Examining determinants of health numeracy and processing of numeric health information by English-as-a-second language immigrants to Canada

Abstract

Health numeracy is a necessary skill for accessing health services. Immigrants have lower levels of health numeracy compared to host populations which constrains their access to health information necessary to make quality health decisions. Factors contributing to immigrants’ low health numeracy skills include language and mathematics self-efficacy. Language is associated with how people acquire and process numeric information. Some languages have more numeric concepts than others. Speakers of languages that lack one or more numeric concepts may be constrained in the comprehension of health information that contains such concepts. Moreover, they may lack the self-efficacy to engage in numeric tasks containing such concepts. Therefore, the overall objectives of this study were: 1) to investigate the effect of primary language and 2) mathematics self-efficacy on its speakers’ comprehension of numeric health information presented in a different language; and also 3) to investigate how speakers of low and high numeric concept languages process numeric health information when the information is presented in a language which is not their primary or first language. The study involved sixty Kikuyu (a low numeric concept language) and sixty Mandarin (a high numeric concept language) speaking immigrants to Canada. Demographic data was collected from the 120 participants using a general information questionnaire. Numeracy was assessed using a context-free numeracy tool (French Kit). Short test of functional literacy in adults (S-TOFHLA) and the newest vital signs (NVS) were used to assess health numeracy and literacy, and self-efficacy was measured with the Mathematics Self-Efficacy Scale (MSES) and the Subjective Numeracy Scale (SNS). Processing of numeric health information was assessed qualitatively using the think-aloud method. Descriptive statistics were generated for performance in numeracy, health numeracy and literacy, and in mathematics self-efficacy. Multiple regression analysis was conducted to determine the predictors of numeracy and health numeracy. Protocol analysis was conducted for the verbal information obtained from the think-aloud process. Results, interpretations and implications for public health practice and research are discussed.