]) were related to more delayed help-seeking intentions. In contrast, beliefs that reflected higher perceived seriousness of a potential cancer diagnosis were related to shorter anticipated help-seeking times (19% decrease [5%–33%]). Conclusions: These results suggest that older adults could benefit from interventions informing them about how to re duce their cancer risk and addressing emotional barriers and beliefs associated with help-seeking delays. Nurses can contribute to educating this vulnerable group and are in a unique position to address some barriers to help-seeking. Study registration: Not registered.Cancer Observatory of the Spanish Association against Cancer (Asociacion Espanola contrael Cancer)Cancer Epidemiological Surveillance Subprogram (VICA) of the CIBER of Epidemiology and Public Health, Carlos III Health Institute, Madrid, SpainSpanish State Research Agency (MCIN/AEI) JC2019-039691-

Predicting biases in very highly educated samples: Numeracy and metacognition

We investigated the relations between numeracy and superior judgment and decision making in two large community outreach studies in Holland (n=5408). In these very highly educated samples (e.g., 30–50% held graduate degrees), the Berlin Numeracy Test was a robust predictor of financial, medical, and metacognitive task performance (i.e., lotteries, intertemporal choice, denominator neglect, and confidence judgments), independent of education, gender, age, and another numeracy assessment. Metacognitive processes partially mediated the link between numeracy and superior performance. More numerate participants performed better because they deliberated more during decision making and more accurately evaluated their judgments (e.g., less overconfidence). Results suggest that well-designed numeracy tests tend to be robust predictors of superior judgment and decision making because they simultaneously assess (1) mathematical competency and (2) metacognitive and self-regulated learning skills

Measuring Risk Literacy: The Berlin Numeracy Test

We introduce the Berlin Numeracy Test, a new psychometrically sound instrument that quickly assesses statistical numeracy and risk literacy. We present 21 studies (n=5336) showing robust psychometric discriminability across 15 countries (e.g., Germany, Pakistan, Japan, USA) and diverse samples (e.g., medical professionals, general populations, Mechanical Turk web panels). Analyses demonstrate desirable patterns of convergent validity (e.g., numeracy, general cognitive abilities), discriminant validity (e.g., personality, motivation), and criterion validity (e.g., numerical and nonnumerical questions about risk). The Berlin Numeracy Test was found to be the strongest predictor of comprehension of everyday risks (e.g., evaluating claims about products and treatments; interpreting forecasts), doubling the predictive power of other numeracy instruments and accounting for unique variance beyond other cognitive tests (e.g., cognitive reflection, working memory, intelligence). The Berlin Numeracy Test typically takes about three minutes to complete and is available in multiple languages and formats, including a computer adaptive test that automatically scores and reports data to researchers (www.riskliteracy.org). The online forum also provides interactive content for public outreach and education, and offers a recommendation system for test format selection. Discussion centers on construct validity of numeracy for risk literacy, underlying cognitive mechanisms, and applications in adaptive decision support

Health professionals prefer to communicate risk-related numerical information using “1-in-X” ratios

Previous research showed that format effects such as the “1-in-X” effect – whereby “1-in-X” ratios lead to a higher perceived probability than “N-in-N*X” ratios – alter perceptions of medical probabilities. We do not know, however, how prevalent this effect is in practice – whether health professionals often use “1-in-X” ratios. We assembled four different sources of evidence, involving experimental work and corpus studies, to examine the use of “1-in-X” and other numerical formats quantifying probability. Our results revealed that the use of “1-in-X” ratios is prevalent and that health professionals prefer this format compared with other numerical formats (i.e., the “N-in-N*X”, %, and decimal formats). In Study 1, UK family physicians preferred to communicate prenatal risk using a “1-in-X” ratio (80.4%, n = 131) across different risk levels and regardless of patients’ numeracy levels. In Study 2, a sample from the UK adult population (n = 203), reported that most GPs (60.6%) preferred to use “1-in-X” ratios compared with other formats. In Study 3, “1-in-X” ratios were the most commonly used format in a set of randomly sampled drug leaflets describing the risk of side effects (100%, n = 94). In Study 4, the “1-in-X” format was the most commonly used numerical expression of medical probabilities or frequencies on the UK’s NHS website (45.7%, n = 2,469 sentences). The prevalent use of “1-in-X” ratios magnifies the chances of increased subjective probability. Further research should establish clinical significance of the “1-in-X” effect

