Poorly Numerate Patients in an Inner City Hospital Misunderstand the American Urological Association Symptom Score
Received 12 May 2009; accepted 25 June 2009. published online 12 October 2009.
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.
aDepartment of Urology, Emory University School of Medicine, Atlanta, Georgia
bDepartment of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, Georgia
cDepartment of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
Reprint requests: Viraj A. Master, M.D., Ph.D., F.A.C.S., Department of Urology, Emory University School of Medicine, 1365 Clifton road, NE, Atlanta, GA 30 322, 404-217-6419
ABSTRACT