New research suggests having — or lacking — certain numeracy skills can help predict chronic disease outcomes. The study, conducted by rheumatologists and psychologists at The Ohio State University, assessed “objective numeracy” (math skills) and “numeric confidence” (having confidence in one’s own math abilities) among patients with systemic lupus erythematosus.
Their results found that lupus patients who are good with numbers and feel confident in their math abilities had less disease activity. This finding may help researchers develop more effective patient engagement strategies.
Math struggles may correlate with health struggles
Previous research has shown that around one-third of American adults are innumerate, meaning they have a hard time understanding or performing basic math. And for people with chronic diseases that affect multiple organs, innumeracy can significantly impact disease management.
“Rheumatic diseases like lupus have a level of complexity that’s different from many other medical conditions,” says rheumatologist and co-principal investigator Alexa Meara, MD, MS, assistant professor, Department of Immunology and Rheumatology. “To keep their lupus under control, patients face complicated tests and treatments that often require math skills. They may need to take different doses of multiple medications at specific times of day, understand the results of lab tests or precisely taper down steroids.”
But being good at math may not be enough to guarantee better health outcomes. The study results, published in Proceedings of the National Academy of Sciences of the United States of America in September 2019, showed that success in managing a complex disease also requires numeric confidence.
Mismatched skills predictive of poorer outcomes
The two-year study was designed with the help of co-principal investigator Ellen Peters, PhD, an internationally renowned decision scientist who studies how to improve decision-making by increasing numeracy. Dr. Peters, a former professor of psychology at Ohio State, is now director of the University of Oregon’s Media Center for Science and Technology.
More than 90 patients from Ohio State’s Lupus, Vasculitis and Glomerulonephritis Registry participated in the numeracy study. They took tests that measured their objective math skills and filled out questionnaires that measured how confident and self-assured they felt using numbers.
“As we predicted, patients whose lupus is well controlled were more likely to have strong objective math skills and high subjective confidence,” says Dr. Meara, who is an assistant professor – clinical at the College of Medicine. “Perhaps more importantly, ‘mismatched’ skills were tied to worse outcomes. Patients with low math skills and high confidence — meaning they thought they were good at math but scored poorly on the test — were most likely to need further lupus treatments compared to the other participants.”
Specifically, their findings showed that:
- Among the most numerate patients, those who were also highly confident had only a 7% chance of having harmful disease activity
- Patients with good math skills but little confidence, which may indicate a willingness to give up easily, were 31% more likely to have disease activity
- Patients with low math skills but high confidence were 44% more likely to have disease activity
- The low confidence/low skill group do better than the discordant group of high confidence/low skill
Improving outcomes by removing obstacles
The team plans to continue their numeracy research among patients with a different autoimmune disease: vasculitis. If their results are consistent — meaning increased disease flares correlate with mismatched numeracy scores — it may provide momentum for clinicians to create targeted interventions.
“An eventual next step may be finding practical ways to identify this subset of high-risk, chronic disease patients,” says Dr. Meara.
In the meantime, she adds, their results serve as a reminder for physicians to identify barriers that make it hard for patients to understand and follow their treatment plans.
“If our patients don’t adhere to their medication regimen or make recommended lifestyle changes, we shouldn’t assume they’re not engaged,” she says. “Instead, we should aim to meet them where they’re at, in a nonjudgmental way, and help them overcome those barriers to the best of their abilities.”