To bin or not to bin? A comparison of symptom frequency response formats in the assessment of health-related quality of life

The goal of this study is to compare three different types of retrospective frequency response formats on the Healthy Days Symptoms Module (HDSM). Responses are compared in terms of intra-individual consistency, psychometric value, and participant feedback about each type of response format.

Respondents each completed three versions of the HDSM, where items were framed to elicit an open-ended frequency, a fixed choice frequency, or a vague quantifier response. Traditional reliability statistics were used to evaluate intra-individual consistency. Differential item functioning (DIF) was used to test for response format effects, and item response theory (IRT) scale scores and standard errors were computed across the three forms to compare psychometric value. Linear mixed modeling was used to examine the associations of IRT scale scores across response formats with respondent characteristics.

People are largely consistent in how they respond to items about their health, regardless of the response format, and no DIF was detected between response formats. The IRT scores computed from the “# of days” frequency response formats tend to have better measurement precision than those from vague quantifiers. Open-ended frequencies capture a greater span of individual differences for people reporting fewer symptoms; however, little measurement precision is lost in collapsing the frequencies into categories.

Both the open-ended and fixed choice frequency response formats offer more measurement precision than vague quantifiers. While the open-ended frequency response format may capture more individual differences, respondents tend to report more difficulty with exact frequency recall, and thus, prefer the fixed choice frequency format.