Abstract
BackgroundSelf-rated health (SRH) is one of the most commonly used summary measures of overall health and well-being available to population scientists due to its ease of administration in large-scale surveys and to its efficacy in predicting mortality. This paper assesses the extent to which SRH is affected by its placement before or after questions about bodyweight on a survey, and whether differences in placement on the questionnaire affects SRH’s predictive validity.MethodsI assessed the validity of SRH in predicting the risk of mortality by comparing outcomes of sample members who were asked to rate their health before reporting on their bodyweight (the control group) and sample members who were asked to rate their health after reporting on their bodyweight (the treatment group). Both the control and treatment group were randomly assigned via an experiment administered as a module in a nationally representative sample of adults in the USA in 2019 (N = 2523).ResultsThe odds of reporting a more favorable appraisal of health are 30% lower for sample members who were in the treatment group when compared with the control group. Additionally, the SRH of treatment group members is significantly associated with their risk of mortality, while the SRH of control group members is not.ConclusionThe findings from this study suggest that for researchers to maximize the utility of SRH, closer attention needs to be paid to the context of the survey within which it asked. SRH is highly sensitive to the questions that precede it, and this sensitivity may in turn mischaracterize the true health of the population that the survey is intending to measure.
Highlights
Self-rated health (SRH) is one of the most commonly used summary measures of overall health and well-being available to population scientists due to its ease of administration in large-scale surveys and to its efficacy in predicting mortality
The first analytical task is to assess the evidence in support of the hypothesis that that sample members will downwardly adjust their SRH if they are first asked to report on their bodyweight (H1)
Control group members, who were asked to rate their health before answering questions about their bodyweight, reported being in excellent or in very good health at higher rates when compared with treatment group members
Summary
Self-rated health (SRH) is one of the most commonly used summary measures of overall health and well-being available to population scientists due to its ease of administration in large-scale surveys and to its efficacy in predicting mortality. In a handful of studies, researchers have documented that when sample members are asked to rate their health after a series of items about specific health conditions, they are more likely to report being in poor health than if they were asked to rate their health prior to the same health condition items [6, 16] This comports with theories about cognitive priming in psychology which posit that exposure to one stimulus (in this case, questions about the prevalence of personal health conditions) influences a response to a subsequent stimulus (in this case, a question about SRH) without conscious guidance or intention [22]. If sample members are prompted to think about specific health conditions they may have as they fill out a survey—even if only briefly— those conditions may unconsciously inform how they appraise their own health when asked a more generic item such as SRH.
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