Tricky Numerical Concepts

Hi Everyone,

I found the following post on another list and would love to get your thoughts as adult educators. Specifically, could you please share with us some examples of challenging mathematical concepts that your students are faced with? It would also be great to get your ideas on how to teach these concepts!

Thanks for your help! Health literacy advocates and health educators are working hard to train health care providers and public health spokespeople to present numerical information in a way that is easier to understand. Your expertise as teachers could be very helpful to this effort!

Best, Julie

Numeracy is an important subset of both literacy and health literacy. We would like to see a comprehensive list of terms and concepts used commonly in health conversations which require the patient to understand a mathematical or numerical concept. Once we have this list, we can begin to build ways of describing the term or the concept so that a person with low numeracy skills can access the information in a real way.

Example: Usual presentation of concept: “The surgery that I am proposing carries a 15% risk of complication. This risk increases to 25% if the patient smokes or is overweight.”

Numeracy skills required to access and understand what the doctor said:  What does percent mean? What does risk mean? What does increase in risk mean?

Real information and concept that the doctor wants and needs the patient to understand:  “We do this surgery enough to know how well it turns out for most patients. Most patients do well, and the surgery goes as planned, and nothing happens afterwards that we do not want to happen, like bleeding or infection. But some patients do have things happen that are not good, like bleeding and infection. Out of every one hundred patients that has this type of surgery does have one of these problems afterwards. If a person smokes or is overweight, he is more likely to have bleeding or infection after this surgery than a person who does not smoke or have too much body weight.”

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Second example: Usual presentation of concept: “Your baby is in the 39^th percentile for head circumference, the 45^th percentile for length, and 89^th percentile for weight.

Numeracy skills required:  What is percentile? How could my baby be in three different groups? What do these measurements mean in terms of how my baby is doing? Is my baby failing on all counts? What is my baby being compared to?

Real information the patient needs to understand: “ We measure three things every time you bring the baby in, to see how she is growing. We measure the size of her head from her forehead around to the back of her head. We measure the length of the baby from top of head to her heels when she is lying down. And we measure her weight. The number give us a general idea of whether she is growing pretty normally or whether any part of her growth is way too much or way too little. These numbers are a comparison of your baby to all the other babies out there. Each number tells us how many babies are bigger or heavier than your baby, as well as how many babies are smaller or lighter than your baby. Today, your baby is heavier than most babies, but certainly not the heaviest baby out there. Your baby is right in the middle of all babies in terms of how long she is, so half the babies out there are longer than she is, and half of them are shorter than she is. Her head is not on the larger side, but is well within the normal size for her age.

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Third example:  Usual presentation of concept: “Decrease the dose by 2mg every day until you reach 10 mg a day, then decrease it by half and keep doing that for one more week.”

Numeracy skills required: What is the concept of so many mg per pill or tablet? What is the difference between decrease by 2 and cut it in half?

Real information the patient needs to understand: “ You are now taking a total of 25 milligrams of medicine every day. In the morning you are taking one tablet with 10 milligrams in it, and in the evening you take a tablet with 15 milligrams in it. You need to take a bit less of this medicine every day, in specific steps. Your schedule will look like this:  Tomorrow take 23 milligrams all together, so take 10 milligrams in the morning and 13 milligrams in the evening. 13 milligrams means one ten milligram tablet plus three tablets of one milligram each.  The day after tomorrow, or Thursday, you will take 21 milligrams all together…”

I would love to solicit examples of common things we say to patients that require comprehension of mathematical or numeric concepts. Please send me as many as you can.