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American Journal of Epidemiology Advance Access originally published online on April 10, 2009
American Journal of Epidemiology 2009 169(12):1525-1530; doi:10.1093/aje/kwp070
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American Journal of Epidemiology © The Author 2009. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

PRACTICE OF EPIDEMIOLOGY

The Effect of Question Order on Self-rated General Health Status in a Multilingual Survey Context

Sunghee Lee and David Grant

Correspondence to Dr. Sunghee Lee, Center for Health Policy Research and Department of Biostatistics, University of California, Los Angeles, 10960 Wilshire Boulevard, Suite 1550, Los Angeles, CA 90025 (e-mail: slee9{at}ucla.edu).

Received for publication October 16, 2008. Accepted for publication March 3, 2009.

Current practices recommend placing a self-rated health question before specific health items in survey questionnaires to minimize potential order effects. Because this recommendation is based on data collected in English, its applicability to other languages is unknown. This study examines whether there is an order effect associated with self-rated health for interviews conducted in English and Spanish languages. An experiment was conducted by using the 2007 California Health Interview Survey, where questions on self-rated health were inserted in 1 of 2 locations: preceding and following question items on specific chronic conditions. Respondents were randomly assigned to 1 of 2 versions of the locations by the split-half method. Although no order effect was present in the English interviews, the authors found a significant and large effect with Spanish interviews: Self-rated health appeared much worse when asked before chronic conditions than when asked after them. This order effect was larger among females than males. Order effects for self-rated health differ by interview language; inferences about the health status of Spanish-speaking populations (and potentially Latinos) depend on question order. If maintaining comparability is important, the authors’ finding contradicts current recommendations, as inserting the self-rated health question before specific questions led to larger differences in health status between English and Spanish speakers.

data collection; emigrants and immigrants; health status; health surveys; Hispanic Americans; minority health; questionnaires; research


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