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Understanding appraisal processes underlying the thentest: a mixed methods investigation

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An Erratum to this article was published on 06 July 2013



Mixed methods investigated the cognitive processes reflected in retrospective pretest (thentest) discrepancy scores [i.e., recalibration response shift (RS)].


People with human immunodeficiency virus/acquired immune disease syndrome (HIV/AIDS) (n = 521) were interviewed at baseline and 6 months using the Quality of Life (QOL) Appraisal Profile, the Rand-36, General Health thentest, and recall items. Open-ended appraisal questions were coded, and factor analyses reduced the data. Ipsative (based on the then-minus-pretest) and normative (based on regression residuals) discrepancy scores were compared. Hypothesis testing related to recall bias and relationships among appraisal parameters and ipsative discrepancies, after covariate adjustment.


Coded frame of reference themes were distinct from experience sampling, standards of comparison, and combinatory algorithm. There was convergence between the ipsative and normative discrepancy scores (r = 0.30), but the former were associated with more appraisal changes and goal-related appraisals than the latter. Thentest effect sizes (ES) were larger than standard change scores, even controlling for recall bias. Multivariate models including appraisal parameters explained 9% more variance over the standard (unadjusted for RS) model.


Ipsative and normative discrepancy scores measure distinct constructs, represent different configurations of appraisal change, and are not invalidated or explained by recall bias. The thentest does not imply recalibration alone but rather a host of health- and self-care-related concerns.

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We are grateful to Emily Samaha and Maya Kahn-Woods for their assistance with coding the qualitative data from the QOL Appraisal Profile, and Brian Quaranto for his assistance on tables and figures included in this manuscript. We are also grateful to Dr. Yuelin Li for his help in creating summary scores using the QOL Appraisal Profile, which were used in the analyses presented here, to Shilpa Patel for helpful comments on earlier drafts of the manuscript, and to Laura Ryniker for help in manuscript preparation. Funding this work was provided in part by the New York State Department of Health AIDS Institute (US Health Resources and Services Administration grant: 2X07 HA 0025-17 to Dr. Rapkin).

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Correspondence to Carolyn E. Schwartz.

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Schwartz, C.E., Rapkin, B.A. Understanding appraisal processes underlying the thentest: a mixed methods investigation. Qual Life Res 21, 381–388 (2012).

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