Self-rated health: analysis of distances and transitions between response options

When Illegitimate Tasks Threaten Patient Safety Culture: A Cross-Sectional Survey in a Tertiary Hospital

Objectives: The current study investigates the prevalence of illegitimate tasks in a hospital setting and their association with patient safety culture outcomes, which has not been previously investigated. Methods: We conducted a cross-sectional survey in a tertiary referral hospital. Patient safety culture outcomes were measured using the Hospital Survey on Patient Safety Culture questionnaire; the primary outcome measures were a low safety rating for the respondent's unit and whether the respondent had completed one or more safety event reports in the last 12 months. Analyses were adjusted for hospital department and staff member characteristics relating to work and health. Results: A total of 2,276 respondents answered the survey (participation rate: 35.0%). Overall, 26.2% of respondents perceived illegitimate tasks to occur frequently, 8.1% reported a low level of safety in their unit, and 60.3% reported having completed one or more safety event reports. In multivariable analyses, perception of a higher frequency of illegitimate tasks was associated with a higher risk of reporting a low safety rating and with a higher chance of having completed event reports. Conclusion: The prevalence of perceived illegitimate tasks was rather high. A programme aiming to reduce illegitimate tasks could provide support for a causal effect of these tasks on safety culture outcomes.

Social protection expenditure on health in later life in 20 European countries: Spending more to reduce health inequalities

BACKGROUND

This study aims to examine whether higher social protection expenditure reduces the negative association of life-course socioeconomic disadvantages with subjective and objective health status and trajectories in later life.

METHODS

We used SHARE data from participants living in 20 European countries aged 50 to 96. Seven waves allowed to examine the trajectories of health inequalities in later life. We used linear mixed-effects models stratified by sex to examine the association between life-course socioeconomic disadvantage and subjective (self-rated health, SRH, N = 55,443) and objective (grip strength, N = 54,718) health. Cross-level interactions between net social protection expenditure as percentage of gross domestic product and life-course socioeconomic disadvantage tested for the moderating effect of social expenditures on the association of disadvantage with SRH and grip strength in later life.

FINDINGS

Higher social protection expenditure reduced socioeconomic health inequalities in both men and women for grip strength, and in women but not men for SRH. For SRH, the health-inequality-reducing effect of social protection expenditure became weaker with increasing age. This was not observed in grip strength. Some separate expenditure functions (disability, family and children) were found to have inequality-widening effects in men's and women's SRH, which were either offset or overcompensated by the other functions. No inequality-widening effects were observed in grip strength.

INTERPRETATION

Higher social spending reduces life-course socioeconomic inequalities in women's subjective health and in men's and women's objective health. However, some specific social protection policies may have the unintentional effect of increasing inequalities in people's evaluation of their own health.

Association between self-rated health and the risk of hip fracture and mortality in a cohort of older women during a 10-year follow-up

Fragility fracture of the hip is associated with reduced functional status and mortality. Poor self-rated health (SRH) might be such an indicator. Our aim was to study if SRH was associated with hip fractures and all-cause mortality within the next 10 years in community-dwelling older women. A population-based sample of 350 women aged between 69 and 79 years (median 72.4) assessed their SRH by answering the question "How would you rate your health right now" by putting a mark on a visual-analogue scale (0-100 mm). Information on hip fracture and mortality over the next 10 years was retrieved from health care registers. The association between SRH and hip fracture and all-cause mortality was tested with a Cox proportional hazards regression model. SRH was divided into low, intermediate, and high (reference) assessed SRH. During the study, 40 hip fractures and 72 deaths occurred. The median value of SRH was 62 mm (IQR 50-81 mm). The age-adjusted hazard ratio (HR) for hip fracture was significantly higher in the group with low and intermediate SRH; HR: 3.17 (95% CI 1.25-8.01), and HR: 2.75 (95% CI 1.08-7.04), compared with high SRH. Adding bone mineral density (at the femoral neck) gave even greater risk. We did not find the hypothesized association between SRH and mortality. In our study, SRH indicated a higher risk of future hip fracture in older women. SRH might be a marker that could add information about the risk of hip fracture independently of bone mineral density.