El procesamiento de compuestos estimulares en juicios de causalidad

Nuestra investigación se centra en el estudio del aprendizaje de relaciones causales en las que un compuesto estimular es una causa fiable de un efecto. En dos experimentos, hemos contrastado las predicciones derivadas de los Modelos Asociativos de Rescorla y Wagner (1972) y Pearce (1994), y los Modelos Inductivos de Cheng y Novick (1992) y Novick y Cheng (2004). En claro contraste con la investigación previa sobre este tema, en nuestros experimentos, hemos utilizado una tarea de juicios de causalidad en la que la información sobre la presencia/ausencia de las causas potenciales y el efecto se presentó mediante muestras o agrupaciones de casos. Los resultados ponen de manifiesto que los mecanismos de aprendizaje involucrados en el procesamiento de compuestos podrían ser de origen asociativo.Our research focuses on learning about causal relationships between events when a candidate cause is a compound integrated by several individual causes. In two experiments, we compared the predictions of the Associative Models of Rescorla and Wagner (1972) and Pearce (1994), the Inductive Models of Cheng and Novick (1992) and Novick and Cheng (2004). In contrast with previous research about this topic, in these experiments, a causality judgments task was used in which the information about the presence/absence of the causes and the effect was presented through small samples of cases. Our results showed that the learning mechanisms involved in compound cue processing could be associative in origin

On the protective effect of resilience in patients with acute coronary syndrome

Research on the contribution of positive personality traits to the progression of coronary heart disease (CHD) is notably absent. Resilience is the capacity to develop oneself successfully despite adverse circumstances. In a study of patients with acute coronary syndrome (ACS), the authors investigated the effect of resilience on indicators of CV severity and the physiological mechanisms underlying this effect. Patients (n = 134) completed a scale measuring resilience. The authors measured troponin-I and myoglobin as indicators of ACS severity, and white blood cell (WBC) count and neutrophils as inflammatory markers. Results showed that self-efficacy-a component of resilience-was negatively related to both myoglobin and troponin after the acute coronary event. The relationship between resilience and these prognostic markers was mediated by the WBC count. Importantly, this result held significant after controlling for the effect of classic CV risk factors and demographics. The authors conclude that resilience decreases the extent of the myocardial infarction by affecting the inflammatory response, showing a protective effect.En la actualidad la investigación sobre la influencia de los rasgos de personalidad positivos sobre la enfermedad coronaria (EC) es escasa. La resiliencia se define como la capacidad para autodesarrollarse con éxito a pesar de las circunstancias adversas. En un estudio, los autores han investigado el efecto de la resiliencia en varios indicadores de severidad en pacientes con síndrome coronario agudo (SCA; n=134) y los mecanismos que subyacen a este efecto. Los pacientes completaron una escala que medían sus niveles de resiliencia. Los autores midieron los niveles de troponina-I y mioglobina como indicadores de la severidad del SCA, y el número total de glóbulos blancos (NGB) y neutrófilos como marcadores de inflamación. Los resultados han puesto de manifiesto que el nivel de auto-eficacia –un componente de la resiliencia– se relaciona negativamente con los niveles de mioglobina y troponina después de un evento coronario agudo. La relación entre la resiliencia y estos marcadores está mediada por el NGB. Este resultado se mantiene tras controlar el efecto de los factores cardiovasculares clásicos y demográficos. Los autores concluyen que la resiliencia reduce la extensión del infarto de miocardio influyendo en la respuesta inflamatoria, mostrando un efecto protector.Open Access funded by Asociación Española de Psicología ConductualThis research was supported by grants PSI2011-22954, to R. García-Retamero and PSI2012-39292 to Andrés Catena

Psychological and cognitive factors related to prehospital delay in acute coronary syndrome: A systematic review

We would like to thank Yolanda Ramírez Casas for her help with data collection. This research is part of the PhD thesis of Mercedes Arrebola Moreno (Programa de Doctorado en Psicología, Universidad de Granada).Background: In acute coronary syndrome the time elapsed between the start of symptoms and the moment the patient receives treatment is an important determinant of survival and subsequent recovery. However, many patients do not receive treatment as quickly as recommended, mostly due to substantial prehospital delays such as waiting to seek medical attention after symptoms have started. Objective: To conduct a systematic review with meta-analysis of the relationship between nine frequently investigated psychological and cognitive factors and prehospital delay. Design: A protocol was preregistered in PROSPERO [CRD42018094198] and a systematic review was conducted following PRISMA guidelines. Data sources: The following databases were searched for quantitative articles published between 1997 and 2019: Medline (PubMed), Web of Science, Scopus, Psych Info, PAIS, and Open grey. Review methods: Study risk of bias was assessed with the NIH Quality Assessment Tool for Observational, Cohort, and Cross-Sectional Studies. A best evidence synthesis was performed to summarize the findings of the included studies. Results: Forty-eight articles, reporting on 57 studies from 23 countries met the inclusion criteria. Studies used very diverse definitions of prehospital delay and analytical practices, which precluded meta-analysis. The best evidence synthesis indicated that there was evidence that patients who attributed their symptoms to a cardiac event (n = 37), perceived symptoms as serious (n = 24), or felt anxiety in response to symptoms (n = 15) reported shorter prehospital delay, with effect sizes indicating important clinical differences (e.g., 1.5–2 h shorter prehospital delay). In contrast, there was limited evidence for a relationship between prehospital delay and knowledge of symptoms (n = 18), concern for troubling others (n = 18), fear (n = 17), or embarrassment in asking for help (n = 14). Conclusions: The current review shows that symptom attribution to cardiac events and some degree of perceived threat are fundamental to speed up help-seeking. In contrast, social concerns and barriers in seeking medical attention (embarrassment or concern for troubling others) may not be as important as initially thought. The current review also shows that the use of very diverse methodological practices strongly limits the integration of evidence into meaningful recommendations. We conclude that there is urgent need for common guidelines for prehospital delay study design and reporting.Juan de la Cierva Fellowship from the Spanish Ministry of Science FJCI-2016-28279Ministerio de Economia y Competitividad (Spain) PSI2014-51842-RAndalusian Regional Goverment SOMM17-6103-UGREuropean Union (EU) SOMM17-6103-UGRMinisterio de Economia, Industria y Competitividad, Spain RYC-2016-2015

