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Numeracy and Risk Literacy: What Have We Learned so Far?

  • Rocio Garcia-Retamero (a1), Agata Sobkow (a2), Dafina Petrova (a3), Dunia Garrido (a1) and Jakub Traczyk (a2)...


Numerical skills are essential to make informed decisions in our daily life. Unfortunately, many people lack basic numeracy, which limits their ability to accurately interpret risks (i.e., risk literacy). In this paper, we provide an overview of research investigating the role of numeracy in two prominent domains, where most research was concentrated, health and finance. We summarize what has been learned so far in these domains and suggest promising venues for future research. We conclude that it is important to conduct interventions to improve numeracy in less numerate individuals and to help them make informed decisions and achieve better life outcomes.

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Corresponding author

*Correspondence concerning this article should be addressed to Rocio Garcia-Retamero. Universidad de Granada. Departamento de Psicología Experimental. Campus de Cartuja S/N. 18071 Granada (Spain). E-mail:


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The second affiliation of Rocio Garcia-Retamero is Harding Center for Risk Literacy, Max Planck Institute for Human Development, Berlin (Germany).

The second and third affiliations of Dafina Petrova are Escuela Andaluza de Salud Pública (EASP), Granada (Spain); and CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid (Spain).

This research was supported by a grant from the Ministerio de Economía y Competitividad (Spain) (PSI2011-22954 and PSI2014-51842-R), the Max Planck Society (Germany), the National Science Centre (Poland) (2015/17/D/HS6/00703), the SWPS University of Social Sciences and Humanities (Poland) (BST/Wroc/2016/B/7), and Dafina Petrova is supported by a Juan de la Cierva Fellowship (FJCI-2016-28279) from the Spanish Ministry of Economy, Industry, and Competitiveness.

How to cite this article:Garcia-Retamero, R., Sobkow, A., Petrova, D., Garrido, D., & Traczyk, J. (2019). Numeracy and risk literacy: What have we learned so far? The Spanish Journal of Psychology, 22. e10. Doi:10.1017/sjp.2019.16