Does the single-item self-rated health measure the same thing across different wordings? Construct validity study

Purpose

The self-rated health (SRH) item is frequently used in health surveys but variations of its form (wording, response options) may hinder comparisons between versions over time or across surveys. The objectives were to determine (a) whether three SRH forms are equivalent, (b) the form with the best construct validity and (c) the best coding scheme to maximize equivalence across forms.

Methods

We used data from 58,023 respondents of the Swiss Health Survey. Three SRH forms were used. Response options varied across forms and we explored four coding schemes (two considering SRH as continuous, two as dichotomous). Construct validity of the SRH was assessed using 34 health predictors to estimate the explained variance.

Results

Distributions of response options were similar across SRH forms, except for the “good” and “very good” options (“good” in form 1: 58.6%, form 2: 65.0% and form 3: 44.1%). Explained variances differed across SRH forms, with form 3 providing the best overall explained variance, regardless of coding schemes. The linear coding scheme maximised the equivalence across SRH forms.

Conclusion

The three SRH forms were not equivalent in terms of construct validity. Studies examining the evolution of SRH over time with surveys using different forms should use the linear coding scheme to maximise equivalence between SRH forms.

Electronic supplementary material

The online version of this article (10.1007/s11136-020-02533-2) contains supplementary material, which is available to authorized users.

Self-Rated Healthy Life Expectancy Changes in Jiangxi Province of China by Gender and Urban-Rural Differences, 2013-2018

Background: Globalization has brought about rapid economic and technological development, and life expectancy (LE) is constantly increasing. However, it is not clear whether an increase in LE will result in an increase in healthy life expectancy (HLE). This study evaluates trends in the self-rated healthy life expectancy (SRHLE) of residents aged 15 and older in Jiangxi Province of China from 2013 to 2018 and analyzes gender differences and urban-rural differences. This study provides a basis for the formulation of relevant public health policies. Methods: Based on two National Health Services Survey databases of Jiangxi in 2013 and 2018 as well as infant mortality rates and under-5 mortality rates from the Health Commission of Jiangxi, the Sullivan method was used to calculate SRHLE. The changes in SRHLE were decomposed into health and mortality effects using the decomposition method. Results: SRHLE decreased from 56.55 to 55.54 years and from 60.00 to 57.87 years for men and women aged 15 from 2013 to 2018, respectively. The SRHLE of women aged 15 was 3.45 and 2.34 years longer than that of men in 2013 and 2018, respectively. The SRHLE of urban men aged 15 was 2.9 and 4.46 years longer than that of rural men in 2013 and 2018, respectively, and that of urban women aged 15 was 3.28 and 5.57 years longer than that of rural women. Conclusions: The decreased SRHLE indicated that the self-rated health (SRH) status of residents in Jiangxi has worsened, and it provided evidence for the expansion of morbidity, mainly due to the increased prevalence of chronic diseases and the improvement in residents' health awareness. Policy efforts are necessary to control the increased morbidity of chronic diseases and reduce gender and urban-rural differences in the quantity and quality of years lived.

Self-rated health and health service use among bisexual female undergraduate students on Canadian Maritime campuses

Objective: To identify predicting factors for self-rated health and use of health services among undergraduate bisexual women in the Maritime Provinces, and improve knowledge on the health needs of this population. Participants: A sample of 357 undergraduate bisexual women who participated in the Maritime Undergraduate Student Sexual Health Services Survey (N = 10, 232) between September and November 2012. Methods: Guided by the Prince Edward Island Conceptual Model for Nursing, a secondary analysis of cross-sectional data was conducted using descriptive statistics and simple/multiple logistic regression models. Results: Logistic regression models revealed that self-rated health was significantly predicted by perceived social support (OR = 1.04), while health service use was significantly predicted by previous experience of forced sex (OR = 0.26). Conclusions: It is hopeful that these findings will support the development of inclusive health strategies that target bisexual women's psychosocial health needs on Maritime university campuses.

