title: Health literacy, numeracy, and interpretation of graphical breast cancer risk estimates.
abstract: OBJECTIVE
  Health literacy and numeracy are necessary to understand health information and to make informed medical decisions. This study explored the relationships among health literacy, numeracy, and ability to accurately interpret graphical representations of breast cancer risk.
  
  
  METHODS
  Participants (N=120) were recruited from the Facing Our Risk of Cancer Empowered (FORCE) membership. Health literacy and numeracy were assessed. Participants interpreted graphs depicting breast cancer risk, made hypothetical treatment decisions, and rated preference of graphs.
  
  
  RESULTS
  Most participants were Caucasian (98%) and had completed at least one year of college (93%). Fifty-two percent had breast cancer, 86% had a family history of breast cancer, and 57% had a deleterious BRCA gene mutation. Mean health literacy score was 65/66; mean numeracy score was 4/6; and mean graphicacy score was 9/12. Education and numeracy were significantly associated with accurate graph interpretation (r=0.42, p<0.001 and r=0.65, p<0.001, respectively). However, after adjusting for numeracy in multivariate linear regression, education added little to the prediction of graphicacy (r(2)=0.41 versus 0.42, respectively).
  
  
  CONCLUSIONS
  In our highly health-literate population, numeracy was predictive of graphicacy.
  
  
  CONCLUSIONS
  Effective risk communication strategies should consider the impact of numeracy on graphicacy and patient understanding.
authors.affiliation: Saddleback Memorial Medical Center, USA.
authors.forename: Sandra M
authors.initials: SM
authors.lastname: Brown
authors.forename: Julie O
authors.initials: JO
authors.lastname: Culver
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Osann
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: MacDonald
authors.forename: Sharon
authors.initials: S
authors.lastname: Sand
authors.forename: Andrea A
authors.initials: AA
authors.lastname: Thornton
authors.forename: Marcia
authors.initials: M
authors.lastname: Grant
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Bowen
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Metcalfe
authors.forename: Harry B
authors.initials: HB
authors.lastname: Burke
authors.forename: Mark E
authors.initials: ME
authors.lastname: Robson
authors.forename: Susan
authors.initials: S
authors.lastname: Friedman
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Weitzel
mesh_terms: D000328:Adult; D000368:Aged; D001296:Audiovisual Aids; D001943:Breast Neoplasms / Q000453:epidemiology*; D003142:Communication; D032882:Comprehension; D003657:Decision Making; D005260:Female; D057220:Health Literacy; D006801:Humans; D008433:Mathematics; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods; D057240:Patient Preference; D011336:Probability; D011594:Psychometrics; D018570:Risk Assessment; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D055815:Young Adult