Excellent, very good, fair? The influence of response scale labels on the assessment of self-rated health

Abstract

Self-rated health (SRH) is a frequently used health measure in (cross-)national surveys. It is usually assessed with a single item, which differs in the wording and response format across surveys. In this paper, we compare four German-language five-point scale versions of self-rated health that vary in response scale labeling using web probing. The web survey (N=1,710) was conducted in 2019. Combining qualitative and quantitative methods, we assess how response scale labels affect response distributions of the SRH item and which health factors respondents consider when answering questions about their health. The main finding is that respondents refer to similar health aspects independent of the scale version they answered the question with. Self-reported health, however, varied across scales which might introduce a comparative bias. Using an unbalanced scale with three response options indicating good health led to a more positive self-assessment of health compared to the balanced scales with two positive, one neutral, and two negative scale points. We discuss practical implementations.