The paradox of self-rated health following joint replacement surgery

PURPOSE

Self-rated health is a commonly used patient-reported outcome, but its responsiveness to is not well documented. We examined the ability of self-rated health to capture health changes attributable to a highly effective surgical intervention.

METHODS

Prospective study of patients with severe osteoarthritis of the hip (N = 990) or knee (N = 907) who underwent total hip replacement (THA) or total knee replacement (TKA). Self-rated health was assessed pre-operatively and 1 year after surgery on a scale between "excellent" and "poor," along with other health items (other 11 items of the SF12 questionnaire) and multi-item Pain and Function scales.

RESULTS

On average, self-rated health was unchanged by surgery. In both THA and TKA cohorts, of 10 patients, 6 rated their health the same after surgery as before, 2 gave a higher rating, and 2 gave a lower rating. In contrast, major improvements were observed for all other SF12 items, and for the Pain and Function scales, in both cohorts of patients. Nevertheless, both before and after surgery, self-rated health was associated with the other SF12 items and with Pain and Function scores. These associations were stronger after surgery than before.

CONCLUSIONS

Self-rated health was not responsive to major improvements in health, documented by other instruments, attributable to joint replacement surgery. However, self-rated health was even more strongly associated with concurrent assessments of more specific health problems after surgery than before. Caution is advised in interpreting changes in self-rated health following health-altering interventions.

EuroQol Visual Analogue Scale (EQ-VAS) as a Predicting Tool for Frailty in Older Korean Adults: The Korean Frailty an Aging Cohort Study (KFACS)

OBJECTIVES

This study was conducted to determine the cutoff value and efficacy of the EuroQol Visual Analogue Scale (EQ-VAS) for predicting frailty.

DESIGN

The EQ-VAS medians (Interquartile Range) were compared and analyzed against the FFI.

PARTICIPANTS

The subjects were 1471 older adults aged 70 to 84 years who had completed both EQ-VAS and Fried Frailty index (FFI) in the first baseline year (2016) of the Korean Frailty and Aging Cohort Study.

RESULTS

Of the 1471 subjects,600 were classified as robust, 716 as pre-frail, and 155 as frail. The median EQ-VAS scores were 80.00 (20.00) for robust, 75.00 (25.00) for pre-frail, and 60.00 (25.00) for frail subjects.The medians of all five components of the FFI, weight loss (70.00 vs. 80.00), grip strength (70.00 vs. 80.00), exhaustion (70.00 vs. 80.00), walking velocity (70.00 vs. 80.00), and physical activity (70.00 vs. 80.00), were lower in the abnormal groups. We tested the efficacy of EQ-VAS as a diagnostic tool to predict frailty, and the area under the curve of EQ-VAS was 0.71 withthe optimal cut-off value of 72.

CONCLUSION

EQ-VAS presented negative correlation with FFI, and the optimal cut off value for frailty was 72. These results suggest that EQ-VAS is a valuable tool for assessing frailty andmay be a good predictor of frailty in Korean elderly population.

Self-rated health is associated with subsequent functional decline among older adults in Japan

BACKGROUND

Previous studies have reported that self-rated health (SRH) predicts subsequent mortality. However, less is known about the association between SRH and functional ability. The aim of this study was to examine whether SRH predicts decline in basic activities of daily living (ADL), even after adjustment for depression, among community-dwelling older adults in Japan.

METHODS

A three-year prospective cohort study was conducted among 654 residents aged 65 years and older without disability in performing basic ADL at baseline. SRH was assessed using a visual analogue scale (range; 0-100), and dichotomized into low and high groups. Information on functional ability, sociodemographic factors, depressive symptoms, and medical conditions were obtained using a self-administered questionnaire. Logistic regression analysis was used to examine the association between baseline SRH and functional decline three years later.