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Ancker, J. S., & Kaufman, D. (2007). Rethinking health numeracy: A multidisciplinary literature review. Journal of the American Medical Informatics Association, 14, 713721.
Anderson, B. L., & Schulkin, J. (2014). Physicians’ understanding and use of numeric information. In Anderson, B. L., & Schulkin, J. (Eds.), Numerical reasoning in judgments and decision making about health (pp. 5979). Cambridge, UK: Cambridge University Press.
Apter, A. J., Cheng, J., Small, D., Bennett, I. M., Albert, C., Fein, D. G., … & van Horne, S. (2006). Asthma numeracy skill and health literacy. Journal of Asthma, 43(9), 705710.
Apter, A. J., Wang, X., Bogen, D., Bennett, I. M., Jennings, R. M., García, L., ... Have, T. T. (2009). Linking numeracy and asthma-related quality of life. Patient Education and Counseling, 75, 386391.
Ashby, N. J. S. (2017). Numeracy predicts preference consistency : Deliberative search heuristics increase choice consistency for choices from description and experience. Judgement and Decision Making, 12(2), 128139.
Baron, J. (2008). Thinking and deciding (4th Ed.). Cambridge, UK: Cambridge University Press.
Bhutoria, A., Jerrim, J., & Vignoles, A. (2018). The financial skills of adults across the world. New estimates from PIAAC. (Working Paper). Retrieved from
Broniatowski, D. A., & Reyna, V. F. (2017). A formal model of fuzzy-trace theory: Variations on framing effects and the Allais Paradox. Decision, 5(4), 205252.
Chapman, G. B., & Liu, J. (2009). Numeracy, frequency, and Bayesian reasoning. Judgment and Decision Making, 4(1), 3440.
Cokely, E. T., Galesic, M., Schulz, E., Ghazal, S., & García-Retamero, R. (2012). Measuring risk literacy: The Berlin Numeracy Test. Judgment and Decision Making, 7, 2547.
Cokely, E. T., Ghazal, S., Galesic, M., García-Retamero, R., & Schulz, E. (2012). How to measure risk comprehension in educated samples. In Garcia-Retamero, R. & Galesic, M. (Eds.), Transparent communication of health risks (pp. 2952). New York, NY: Springer.
Cokely, E. T., Ghazal, S., & García-Retamero, R. (2014). Measuring numeracy. In Anderson, B. L. & Schulkin, J. (Eds.), Numerical reasoning in judgments and decision making about health (pp. 1138). Cambridge, UK: Cambridge University Press.
Cokely, E. T., Feltz, A., Ghazal, S., Allan, J. N., Petrova, D., & García-Retamero, R. (2018). Decision making skill: From intelligence to numeracy and expertise. In Ericsson, K. A., Hoffman, R. R., Kozbelt, A., & Williams, A. M. (Eds.), Cambridge handbook of expertise and expert performance (2nd Ed., pp. 476505). New York, NY: Cambridge University Press.
Cokely, E. T., & Kelley, C. M. (2009). Cognitive abilities and superior decision making under risk : A protocol analysis and process model evaluation. Judgement and Decision Making, 4(1), 2033.
Davids, S. L., Schapira, M. M., McAuliffe, T. L., & Nattinger, A. B. (2004). Predictors of pessimistic breast cancer risk perceptions in a primary care population. Journal of General Internal Medicine, 19(4), 310315.
Estrada, C. A., Martin-Hryniewicz, M., Collins, C., Byrd, J. C., & Peek, B. T. (2004). Literacy and numeracy skills and anticoagulation control. The American Journal of the Medical Sciences, 328(2), 8893.
Estrada-Mejía, C., de Vries, M., & Zeelenberg, M. (2016). Numeracy and wealth. Journal of Economic Psychology, 54, 5363.
Fagerlin, A., Ubel, P. A., Smith, D. M., & Zikmund-Fisher, B. J. (2007). Making numbers matter: Present and future research in risk communication. American Journal of Health Behavior, 31(Suppl. 1), S47S56.
Fernandes, D., Lynch, J. G. Jr., & Netemeyer, R. G. (2014). Financial literacy, financial education, and downstream financial behaviors. Management Science, 60(8), 18611883.
Gaissmaier, W., Giese, H., Galesic, M., García-Retamero, R., Kasper, J., Kleiter, I., … & Heesen, C. (2018). Numeracy of multiple sclerosis patients: A comparison of patients from the PERCEPT study to a German probabilistic sample. Patient Education and Counseling, 101, 7478,
Galesic, M., & García-Retamero, R. (2010). Statistical numeracy for health: A cross-cultural comparison with probabilistic national samples. Archives of Internal Medicine, 170, 462468.
Galesic, M., & García-Retamero, R. (2011). Do low-numeracy people avoid shared decision making? Health Psychology, 30, 336341.
