Deciphering the Data: Health Numeracy and Its Impact on Decision-Making in Breast Augmentation

Abstract

Purpose: Numeracy, the ability to understand numerical concepts, is a key component of health literacy. This study examines rates of innumeracy and its association with demographics to inform patient education strategies in plastic surgery.

Methods: A survey was distributed via Amazon Mechanical Turk. Participants rated the perceived safety of breast augmentation using a 5-point Likert scale based on fictional statistics presented as percentages, fractions, pie charts, and pictograms. They then assessed and rated their willingness to consider breast augmentation using a novel implant option compared to a traditional implant using odds ratios, absolute risk, and risk ratios.

Results: Among 578 participants (median age: 32 years), surgical safety perception varied significantly by data presentation. Positively framed statistics (e.g., "97% success rate") received higher ratings on 5-point Likert scale (mean: 3.9, SD: 0.7) than negatively framed data (e.g., "3% complication rate"; mean: 3.6, SD: 1.0). Visual formats such as pie charts (mean: 3.9, SD: 0.8) and pictograms (mean: 3.7, SD: 0.9) led to higher safety ratings than numerical representations. Only 26% of participants rated the same complication rate consistently across all formats, and just 5.4% correctly identified the safest implant. Higher income (> $100,000; p < 0.001) and postgraduate education (p = 0.037) were associated with improved numeracy. Bar graphs were the most misinterpreted format for odds ratios, with only 42.4% providing correct responses.

Conclusion: Current healthcare data presentation may lead to misinterpretation. Plastic surgeons should address patient innumeracy in consultations and education. Optimizing numeracy strategies can improve patient understanding and decision-making.

Level of evidence v: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Keywords: Breast augmentation; Health literacy; Health numeracy; Patient comprehension; Patient education; Risk communication.