RESULTS

One hundred and eight (16.5%) participants reported a decline in basic ADL at the three-year follow-up. Multiple logistic regression analysis showed that the low SRH group had a higher risk for functional decline compared to the high SRH group, even after controlling for potential confounding factors (odds ratio (OR) = 2.4; 95% confidence interval (CI) = 1.3-4.4). Furthermore, a 10-point difference in SRH score was associated with subsequent functional decline (OR = 1.37; 95% CI = 1.16-1.61).

CONCLUSIONS

SRH was an independent predictor of functional decline. SRH could be a simple assessment tool for predicting the loss or maintenance of functional ability in community-dwelling older adults. Positive self-evaluation might be useful to maintain an active lifestyle and stay healthy.

Self-Rated Health and Sick Leave among Nurses and Physicians: The Role of Regret and Coping Strategies in Difficult Care-Related Situations

Moral distress - such as feeling strong regret over difficult patient situations - is common among nurses and physicians. Regret intensity, as well as the coping strategies used to manage regrets, may also influence the health and sickness absence of healthcare professionals. The objective of this study was to determine if the experience of regret related to difficult care-related situations is associated with poor health and sick leave and if coping strategies mediate these associations. Two cross-sectional surveys were conducted in Switzerland (Geneva, 2011 and Zurich, 2014). Outcomes were self-rated health (SRH) and sick leave in the last 6 months. We examined the associations of regret intensity with the most important care-related regret, number of recent care-related regrets, and coping strategies, using regressions models. Among 775 respondents, most reported very good SRH and 9.7% indicated absence from work during four working days or more. Intensity of the most important regret was associated with poor SRH among nurses and physicians, and with higher sick leave among nurses. Maladaptive emotion-focused strategies were associated with poor SRH among nurses, whereas adaptive emotion-focused strategies were positively associated with higher SRH and lower sick leave among physicians. Because care-related regret is an integral part of clinical practice in acute care hospitals, helping physicians and, especially, nurses to learn how to deal with negative events may yield beneficial consequences at the individual, patient care, and institutional level.

Research in and Prospects for the Measurement of Health Using Self-Rated Health

Self-rated health (SRH)-for example, "in general would you say your health is excellent, very good, good, fair, or poor?"-is the most widely used measure of health across a range of survey research studies. This paper synthesizes extant research and provides a framework for future research on the measurement of health using SRH, focusing on four interrelated topics: the factors that influence respondents' health ratings, the survey measurement features of SRH, how SRH answers are analyzed, and the stated purpose of SRH as a proxy for more objective health or as a perception of health. Extant research on the health, psychological, and social factors influencing respondents' SRH answers is reviewed, as is research concerned with the survey measurement features of SRH that influence how respondents rate their health. The synthesis proposes a framework for future research that focuses on further explicating the factors that underlie respondents' SRH answers and improving features of SRH measurement and analysis in ways that are consistent with the various goals of the researchers who both collect and analyze the data.

The relationship between perceived own health state and health assessments of anchoring vignettes

Background/Objective: Self-reported health depends on the internal frame of reference and on response styles. One way of studying this dependency is using anchoring vignettes. Response shift effects are assumed to induce a negative correlation between self-reported health and the health assessments attributed to the vignettes. Method: A representative sample of the German adult population (N = 2,409) was selected. Participants were asked to rate their health state and the health states of two rather complex vignettes representing patients with several health complaints on a 0-100 scale. Results: The mean score of self-assessed health was M = 76.20 (SD = 20.6). There was a very small positive correlation between the assessment of the vignettes and the self-assessed health state (r = .12). After controlling for a proxy of objective health, measured in terms of chronic conditions, the relationship remained slightly positive. Chronic conditions were only marginally associated with the assessments of the vignettes (0 conditions: M = 44.8; ≥ 2 conditions: M = 42.2). Conclusions: The lack of the postulated association between self-reported health and vignettes' ratings means that we cannot derive tools to correct the subjective ratings for differential use of frames of reference.