Galesic, M., & García-Retamero, R. (2013). Using analogies to communicate information about health risks. Applied Cognitive Psychology, 27, 3342.
García-Retamero, R., Andrade, A., Sharit, J., & Ruiz, J. G. (2015). Is patients’ numeracy related to physical and mental health? Medical Decision Making, 35(4), 501511.
García-Retamero, R., & Cokely, E. T. (2013). Communicating health risks with visual aids. Current Directions in Psychological Science, 22, 392399.
García-Retamero, R., & Cokely, E. (2014). The influence of skills, message frame, and visual aids on prevention of sexually transmitted diseases. Journal of Behavioral Decision Making, 27, 179189.
García-Retamero, R., & Cokely, E. T. (2017). Designing visual aids that promote risk literacy: A systematic review of health research and evidence-based design heuristics. Human Factors, 59, 582627.
García-Retamero, R., Cokely, E. T., & Hoffrage, U. (2015). Visual aids improve diagnostic inferences and metacognitive judgment calibration. Frontiers in Psychology, 6, article 932.
García-Retamero, R., Cokely, E. T., Wicki, B., & Joeris, A. (2016). Improving risk literacy in surgeons. Patient Education and Counseling, 99, 11561161.
García-Retamero, R., & Galesic, M. (2009). Communicating treatment risk reduction to people with low numeracy skills: A cross-cultural comparison. American Journal of Public Health, 99(12), 21962202.
García-Retamero, R., & Galesic, M. (2010). How to reduce the effect of framing on messages about health. Journal of General Internal Medicine, 25, 13231329.
García-Retamero, R., & Galesic, M. (2011). Using plausible group sizes to communicate information about medical risks. Patient Education and Counseling, 84, 245250.
García-Retamero, R., & Galesic, M. (2013). Transparent communication of health risks: Overcoming cultural differences. New York, NY: Springer.
García-Retamero, R., & Hoffrage, U. (2013). Visual representation of statistical information improves diagnostic inferences in doctors and their patients. Social Science & Medicine, 83, 2733.
García-Retamero, R., Wicki, B., Cokely, E. T., & Hanson, B. (2014). Factors predicting surgeons’ preferred and actual roles in interactions with their patients. Health Psychology, 33, 920928.
Gardner, P. H., McMillan, B., Raynor, D. K., Woolf, E., & Knapp, P. (2011). The effect of numeracy on the comprehension of information about medicines in users of a patient information website. Patient Education and Counseling, 83(3), 398403.
Ghazal, S., Cokely, E. T., & García-Retamero, R. (2014). Predicting biases in very highly educated samples: Numeracy and metacognition. Judgment and Decision Making, 9(1), 1534.
Gigerenzer, G., Gaissmaier, W., Kurz-Milcke, E., Schwartz, L. M., & Woloshin, S. (2007). Helping doctors and patients make sense of health statistics. Psychological Science in the Public Interest, 8(2), 5396.
Gilovich, T., Griffin, D., & Kahneman, D. (Eds.) (2002). Heuristics and biases: The psychology of intuitive judgment. Cambridge, UK: Cambridge University Press.
Ginde, A. A., Clark, S., Goldstein, J. N., & Camargo, C. A. Jr., (2008). Demographic disparities in numeracy among emergency department patients: Evidence from two multicenter studies. Patient Education and Counseling, 72(2), 350356.
Gurmankin, A. D., Baron, J., & Armstrong, K. (2004). Intended message versus message received in hypothetical physician risk communications: Exploring the gap. Risk Analysis, 24, 13371347.
Huizinga, M. M., Beech, B. M., Cavanaugh, K. L., Elasy, T. A., & Rothman, R. L. (2008). Low numeracy skills are associated with higher BMI. Obesity, 16(8), 19661968.
Jasper, J. D., Bhattacharya, C., Levin, I. P., Jones, L., & Bossard, E. (2013). Numeracy as a predictor of adaptive risky decision making. Journal of Behavioral Decision Making, 26(2), 164173.
Johnson, E. D., & Tubau, E. (2013). Words, numbers, & numeracy: Diminishing individual differences in Bayesian reasoning. Learning and Individual Differences, 28, 3440.
Johnson, E. D., & Tubau, E. (2017). Structural mapping in statistical word problems: A relational reasoning approach to Bayesian inference. Psychonomic Bulletin & Review, 24(3), 964971.
Kable, J. W., Caulfield, M. K., Falcone, M., McConnell, M., Bernardo, L., Parthasarathi, T., … Lerman, C. (2017). No effect of commercial cognitive training on neural activity during decision-making. The Journal of Neuroscience, 37, 73907402.
