Bowling A, Windsor J
Department of Primary Care and Population Sciences, University College London, London, UK.
J Epidemiol Community Health. 2008 Jan;62(1):81-5. doi: 10.1136/jech.2006.058214.
One of the most ubiquitous global health measures is a single self-rated health item. This item may be sensitive to its position in questionnaires and to response-choice wording. The aims of this paper were to investigate the effects of question order and response choice on self-reported health status.
A secondary analysis of wave 1 of the English Longitudinal Study of Ageing (ELSA). Participants were a nationally representative sample of people aged 50 years and over living at home. Over 11 000 respondents were interviewed face-to-face in their homes, and were randomly assigned to one of two versions of a self-rated health item.
The health status item asked after, rather than before, a module of health questions, resulted in more optimal health assessments, although the effect size was small. The version of the health status item with "excellent", rather than "very good" as the first response category resulted in more optimal health assessments, although it had a smaller ceiling effect.
There was support for the insertion of the health status question at the beginning of health questionnaires, as it may be influenced by questions about health and disease if placed at the end, although the effect size was small. Evidence for the version of the item with "excellent", rather than "very good", as the first response choice was more mixed as, although optimism bias appeared higher, the ceiling effects were lower. The smaller ceiling effects for the "excellent" version has important implications for the ability to detect improvements in follow-up studies.
最普遍的全球健康衡量指标之一是单个自评健康项目。该项目可能对其在问卷中的位置以及回答选项措辞敏感。本文旨在研究问题顺序和回答选项对自我报告健康状况的影响。
对英国老龄化纵向研究（ELSA）第一波数据进行二次分析。参与者是全国范围内具有代表性的50岁及以上居家生活人群样本。超过11000名受访者在家中接受面对面访谈，并被随机分配到自评健康项目的两个版本之一。
在一组健康问题模块之后而非之前询问健康状况项目，会得出更优的健康评估结果，尽管效应量较小。健康状况项目版本中，将“优秀”而非“非常好”作为第一个回答类别会得出更优的健康评估结果，尽管其天花板效应较小。
支持将健康状况问题置于健康问卷开头，因为如果放在末尾可能会受到关于健康和疾病问题的影响，尽管效应量较小。对于将“优秀”而非“非常好”作为第一个回答选项的项目版本，证据则较为复杂，因为尽管乐观偏差似乎更高，但其天花板效应较低。“优秀”版本较小的天花板效应对于在随访研究中检测改善情况的能力具有重要意义。
