Efforts by policymakers to involve patients in treatment decision making are increasing worldwide. Some of these efforts must accommodate patients with different levels of health literacy, but do not specify if numeracy is part of health literacy. This research asked, How are health literacy and numeracy defined in the academic literature and what empirical relationship(s) do they have with the three stages of the treatment decision making process? I conducted a systematic review and two scoping reviews. In the systematic review, I identify definitions of health literacy used in the academic literature and interpretations possible for the most commonly used definitions. In the first scoping review, I map the empirical relationships between health literacy and the three stages of treatment decision making (information exchange, deliberation, and deciding on the treatment to implement). In the second scoping review, I map the empirical relationships between numeracy and the three stages of treatment decision making, and examine if, and how, numeracy has been mentioned in relation to health literacy. The systematic review identified 250 different definitions of health literacy and found the most commonly used definitions open to differing interpretations. The scoping reviews revealed a lack of: (1) agreement over the definition, measurement, and handling of health literacy and numeracy in studies, and (2) overlap in the relationship(s) examined. Health literacy and numeracy were largely treated as separate concepts. Knowledge gaps and measurement-related problems were identified. The findings from the systematic review pose significant challenges for the measurement of health literacy and for the implementation of health literacy-related policy initiatives. The meaning(s) of health literacy must be explicated by both researchers and policymakers. The findings from the scoping reviews indicate that the relationship(s) between health literacy, numeracy, and treatment decision making is unclear. Researchers must address the knowledge gaps and measurement-related problems identified. / Dissertation / Doctor of Philosophy (PhD) / Health literacy – the ability to obtain, understand, evaluate, and communicate information - is gaining increasing attention from both researchers and policymakers. This attention is important to efforts seeking to involve patients in their treatment decisions. Some of these efforts require attention to patients’ health literacy, but do not make clear if numeracy (or math skills) is part of health literacy. This research examines how health literacy and numeracy are defined. The relationship(s) that health literacy and numeracy have with the three stages of the treatment decision making process are also examined. The findings show that health literacy and numeracy have been: (1) defined and measured differently in studies, and (2) largely treated as separate concepts by researchers. The relationships between health literacy, numeracy, and the three stages of treatment decision making are also unclear because of knowledge gaps and measurement-related problems.

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<div>A number of studies provide evidence that the home numeracy environment (HNE) is important for the development of early numeracy skills. There is also evidence that preschoolers understanding of math language is a strong predictor of numeracy skills. However, there is limited research on the role of math language knowledge in the relation between the HNE and early numeracy skills. The purpose of this study was to investigate the relation between different aspects of the HNE (direct vs. indirect numeracy activities) and numeracy skills while considering math language as a moderator. Participants included 125 children between 3.01 to 5.17 years (M = 4.09) and their parents. Parents reported on the frequency of engaging children in home numeracy activities. Children were assessed in the fall and spring of their preschool year on their numeracy skills and math language knowledge. Hierarchical multiple regressions were conducted to test if prior math language knowledge would moderate the relation between each component of the HNE (indirect and direct numeracy activities) and later numeracy skills. Results indicate that math language was not a moderator of these relations. However, supplemental analyses suggest that math language mediates the relation between direct HNE and numeracy skills. These findings provide evidence that the relation between the direct HNE and early numeracy may be explained by preschooler’s math language knowledge.</div><div><br></div>

Early numeracy skills are related to children’s later mathematics and reading skills. Early interventions that target parent-child numeracy practices may be an effective way to promote these skills in young children. The aim of the current study was to evaluate the effectiveness of a home numeracy environment (HNE) intervention in increasing preschool children’s early numeracy skills through a randomized controlled trial. The intervention was designed to incorporate practices that have been shown to improve children’s numeracy development, in addition to a number of practices that have been shown to lead to effective outcomes for parenting interventions more broadly. Parents were randomly assigned to participate in either the HNE intervention or an active comparison condition. Both groups of parents attended a brief informational meeting and received daily text messages for four weeks; parents in the intervention group received information about the importance of early mathematics development and strategies for incorporating numeracy into their children’s daily routines and parents in the active comparison condition received information on general development in preschool. Before and after the intervention, parents completed a questionnaire on their numeracy beliefs and practices, and children were assessed on their early numeracy skills. Findings indicate that, compared to parents in the comparison condition, parents who participated in the intervention reported more frequent direct HNE activities and their children showed greater improvement on numeracy skills. There were no group differences on beliefs of importance of math, self-efficacy for teaching math, or engagement in indirect HNE practices. The study provides initial evidence that a brief HNE intervention is feasible for parents to implement and is effective in improving preschool children’s numeracy skills.

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.

<p>  </p> <p>The Home Numeracy Environment (HNE) is an essential factor that helps explain children’s numeracy skills. Research in this field has been developed mostly focused on monolingual English-speaking families. More recent studies have analyzed this construct for Latine families using existing HNE measures. However, the existing HNE scales have not taken into consideration cultural differences that contextualize the home environment (Kung et al., 2020), and using those measures in more diverse samples might provide biased results from a deficit perspective. </p> <p>Given the growth of the Latine population in the U.S. and the importance of the HNE for explaining monolingual children’s early numeracy skills, it is important to understand how Latine families foster those skills by identifying and recognizing those families’ funds of knowledge. In this thesis, I use a sequential mixed methods design with the overarching purpose of first understanding the HNE of Latine families living in the U.S. through semi-structured interviews and then developing a culturally contextualized HNE scale for Latine families. Findings from the interviews highlight that numeracy for Latine Families is everywhere and part of everyday informal interactions. The developed HNE scale for Latine families consist of 30 items and reflects three factors: Parents-Child Interactions, Parents’ Math Anxiety, and Math Beliefs. This work enriches the body of knowledge regarding the HNE, not only because of the focus on Latine families but also because of the use of inductive and deductive approaches, the inclusion of a group of experts to validate the scale, and procedures such as IRT to assess items’ performance on the scale. This study updates and increases the cultural relevance of an important measure, as it is the HNE </p>

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