Poorly Numerate Patients in an Inner City Hospital Misunderstand the American Urological Association Symptom Score

Objectives

To hypothesize that numeracy may also predict patient misunderstanding of the American Urological Association symptom score (AUA-SS). Health literacy consists of document and prose literacy, both considered “traditional” literacy. But, health literacy also comprises quantitative literacy or numeracy. We previously reported that document literacy independently predicts misunderstanding of the AUA-SS. However, the AUA-SS consists of written and numeric information.

Methods

Prospective cohort study of male patients who completed a validated, 3-question numeracy test once and the AUA-SS twice, which were self-administered and then interviewer-assisted. These 2 responses were compared with assessed patient understanding of the AUA-SS. Multivariate logistic regression analyses examined the association between patient characteristics and poor understanding of the symptom score, defined as understanding fewer than half of the questions, by calculating the odds ratios and corresponding 95% confidence intervals.

Results

A total of 571 patients completed the study, with an average age and education level of 58 and 13.5 years, respectively. On the numeracy test, 16%, 18%, 35%, and 31% correctly answered 3, 2, 1, and 0 questions, respectively. After adjusting for the highest educational level completed, written literacy, and demographics, completely innumerate respondents (score = 0 points) were more than 3 times as likely (odds ratio = 3.55; 95% confidence interval: 1.58-7.99; P = .002) to misrepresent their AUA-SS compared with those who had some numeracy (1-3 points).

Conclusions

Regardless of educational or literacy status, a significant number of patients self-report AUA-SS scores that are different from interviewer-assisted scores, which may severely limit their access to appropriate care.