Kaplan, R. M., & Frosch, D. L. (2005). Decision making in medicine and health care. Annual Review of Clinical Psychology, 1, 525556.
Kucian, K., Grond, U., Rotzer, S., Henzi, B., Schönmann, C., Plangger, F., … von Aster, M. (2011). Mental number line training in children with developmental dyscalculia. NeuroImage, 57(3), 782795.
Kutner, M., Greenburg, E., Jin, Y., & Paulsen, C. (2006). The Health Literacy of America’s Adults: Results from the 2003 National Assessment of Adult Literacy. NCES 2006–483. Washington, WA: National Center for Education Statistics.
Lipkus, I. M., Samsa, G., & Rimer, B. K. (2001). General performance on a numeracy scale among highly educated samples. Medical Decision Making, 21(1), 3744.
Manganello, J. A., & Clayman, M. L. (2011). The association of understanding of medical statistics with health information seeking and health provider interaction in a national sample of young adults. Journal of Health Communication, 16(Suppl. 3), 163176.
McCaffery, K. J., Smith, S. K., & Wolf, M. (2010). The challenge of shared decision making among patients with lower literacy: A framework for research and development. Medical Decision Making, 30(1), 3544.
McNair, S., & Feeney, A. (2015). Whose statistical reasoning is facilitated by a causal structure intervention? Psychonomic Bulletin & Review, 22(1), 258264.
Millroth, P., & Juslin, P. (2015). Prospect evaluation as a function of numeracy and probability denominator. Cognition, 138, 19.
Paasche-Orlow, M. K., & Wolf, M. S. (2007). The causal pathways linking health literacy to health outcomes. American Journal of Health Behavior, 31(1), S19S26.
Pachur, T., & Galesic, M. (2013). Strategy selection in risky choice: The impact of numeracy, affect, and cross-cultural differences. Journal of Behavioral Decision Making, 26(3), 260271.
Park, J., & Brannon, E. M. (2013). Training the approximate number system improves math proficiency. Psychological Science, 24(10), 20132019.
Patalano, A. L., Saltiel, J. R., Machlin, L., & Barth, H. (2015). The role of numeracy and approximate number system acuity in predicting value and probability distortion. Psychonomic Bulletin & Review, 22(6), 18201829.
Peters, E. (2012). Beyond comprehension: The role of numeracy in judgments and decisions. Current Directions in Psychological Science, 21(1), 3135.
Peters, E., & Bjalkebring, P. (2015). Multiple numeric competencies: When a number is not just a number. Journal of Personality and Social Psychology, 108(5), 802822.
Peters, E., & Levin, I. P. (2008). Dissecting the risky-choice framing effect : Numeracy as an individual-difference factor in weighting risky and riskless options. Literacy, 3(6), 435448.
Peters, E., Shoots-Reinhard, B., Tompkins, M. K., Schley, D., Meilleur, L., Sinayev, A., … Crocker, J. (2017). Improving numeracy through values affirmation enhances decision and STEM outcomes. PloS ONE, 12(7), e0180674.
Peters, E., Västfjäll, D., Slovic, P., Mertz, C. K., Mazzocco, K., & Dickert, S. (2006). Numeracy and decision making. Psychological Science, 17(5), 407413.
Petrova, D., García-Retamero, R., Catena, A., & van der Pligt, J. (2016). To screen or not to screen: What factors influence complex screening decisions? Journal of Experimental Psychology: Applied, 22(2), 247.
Petrova, D., García-Retamero, R., Catena, A., Cokely, E. T., Heredia Carrasco, A., Arrebola Moreno, A., & Ramírez-Hernández, J. A. (2017). Numeracy predicts risk of pre-hospital decision delay: A retrospective study of acute coronary syndrome survival. Annals of Behavioral Medicine, 51, 292306.
Petrova, D., Kostopoulou, O., Delaney, B. C., Cokely, E. T., & García-Retamero, R. (2017). Strengths and gaps in physicians’ risk communication: A scenario study of the influence of numeracy on cancer screening communication. Medical Decision Making, 38(3), 355365.
Petrova, D. G., van der Pligt, J., & García-Retamero, R. (2014). Feeling the numbers: On the interplay between risk, affect, and numeracy. Journal of Behavioral Decision Making, 27(3), 191199.
Portnoy, D. B., Roter, D., & Erby, L. H. (2010). The role of numeracy on client knowledge in BRCA genetic counseling. Patient Education and Counseling, 81(1), 131136.
