Individual Interviews

Individual interviews were conducted in a quiet room at the University of Waterloo for approximately 1 hour and 30 minutes. For comfort and to be culturally safe for participants, a Mandarin-speaking facilitator was always present when Mandarin-speaking participants were being interviewed. First, participants filled the general information questionnaire, followed by the Subjective Numeracy Scale. Next was the S-TOFHLA numeracy and prose exercises. The MSES was administered subsequently followed by the NVS and the French-Kit (addition and addition and subtraction correction). The Think-aloud exercise was administered last. Following are details of the administration process.

Participants started by filling the general information questionnaire. This instrument had items that covered various issues of interest, such as everyday language usage, the language spoken as a child, the language used in elementary education math instruction, and the language used when talking with healthcare providers. This questionnaire was followed with the SNS where participants were

instructed to self-assess their math ability and preference on a scale from 1 (not good at all) to 6 (extremely good). All questions except question 7 (which was reverse- coded 6-1) were scored on a Likert-Scale from 1-6. The SNS score was the average rating across the 8 questions. The scores for each item were tallied and the final score indicated the individual’s reported anxiety level, with 6 being the highest level. SNS ability subscale score was the average rating on questions 1-4 and the SNS preference subscale score was the average rating on questions 5-8.

Participants were next introduced to the S-TOFHLA. Although they were not informed, participants were expected to take 5 minutes on the numeracy component and 7 minutes on the comprehension component. For the numeracy component, the interviewer gave participants cue card in the following sequence: 1) information on a prescription bottle, 2) prompt card with information on blood sugar level, 3)

appointment card, and 4) information on prescription bottle. Participants read the information and orally answered the questions that were read to them. Each correct answer was awarded 7 points, with a maximum of 48 points.

Participants were then given the comprehension component of the S-TOFHLA which was self-administered. The interviewer secretly timed the process, noted the point at which the 7 minutes were used and carefully stopped the participant with words like “You can stop now. I think I now have all the information I need form

that exercise. Thank you very much”. The S-TOFHLA comprehension score was calculated by awarding each correct answer 2 points, up to a total of 72 points for the 32 items. Together, the numeracy and the comprehension scores constituted the individual’s S-TOFHLA score. This score reflected whether the individual had 1) inadequate functional health literacy (0-53), 2) marginal functional health literacy (54-66), and 3) adequate functional health literacy (67-100).

After the S-TOFHLA, the MSES was introduced. The MSES involved

answering 18 questions on a Likert scale from 0 (no confidence at all) to 9 (complete confidence). This instrument was self-administered and participants used pencil and paper to mark their level on the scale. The MSES score was obtained by summing the response numbers given to each of the 18 items in the scale and dividing that sum by 18, to derive an average score.

The next exercise was the NVS. Participant were given and asked to read a laminated copy of the nutrition label of an ice cream can. After reading, they were asked the six NVS questions based on the label. Participants referred to the nutrition label when answering the questions. The questions were asked orally and the

responses were recorded on a score sheet. This process took about 3 minutes. The maximum NVS score is 6 points, with each correct answer getting one point.

The exercise to test participants’ response time and facility with simple math process involved two arithmetic tasks from the French-Kit (addition, and addition and subtraction-correction test). To avoid anxiety, participants were not informed that the exercise was timed although each exercise was supposed to take 2 minutes. In the addition exercise, participants wrote solutions to a set of arithmetic problems. Each correct answer was awarded 1 mark. In the second exercise, participants were asked to mark “C” (correct) or “I” (incorrect) beside each answer of the math

problem. The score for this exercise was the number of items marked correctly minus the number marked incorrectly.

The final exercise was the think-aloud. Participants were given information on diabetes diet involving whole numbers and fractions. The problems were developed from diabetes information from the Canadian Diabetes Association website, and involved five items that included simple addition, division and/or multiplication. The task was to calculate the daily diet intake of a mother who had diabetes.

Participants were asked for permission to be audio-recorded as they did the exercise, because they were supposed to “think aloud” as they solved the problems. If a

participant was silent, the researcher politely reminded him of her to “think aloud”. Study participants were advised to focus on solving the problem and to only express their thoughts verbally. The recording from the think-aloud exercise were

transcribed and analyzed and the results were used to develop the think-aloud task for the main study.