Identifying Expressive Language Impairments in School Age Children

Los problemas lingüísticos menos severos son detectados a menudo en la edad escolar por los docentes, quienes presentan sobrecarga laboral. Estas dificultades se asocian con consecuencias negativas en el desarrollo curricular posterior. El principal objetivo de este trabajo es investigar si es posible ofrecer a los profesores un screening breve para detectar problemas de lenguaje (a nivel comprensivo y expresivo). Se llevaron a cabo dos estudios exploratorios de muestreo de cadena en los que participaron un total de 96 niños de entre 3 y 9 años (M = 6.03; DE = 1.42) y 16 docentes de entre 30 y 56 años (M = 41.25; DE = 7.22). En el estudio 1, se examinó la precisión del juicio de los docentes sobre la detección de dificultades en el lenguaje expresivo y comprensivo. Los resultados mostraron una mayor precisión de los docentes sobre las dificultades de expresión. Tras analizar los datos de forma inferencial y correlacional, se seleccionaron los ítems con mejores propiedades psicométricas para reducir la escala original utilizada. En el estudio 2, se procedió a la validación de la reducción de la escala y, en línea con el estudio previo, los resultados mostraron que la escala breve tenía unas buenas propiedades psicométricas (alpha de Cronbach = 0.96). Se desarrolló y validó una versión breve de una escala de observación que puede ser utilizada como prueba de screening para detectar dificultades expresivas de forma efectiva y rápida.Less severe linguistic difficulties are often detected in the classroom, by teachers who feel overworked. These difficulties are related to negative results for curriculum development. The main objective is to investigate whether it is possible to offer teachers a brief screening technique that helps them detect language problems (comprehensive and expressive). In two exploratory studies, chain referral sampling, participated 96 children between 3 and 9 years (M=6.03; SD=1.42) and 16 teachers between 30 and 56 years (M=41.25; SD=7.22). In Study 1, we examined the accuracy of teachers on expressive and receptive difficulties. Results showed that teachers showed more accurate judgments about expression difficulties. After inferential and correlational analyses, we selected those items with better psychometric properties to construct a brief scale. In Study 2 we validated the brief scale, and in line with the previous study, results showed that the brief scale has good psychometric properties (Cronbach’s Alpha= 0.96). We developed and validated a simplified version of the scale of observation that could be a useful screening tool to detect effectively and rapidly linguistic problems in children

Measuring feelings about choices and risks: The Berlin Emotional Responses to Risk Instrument (BERRI)

We introduce a brief instrument specifically validated for measuring positive and negative feelings about risks—the Berlin Emotional Responses to Risk Instrument (BERRI). Based on seven studies involving diverse adults from three countries (n = 2120), the BERRI was found to robustly estimate anticipatory affective reactions derived from subjective evaluations of positive (i.e., assured, hopeful, and relieved) and negative emotions (i.e., anxious, afraid, and worried). The brief BERRI outperformed a 14-item assessment, uniquely tracking costs/benefits associated with cancer screening among men and women (Studies 1 and 2). Predictive validity was further documented in paradigmatic risky choice studies wherein options varied over probabilities and severities across six contexts (health, social, financial, technological, ethical, and environmental; Study 3). Studies 4–6, conducted during the Ebola epidemic and COVID- 19 pandemic, indicated BERRI responses were sensitive to subtle effects caused by emotion-related framing manipulations presented in different cultures and languages (the United States, Spain, and Poland). Study 7 indicated BERRI responses remained stable for 2 weeks. Although the BERRI can provide an estimate of overall affect, choices were generally better explained by the unique influences of positive and negative affect. Overall, results suggest the novel, brief instrument can be an efficient tool for high-stakes research on decision making and risk communication.The National Research Agency of Spain (MCIN/AEI), JC2019-039691-