Intervals between response choices on a single-item measure of quality of life

Background

A single overall rating of quality of life (QoL) is a sensitive method that is often used in population surveys. However, the exact meaning of response choices is unclear. In particular, uneven spacing may affect the way QoL ratings should be analyzed and interpreted. This study aimed to determine the intervals between response choices to a single-item QoL assessment.

Methods

A secondary analysis was conducted on data from the Lc65+ cohort study and two additional, population-based, stratified random samples of older people (N = 5,300). Overall QoL was rated as excellent, very good, good, fair or poor. A QoL score (range 0–100) was derived from participants’ answers to a 28-item QoL assessment tool. A transformed QoL score ranging from 1 (poor) to 5 (excellent) was calculated. The same procedure was repeated to compute seven domain-specific QoL subscores (Feeling of safety; Health and mobility; Autonomy; Close entourage; Material resources; Esteem and recognition; Social and cultural life).

Results

Mean (95 % confidence intervals) QoL scores were 96.23 (95.81–96.65) for excellent, 93.09 (92.74–93.45) for very good, 81.45 (80.63–82.27) for good, 65.44 (62.67–68.20) for fair and 54.52 (45.31–63.73) for poor overall QoL, corresponding to transformed QoL scores of respectively 5.00, 4.70, 3.58, 2.05, and 1.00. Ordinality of the categories excellent to poor was preserved in all seven QoL subscores.

Conclusions

The excellent-to-poor rating scale provides an ordinal measure of overall QoL. The intervals between response choices are unequal, but an interval scale can be obtained after adequate recoding of excellent, very good, good, fair and poor.

Electronic supplementary material

The online version of this article (doi:10.1186/s12955-016-0443-5) contains supplementary material, which is available to authorized users.

Exploring self-rated health among adolescents: a think-aloud study

Background

Despite extensive use of self-rated health questions in youth studies, little is known about what such questions capture among adolescents. Hence, the aim of this study was to explore how adolescents interpret and reason when answering a question about self-rated health.

Methods

A qualitative study using think-aloud interviews explored the question, “How do you feel most of the time?”, using five response options (“Very good”, “Rather good”, “Neither good, nor bad”, “Rather bad”, and “Very bad”). The study involved 58 adolescents (29 boys and 29 girls) in lower secondary school (7th grade) and upper secondary school (12th grade) in Sweden.

Results

Respondents’ interpretations of the question about how they felt included social, mental, and physical aspects. Gender differences were found primarily in that girls emphasized stressors, while age differences were reflected mainly in the older respondents’ inclusion of a wider variety of influences on their assessments. The five response options all demonstrated differences in self-rated health, and the respondents’ understanding of the middle option, “Neither good, nor bad”, varied widely. In the answering of potential sensitive survey questions, rationales for providing honest or biased answers were described.

Conclusions

The use of a self-rated health question including the word ‘feel’ captured a holistic view of health among adolescents. Differences amongst response options should be acknowledged when analyzing self-rated health questions. If anonymity is not feasible when answering questions on self-rated health, a high level of privacy is recommended to increase the likelihood of reliability.

Using Marginal Structural Modeling to Estimate the Cumulative Impact of an Unconditional Tax Credit on Self-Rated Health

