Numeracy Predicts Risk of Pre-Hospital Decision Delay: a Retrospective Study of Acute Coronary Syndrome Survival

• Published in: Annals of behavioral medicine Vol. 51; no. 2; pp. 292 - 306
• Main Authors: Petrova, Dafina, Garcia-Retamero, Rocio, Catena, Andrés, Cokely, Edward, Heredia Carrasco, Ana, Arrebola Moreno, Antonio, Ramírez Hernández, José Antonio
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-04-2017; Oxford University Press
• Subjects: Acute Coronary Syndrome - psychology; Acute coronary syndromes; Adult; Aged; Decision Making; Family Medicine; Female; General Practice; Health behavior; Health Knowledge, Attitudes, Practice; Health Literacy; Health Psychology; Health services utilization; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article; Patient Acceptance of Health Care - psychology; Retrospective Studies; Survival analysis; Survivors; Time-to-Treatment; Health literacy; Delay in seeking medical attention; Acute coronary syndrome; Numeracy; Decision making, risk literacy; Heart attack
• ISSN: 0883-6612; 1532-4796
• DOI: 10.1007/s12160-016-9853-1

Background
Many patients delay seeking medical attention during acute coronary syndromes (ACS), profoundly increasing their risk for death and major disability. Although research has identified several risk factors, efforts to improve patient decision making have generally been unsuccessful, prompting a call for more research into psychological factors.
Purpose
The purpose of this study is to estimate the relationship between ACS decision delay and numeracy, a factor closely related to general decision making skill and risk literacy.
Methods
About 5 days after experiencing ACS, 102 survivors (mean age = 58, 32–74) completed a questionnaire including measures of numeracy, decision delay, and other relevant factors (e.g., anxiety, depression, symptom severity, knowledge, demographics).
Results
Low patient numeracy was related to longer decision delay, OR = 0.64 [95 % confidence interval (CI) 0.44, 0.92], which was in turn related to higher odds of positive troponin on arrival at the hospital, OR = 1.37 [95 % CI 1.01, 2.01]. Independent of the influence of all other assessed factors, a patient with high (vs. low) numeracy was about four times more likely to seek medical attention within the critical first hour after symptom onset (i.e., OR
high-low
 = 3.84 [1.127, 11.65]).
Conclusions
Numeracy may be one of the largest decision delay risk factors identified to date. Results accord with theories emphasizing potentially pivotal roles of patient deliberation, denial, and outcome understanding during decision making. Findings suggest that brief numeracy assessments may predict which patients are at greater risk for life-threatening decision delay and may also facilitate the design of risk communications that are appropriate for diverse patients who vary in risk literacy.