Quality of Life Research

, Volume 24, Issue 6, pp 1443–1453

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

  • Dana Garbarski
  • Nora Cate Schaeffer
  • Jennifer Dykema

DOI: 10.1007/s11136-014-0861-y

Cite this article as:
Garbarski, D., Schaeffer, N.C. & Dykema, J. Qual Life Res (2015) 24: 1443. doi:10.1007/s11136-014-0861-y



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.


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.


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.


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.


Self-rated health Response option order Question order Assimilation effects Validity USA 

Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Dana Garbarski
    • 1
  • Nora Cate Schaeffer
    • 2
    • 3
  • Jennifer Dykema
    • 3
  1. 1.Department of SociologyLoyola University ChicagoChicagoUSA
  2. 2.Department of SociologyUniversity of Wisconsin–MadisonMadisonUSA
  3. 3.University of Wisconsin Survey CenterUniversity of Wisconsin–MadisonMadisonUSA

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