The influence of question framing on symptom report and perceived health status

Abstract

Self-reports of symptom experience and subjective ratings of health were obtained from 157 undergraduates. The format of the symptom-report question was varied so that half the participants underlined any symptoms (in a list of 30) they had experienced (endorse condition), whereas the remaining participants crossed out any they had not experienced (exclude condition). Within each of these conditions, half were asked to record symptoms over the last month, and half over the last year. Participants in the exclude condition reported, on average, 70% more symptoms than those in the endorse condition. More symptoms were reported over the last year than the last month. Adjusting for the number of symptoms reported and the perceived seriousness of the symptom set as a whole, participants rated their own state of health more negatively in the endorse than exclude condition. This is consistent with research on the “feature-positive” effect, suggesting that active responses have greater influence on self-perceptions. It is argued that self-report measures of health status must be interpreted in relative, rather than absolute terms, and that attention should be paid to the underlying cognitive processes.