A good life with spina bifida: experimental evidence on how question order influences outcomes when asking about quality of life

Abstract

Abstract Question-order effects can considerably bias responses in surveys. Yet, question order is largely neglected in survey design. Most scales use one fixed sequence and do not consider how different sequences might affect the measure. We examined the impact of question-order effects on measures of health-related quality of life (HRQOL) and life satisfaction in a sample of participants with spina bifida and a comparison group. Participants responded to an online questionnaire. They were randomly assigned to one of four versions of that questionnaire, manipulating the positions of an item asking about spina bifida and an item asking about global health. A question-order effect occurred for participants with spina bifida: participants who were asked about having spina bifida before rating HRQOL rated it to be higher than participants that were asked about having spina bifida after rating HRQOL. The comparison group was unaffected by the position of the item asking about spina bifida. The measure of life satisfaction was not affected by question order, nor did it differ between the two groups. Measures of HRQOL depend on when a specific diagnosis has to be indicated. Question order effects must be taken into account for the development of survey instruments and their interpretation.

Keywords

• Well being
• Life satisfaction
• Question-order effects
• Whole-part effect
• HRQOL