In previous studies, researchers estimated short-term relationships between financial credits and health outcomes using conventional regression analyses, but they did not account for time-varying confounders affected by prior treatment (CAPTs) or the credits' cumulative impacts over time. In this study, we examined the association between total number of years of receiving New Zealand's Family Tax Credit (FTC) and self-rated health (SRH) in 6,900 working-age parents using 7 waves of New Zealand longitudinal data (2002-2009). We conducted conventional linear regression analyses, both unadjusted and adjusted for time-invariant and time-varying confounders measured at baseline, and fitted marginal structural models (MSMs) that more fully adjusted for confounders, including CAPTs. Of all participants, 5.1%-6.8% received the FTC for 1-3 years and 1.8%-3.6% for 4-7 years. In unadjusted and adjusted conventional regression analyses, each additional year of receiving the FTC was associated with 0.033 (95% confidence interval (CI): -0.047, -0.019) and 0.026 (95% CI: -0.041, -0.010) units worse SRH (on a 5-unit scale). In the MSMs, the average causal treatment effect also reflected a small decrease in SRH (unstabilized weights: β = -0.039 unit, 95% CI: -0.058, -0.020; stabilized weights: β = -0.031 unit, 95% CI: -0.050, -0.007). Cumulatively receiving the FTC marginally reduced SRH. Conventional regression analyses and MSMs produced similar estimates, suggesting little bias from CAPTs.

Marital breakup in later adulthood and self-rated health: a cross-sectional survey in Switzerland

OBJECTIVES

This research examines the impact of relationship status on self-rated health (SRH) by taking into account intrapersonal and social resources.

METHODS

Data stem from a Swiss-based survey of 1355 participants aged 40-65 years. Three groups are compared: continuously married (n = 399), single divorcees (n = 532) and repartnered divorcees (n = 424). Linear regression models are used to examine the predictive role of relationship status on SRH and to investigate the moderating role of intrapersonal and social resources on SRH.

RESULTS

Single divorcees show the lowest SRH scores, whereas their repartnered counterparts reported scores comparable to the continuously married-even after controlling for socio-demographic and economic variables. Although single divorcees reported higher levels of loneliness and agreeableness in addition to lower levels of resilience when compared with the other groups, none of these variables had a significant moderation effect on SRH.

CONCLUSIONS

Our results underscore the positive effect of relationship status on SRH, and contribute new insights on the impact of later-life divorce. Given the growing number of divorcees, related public health challenges are likely to increase.

Individual-level changes in self-rated health before and during the economic crisis in Europe

BACKGROUND

Changes over time in self-rated health (SRH) are increasingly documented during the current economic crisis, though whether these are due to selection, causation, or methodological artefacts is unclear. This study accordingly investigates changes in SRH, and social inequalities in these changes, before and during the economic crisis in 23 European countries.

METHODS

We used balanced panel data, 2005-2011, from the European Union Statistics on Income and Living Conditions (EU-SILC). We included the working-age population (25-60 years old) living in 23 European countries. The data cover 65,618 respondents, 2005-2007 (pre-recession cohort), and 43,188 respondents, 2008-2011 (recession cohort). The data analyses used mixed-effects ordinal logistic regression models considering the degree of recession (i.e., pre, mild, and severe).

RESULTS

Individual-level changes in SRH over time indicted a stable trend during the pre-recession period, while a significant increasing trend in fair and poor SRH was found in the mild- and severe-recession cohorts. Micro-level demographic and socio-economic status (SES) factors (i.e., age, gender, education, and transitions to employment/unemployment), and macro-level factors such as welfare generosity are significantly associated with SRH trends across the degrees of recession.

CONCLUSIONS

The current economic crisis accounts for an increasing trend in fair and poor SRH among the general working-age population of Europe. Despite the general SES inequalities in SRH, the health of vulnerable groups has been affected the same way before and during the current recession.

Prostate cancer screening in Switzerland: 20-year trends and socioeconomic disparities

BACKGROUND

Despite important controversy in its efficacy, prostate cancer (PCa) screening has become widespread. Important socioeconomic screening disparities have been reported. However, trends in PCa screening and social disparities have not been investigated in Switzerland, a high risk country for PCa. We used data from five waves (from 1992-2012) of the population-based Swiss Health Interview Survey to evaluate trends in PCa screening and its association with socioeconomic indicators.

METHODS

We used multivariable Poisson regression to estimate prevalence ratios (PR) and 95% Confidence Intervals (CI) adjusting for demographics, health status, and use of healthcare.

