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

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.