Understanding health risk comprehension: The role of math anxiety, subjective numeracy, and objective numeracy

Background. Numeracy skills are important for medical decision making as lower numeracy is associated with misinterpreting statistical health risks. Math anxiety, characterized by negative emotions about numerical tasks, and lower subjective numeracy (i.e., self-assessments of numerical competence) are also associated with poor risk comprehension. Objective. To explore independent and mediated associations of math anxiety, numerical ability, and subjective numeracy with risk comprehension and to ascertain whether their associations are specific to the health domain. Methods. Objective numeracy was measured with a 14-item test. Math anxiety and subjective numeracy were assessed with self-report scales. Risk comprehension was measured with a 12-item test. In Experiment 1, risk comprehension items were limited to scenarios in the health domain. In Experiment 2, participants were randomly assigned to receive numerically-equivalent risk comprehension items in either a health or non-health domain. Results. Linear regression analyses revealed that individuals with higher objective numeracy were more likely to respond correctly to the risk comprehension items, as were individuals with higher subjective numeracy. Higher math anxiety was associated with a lower likelihood of correct responding when controlling for objective numeracy, but not when controlling for subjective numeracy. Mediation analyses indicated that math anxiety may undermine risk comprehension in three ways, including through: (1) objective numeracy; (2) subjective numeracy; and (3) objective and subjective numeracy in serial, with subjective numeracy mediating the association between objective numeracy and risk comprehension. Findings did not differ by domain. Conclusions. Math anxiety, objective numeracy, and subjective numeracy are associated with risk comprehension through unique pathways. Education initiatives for improving health risk comprehension may be most effective if jointly aimed at tack-ling numerical ability as well as negative emotions and self-evaluations related to numeracy.