Title: (In)Consistency of responses to self-assessed health measures and implications for biosocial research
Funder: Economic and Social Research Council

Abstract: Much of the existing research on the interplay between social, economic circumstances and health is based on subjective, self-reported assessment of health, with self-assessed health (SAH) being the most widely used health measure. This is mostly because of the limited availability of datasets that combine more objective health measures with a wide range of socio-economic data, along with the simplicity that self-reported health measures offer. We will exploit a distinctive feature in the survey design of Understanding Society (UKHLS) to explore the consistency of responses to SAH questions and the potential implication of reporting inconsistencies in SAH for the existing social science and economic research and policy making. Specifically, in the UKHLS, SAH is collected twice for each respondent on a longitudinal bases, with different survey modes of collection (open interview versus self-completion) taken within a short space of time. Our preliminary evidence shows that about the one-fourth of the respondents changed their SAH responses within each wave in a time frame of less than an hour. Along with the availability of detailed objectively measured health indicators (biomarkers) and a rich set of longitudinal socio-economic data for all adult household members, we will further exploit these inconsistencies in SAH responses to address questions relevant to the survey measurement of health and the implications of reporting inconsistency in SAH for the existing social science research as well as social and health policy. We will address these issues by answering the following research questions: Aim 1. How consistent are individual responses to SAH questions? a. Do responses to SAH differ between the self-completion and the open interview mode within the same wave and for the same individuals over time? b. Are these reporting inconsistencies a systematic behaviour that is repeated over time for certain population groups rather than random phenomenon? c. Do past histories of reporting inconsistencies in SAH affect future reporting and does the magnitude of these inconsistencies systematically vary depending on previous histories of inconsistent reporting behavior in the SAH questions? Aim 2. What are the characteristics of those providing consistent and those providing inconsistent SAH status reports? a. Are inconsistencies in SAH responses associated with objectively measured health status over and above the role of demographic, socio-economic factors and the effect of interview mode itself? Aim 3. What is the role of household peer-effects on reporting of SAH? a. What is the role of the within-household peer-effects, such as the "not in front of the children or partner" effects, on shaping individual responses to SAH questions? b. Does the presence of a partner and/or children at the face-to-face interviews affect the reporting inconsistency in SAH versus the self-completion mode? Aim 4. Does reporting inconsistencies in SAH affect research on health inequalities and on the role of health on labour market outcomes, which is based on SAH? a. What are the implications of reporting inconsistencies in SAH on the measurement of the socio-economic inequalities in health that has relied on SAH to measure health? b. What about the consequences of reporting inconsistencies in SAH for analysing the role of health on labour market outcomes (such as unemployment, retirement decisions and wages), given the existing research based on SAH measures? Aim 5. What are the implications of our findings for the survey measurement of health? a. Is the self-completion, versus the open interview mode, more relevant for mitigating the role of the micro-social bias in the responses to self-reported health measures during survey interviews?

Lay abstract: The interplay between socio-economic circumstances and health is of major importance for individuals' lives and the human capital investment of the society. However, much of the existing research is conducted using subjective, self-reported proxies of health, which may impose significant biases. Recent advances in the large social-science surveys involve the collection of physical measurements and markers derived from biological samples, in addition to the conventional self-reported health assessments. In this project, we focus on the most popular self-reported health measures, self-assessed health (SAH). We exploit a distinctive feature of the ESRC funded national panel, Understanding Society: the UK Household Longitudinal Study (UKHLS), with longitudinal information on SAH collected twice for each respondent within waves, with different survey modes (open interview versus self-completion) taken within a short space of time. About 25% of respondents changed their responses within the same wave, with about 25% of those with inconsistent reports at UKHLS wave 2 also reporting SAH inconsistently at UKHLS wave 5. Capitalising on this feature of the survey's design along with the availability of objectively measured biomarker data and a rich set of longitudinal socio-economic data for all adult household members we are aiming to make a number of distinct contributions to social science research on health, survey measurement of health and health policy. The proposed project focuses on reporting inconsistencies in SAH and the potential implications for the social science research and policymaking. Although SAH is one of the most popular health measures used in economics, sociology, social epidemiology, medical research and as instrument in clinical trials, research on assessing the consistency of responses to SAH questions is sparse compared to that using SAH as a measure of health. We anticipate that our project will illustrate the importance of capacity building and further development for biosocial data sources. Specifically, in this project we will address research questions on the consistency of the SAH responses, characterising the demographic and socio-economic profile of those who are more likely to provide inconsistent SAH reports as well as the role of the micro-social environment at the fieldwork (interview) stage in affecting individual responses to SAH questions. We will also address the implications of reporting inconsistency in SAH for existing research on socio-economic inequalities in health as well as on the ramifications of ill health for people's employment outcomes (such as unemployment, wages and retirement decisions). A prerequisite for scientifically-sound, evidence-based social and health policy is the availability of robust and unbiased research evidence. Dissemination and communication with the research community will operate through conference presentations, symposia and four publications in peer-reviewed journals to draw attention to our research findings. We will achieve a good representation of our findings in discipline-specific and multidisciplinary journals. We will also work with policymakers and third-party organisations to disseminate and enhance engagement to the policy implications of our analysis and the value of robust health measurement using more objectively measured health proxies.

Research activity codes: 2.5 RESEARCH DESIGN AND METHODOLOGIES (AETIOLOGY)
Health categories: GENERIC HEALTH RELEVANCE