Erika Heiges- Numeracy: A Key Component of Health Literacy

Numbers, numbers, numbers.  Just like words, they’re everywhere in the information we read.  Numbers are used to quantify something, to interpret a message in order to take action.  I often come across numbers and marvel at how unruly, complex, and confusing they can be.  I think about others – the patients I work for and the adult learners I tutor and wonder how numeracy skills affect them.

I think about an adult learner I tutor – Anna.  Anna is 45 years old and has basic literacy skills – she reads at about a fifth to sixth grade reading level.  Anna often brings magazines and books for us to tutor from.  She talks about recipes she’s tried over the weekend.  As we look at recipes to try, I discover she has difficulty with numbers, particularly fractions and measurements.  She often follows a recipe’s ingredients but estimates portion sizes.

Now let’s just interplay my work as a health educator and my tutoring experience.  What if Anna were living with diabetes?  What might be the role of numbers in her life? Anna would need to understand the nutrition content of foods, portion sizes, blood glucose numbers and ranges, and how to accurately take pills or injections.  Numeracy skills would be a critical part of Anna’s daily diabetes management.

Supporting numeracy skills

Let’s say Anna is just learning to check and log her blood sugars.  She has just checked her blood sugar, and needs to log the result and determine what action to take, based on her blood glucose meter reading.  Her blood sugar log simply says:

Write down the results of your before- and after-meal blood sugar in the log below.

• Your before-meal blood sugar should be in the range of 70-130 mg/dL
• Your after-meal blood sugar  should be below 180 mg/dL                               

My blood sugar results mg/dL	Before meals	After meals

Instead, we can provide clearer direction and ways to facilitate understanding and action such as:

Write down the results of your before and after-meal blood sugars in the log below.

• Your before meal blood sugars should be between 70 and 130 mg/dL
• Your after meal blood sugars should be between 70 and 180 mg/dL

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*If your blood sugar numbers are in the high or low ranges, follow your doctor’s instructions on what to do to treat low or high blood sugar.

Supporting numeracy in our efforts

Studies have shown that people with low or even basic literacy levels often have poor understanding and control of their conditions and are less likely to actively participate in their healthcare decision making – whether that be making and attending appointments, clearly understanding what healthcare providers communicate, or accurately taking medication.  And as the trend in chronic health care moves toward more patient self-management and collaborative team care, health literacy – and numeracy –become even more important.  As experts and professionals working with adult learners, we can support learners’ health literacy and numeracy skills by making clear communications for use in the field, in research and practice, and by touting valuable resources for healthcare providers to use with patients.

Some resources and research tools available:

• American Medical Association’s Health Literacy and Patient Safety:  Help Patients Understand educational kit
• EMPower curriculum for adults
• Diabetes Literacy and Numeracy Educational Toolkit (DLNET)
• Diabetes Numeracy Test (DNT)