Reyna, V. F., Nelson, W. L., Han, P. K., & Dieckmann, N. F. (2009). How numeracy influences risk comprehension and medical decision making. Psychological Bulletin, 135, 943973.
Rodríguez, V., Andrade, A. D., García-Retamero, R., Anam, R., Rodríguez, R., Lisigurski, M., … Ruiz, J. G. (2013). Health literacy, numeracy, and graphical literacy among veterans in primary care and their effect on shared decision-making and trust in physicians. Journal of Health Communication, 18, 273289.
Rothman, R. L., Housam, R., Weiss, H., Davis, D., Gregory, R., Gebretsadik, T., ... & Elasy, T. A. (2006). Patient understanding of food labels: The role of literacy and numeracy. American Journal of Preventive Medicine, 31, 391398.
Roter, D. L. (2005). Health literacy and the patient–provider relationship. In Schwartzberg, J. G., van Geest, J, & Wang, C. C. (Eds.), Understanding health literacy: Implications for medicine and public health (pp. 87100). Chicago, IL: AMA Press.
Sharit, J., Lisigurski, M., Andrade, A. D., Karanam, C., Nazi, K. M., Lewis, J. R., & Ruiz, J. G. (2014). The roles of health literacy, numeracy, and graph literacy on the usability of the VA’s personal health record by veterans. Journal of Usability Studies, 9, 173193.
Schley, D. R., & Peters, E. (2014). Assessing “economic value”: Symbolic-number mappings predict risky and riskless valuations. Psychological Science, 25(3), 753761.
Schwartz, L. M., Woloshin, S., Black, W. C., & Welch, H. G. (1997). The role of numeracy in understanding the benefit of screening mammography. Annals of Internal Medicine, 127(11), 966972.
Simon, H. A. (1990). Invariants of human behavior. Annual Review of Psychology, 41(1), 120.
Simons, D. J., Boot, W. R., Charness, N., Gathercole, S. E., Chabris, C. F., Hambrick, D. Z., & Stine-Morrow, E. A. L. (2016). Do “brain-training” programs work? Psychological Science in the Public Interest, 17(3), 103186.
Skagerlund, K., Lind, T., Strömbäck, C., Tinghög, G., & Västfjäll, D. (2018). Financial literacy and the role of numeracy – How individuals’ attitude and affinity with numbers influence financial literacy. Journal of Behavioral and Experimental Economics, 74, 1825.
Starmer, C. (2000). Developments in non-expected utility theory: The hunt for a descriptive theory of choice under risk. Journal of Economic Literature, 38(2), 332382.
Traczyk, J., & Fulawka, K. (2016). Numeracy moderates the influence of task-irrelevant affect on probability weighting. Cognition, 151, 3741.
Traczyk, J., Lenda, D., Serek, J., Fulawka, K., Tomczak, P., Strizyk, K., … Sobkow, A. (2018). Does fear increase search effort in more numerate people? An experimental study investigating information acquisition in a decision from experience task. Frontiers in Psychology, 9, article 1203.
Traczyk, J., Sobkow, A., Fulawka, K., Kus, J., Petrova, D., & García-Retamero, R. (2018). Numerate decision makers don’t use more effortful strategies unless it pays: A process tracing investigation of skilled and adaptive strategy selection in risky decision making. Judgment and Decision Making, 13(4), 372381.
von Neumann, J., & Morgenstern, O. (1944). Theory of games and economic behavior. Princeton, NJ: Princeton University Press.
von Wagner, C., Steptoe, A., Wolf, M. S., & Wardle, J. (2009). Health literacy and health actions: A review and a framework from health psychology. Health Education & Behavior, 36(5), 860877.
Waldrop-Valverde, D., Jones, D. L., Gould, F., Kumar, M., & Ownby, R. L. (2010). Neurocognition, health-related reading literacy, and numeracy in medication management for HIV infection. AIDS Patient Care and STDs, 24(8), 477484.
Weinfurt, K. P., Castel, L. D., Li, Y., Sulmasy, D. P., Balshem, A. M., Benson, A. B. III., ... Meropol, N. J. (2003). The correlation between patient characteristics and expectations of benefit from Phase I clinical trials. Cancer, 98, 166175.
Zikmund-Fisher, B. J., Mayman, G., & Fagerlin, A. (2014). Patient numeracy: What do patients need to recognize, think or do with health numbers. In Anderson, B. L. & Schulkin, J. (Eds.), Numerical reasoning in judgments and decision making about health (pp. 80104.). Cambridge, UK: University Press.


Numeracy and Risk Literacy: What Have We Learned so Far?

  • Rocio Garcia-Retamero (a1), Agata Sobkow (a2), Dafina Petrova (a3), Dunia Garrido (a1) and Jakub Traczyk (a2)...


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