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The effects of response option order and question order on self-rated health

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Abstract

Objectives

This study aims to assess the impact of response option order and question order on the distribution of responses to the self-rated health (SRH) question and the relationship between SRH and other health-related measures.

Methods

In an online panel survey, we implement a 2-by-2 between-subjects factorial experiment, manipulating the following levels of each factor: (1) order of response options (“excellent” to “poor” versus “poor” to “excellent”) and (2) order of SRH item (either preceding or following the administration of domain-specific health items). We use Chi-square difference tests, polychoric correlations, and differences in means and proportions to evaluate the effect of the experimental treatments on SRH responses and the relationship between SRH and other health measures.

Results

Mean SRH is higher (better health) and proportion in “fair” or “poor” health lower when response options are ordered from “excellent” to “poor” and SRH is presented first compared to other experimental treatments. Presenting SRH after domain-specific health items increases its correlation with these items, particularly when response options are ordered “excellent” to “poor.” Among participants with the highest level of current health risks, SRH is worse when it is presented last versus first.

Conclusion

While more research on the presentation of SRH is needed across a range of surveys, we suggest that ordering response options from “poor” to “excellent” might reduce positive clustering. Given the question order effects found here, we suggest presenting SRH before domain-specific health items in order to increase inter-survey comparability, as domain-specific health items will vary across surveys.

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Notes

  1. Question 2, about alcohol consumption, is excluded from the index of current health risks. This question was included as part of the corpus to prime respondents in the conditions in which SRH is presented last to think of a range of health behaviors, conditions, and limitations, but cannot be used to reliably estimate behavioral risk given that the complex relationship between alcohol consumption and health cannot be assessed without additional data on the number of alcoholic drinks consumed daily [28].

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Acknowledgments

This research was supported in part by funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development grants to the Center for Demography and Ecology (T32 HD007014) and the Health Disparities Research Scholars training program (T32 HD049302), and from core funding to the Center for Demography and Ecology (R24 HD047873) at the University of Wisconsin–Madison. The data used in this study were collected by GfK with funding from Time-sharing Experiments for the Social Sciences (NSF Grant SES-0818839, Jeremy Freese and James Druckman, Principal Investigators). This study was approved by the Social and Behavioral Sciences Institutional Review Board at the University of Wisconsin–Madison. A previous version of this paper was presented at the 2014 meeting of the American Association for Public Opinion Research in Anaheim, CA. We thank conference participants and the peer reviewers for their insightful comments. The opinions expressed herein are those of the authors, and any errors are the sole responsibility of the authors.

Conflict of interest

None declared.

Author information

Authors and Affiliations

  1. Department of Sociology, Loyola University Chicago, 1032 West Sheridan Road, Chicago, IL, 60660, USA

    Dana Garbarski

  2. Department of Sociology, University of Wisconsin–Madison, Madison, WI, USA

    Nora Cate Schaeffer

  3. University of Wisconsin Survey Center, University of Wisconsin–Madison, Madison, WI, USA

    Nora Cate Schaeffer & Jennifer Dykema

Authors
  1. Dana Garbarski
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  2. Nora Cate Schaeffer
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  3. Jennifer Dykema
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Corresponding author

Correspondence to Dana Garbarski.

Appendix

Appendix

See Table 6.

Table 6 Survey questions
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Garbarski, D., Schaeffer, N.C. & Dykema, J. The effects of response option order and question order on self-rated health. Qual Life Res 24, 1443–1453 (2015). https://doi.org/10.1007/s11136-014-0861-y

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