RESULTS

The study included 12,034 men aged ≥50 years (mean age: 63.9). Between 1992 and 2012, ever use of PCa screening increased from 55.3% to 70.0% and its use within the last two years from 32.6% to 42.4% (p-value <0.05). Income, education, and occupational class were independently associated with PCa screening. PCa screening within the last two years was greater in men with the highest (>$6,000/month) vs. lowest income (≤$2,000) (46.5% vs. 38.7% in 2012, PR for overall period =1.29, 95%CI: 1.13-1.48). These socioeconomic disparities did not significantly change over time.

CONCLUSIONS

This study shows that about half of Swiss men had performed at least one PCa screening. Men belonging to high socioeconomic status are clearly more frequently screened than those less favored. Given the uncertainty of the usefulness of PCa screening, men, including those with high socioeconomic status, should be clearly informed about benefits and harms of PCa screening, in particular, the adverse effect of over-diagnosis and of associated over-treatment.

U.S. General Population Estimate for "Excellent" to "Poor" Self-Rated Health Item

BACKGROUND

The most commonly used self-reported health question asks people to rate their general health from excellent to poor. This is one of the Patient-Reported Outcomes Measurement Information System (PROMIS) global health items. Four other items are used for scoring on the PROMIS global physical health scale. Because the single item is used on the majority of large national health surveys in the U.S., it is useful to construct scores that can be compared to U.S. general population norms.

OBJECTIVE

To estimate the PROMIS global physical health scale score from the responses to the single excellent to poor self-rated health question for use in public health surveillance, research, and clinical assessment.

DESIGN

A cross-sectional survey of 21,133 individuals, weighted to be representative of the U.S. general population.

PARTICIPANTS

The PROMIS items were administered via a Web-based survey to 19,601 persons in a national panel and 1,532 subjects from PROMIS research sites. The average age of individuals in the sample was 53 years, 52 % were female, 80 % were non-Hispanic white, and 19 % had a high school degree or lower level of education.

MAIN OUTCOME MEASURES

PROMIS global physical health scale.

KEY RESULTS

The product-moment correlation of the single item with the PROMIS global physical health scale score was 0.81. The estimated scale score based on responses to the single item ranged from 29 (poor self-rated health, 2.1 SDs worse than the general population mean) to 62 (excellent self-rated health, 1.2 SDs better than the general population mean) on a T-score metric (mean of 50).

CONCLUSIONS

This item can be used to estimate scores for the PROMIS global physical health scale for use in monitoring population health and achieving public health objectives. The item may also be used for individual assessment, but its reliability (0.52) is lower than that of the PROMIS global health scale (0.81).

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

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.

Comparing self and maternal reports of adolescents' general health status: do self and proxy reports differ in their relationships with covariates?

PURPOSE

Given that mothers often-but do not always-report children's health status in surveys, it is essential to gain an understanding of whether the relationship between children's general health status and relevant covariates depends on who reports children's general health status.

METHODS

Using data from the first wave of the National Longitudinal Study of Youth 1997 cohort (N = 6,466), a nationally representative sample of adolescents in the United States ages 12 to 17 in 1997, the study first examined the concordance between self and maternal reports of adolescents' general health status. Then, self and maternal reports of adolescents' general health status were each regressed on health-relevant covariates, and tests of differences in coefficients across the models were estimated.

RESULTS

Self and maternal reports of adolescents' general health status are moderately concordant. Furthermore, the associations of adolescents' general health status with adolescent BMI and the adolescent being female significantly differ across reporters, such that the negative relationships are even more negative with self compared to maternal reports of adolescents' general health status. The associations of adolescents' general health status with the measures of adolescents' health limitations, maternal self-rated health, and certain sociodemographic covariates differ across reporters, such that each has a greater relationship with maternal compared to self-reports of adolescents' general health status.

CONCLUSION

The results are important for interpreting research on the causes and consequences of child and adolescent health, as results across studies may not be comparable if the reporter is not the same.