Abstract
BackgroundComparing self-rating health responses across individuals and cultures is misleading due to different reporting behaviors. Anchoring vignettes is a technique that allows identifying and adjusting self-rating responses for reporting heterogeneity (RH).ObjectiveThis article aims to test two crucial assumptions of vignette equivalence (VE) and response consistency (RC) that are required to be met before vignettes can be used to adjust self-rating responses for RH.DesignWe used self-ratings, vignettes, and objective measures covering domains of mobility and cognition from the WHO study on global AGEing and adult health, administered to older adults aged 50 years and above from eight low- and middle-income countries in Africa and Asia. For VE, we specified a hierarchical ordered probit (HOPIT) model to test for equality of perceived vignette locations. For RC, we tested for equality of thresholds that are used to rate vignettes with thresholds derived from objective measures and used to rate their own health function.ResultsThere was evidence of RH in self-rating responses for difficulty in mobility and cognition. Assumptions of VE and RC between countries were violated driven by age, sex, and education. However, within a country context, assumption of VE was met in some countries (mainly in Africa, except Tanzania) and violated in others (mainly in Asia, except India).ConclusionWe conclude that violation of assumptions of RC and VE precluded the use of anchoring vignettes to adjust self-rated responses for RH across countries in Asia and Africa.
Highlights
Comparing self-rating health responses across individuals and cultures is misleading due to different reporting behaviors
We focus our analysis on the two self-ratings of mobility and cognition as objective measures needed to test assumptions of vignettes were available for these domains
Of the 38,793 individuals who participated in study on global AGEing and adult health (SAGE), 36,170 (93%) were administered vignettes in the different domains Á 9,375 for mobility and affect; 8,788 for self-care and cognition; 9,205 for pain and relationships; 8,802 for vision and sleep
Summary
Comparing self-rating health responses across individuals and cultures is misleading due to different reporting behaviors. Design: We used self-ratings, vignettes, and objective measures covering domains of mobility and cognition from the WHO study on global AGEing and adult health, administered to older adults aged 50 years and above from eight low- and middle-income countries in Africa and Asia. Conclusion: We conclude that violation of assumptions of RC and VE precluded the use of anchoring vignettes to adjust self-rated responses for RH across countries in Asia and Africa. The anchoring vignettes approach requires two fundamental assumptions to be met Á vignette equivalence (VE), that is, all respondents understand the health state described by a vignette in the same way; and response consistency (RC), that is, a respondent uses the same thresholds to rate vignettes as she/he does to rate his/her own self. We use the SAGE data on self-ratings and vignettes in mobility and cognition to test the assumptions of VE and RC that are essential for the use of the anchoring vignettes approach
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