title: Literacy affected ability to adequately discriminate among categories in multipoint Likert Scales.
abstract: OBJECTIVE
  To assess the effect of inability to read on a five-point Likert scale, using the WHOQOL-BREF response scale. It is hypothesized that inability to read is related to loss of discriminant power among the five-category response scale.
  
  
  METHODS
  In a cross-sectional design, nonreaders (n=141) and subjects educated at a graduate level (n-907) were assessed. Statistical analyses combined classic and modern psychometric approaches (Confirmatory factor analysis and Rasch analysis).
  
  
  RESULTS
  There is a remarkable difference in the psychometric performance of items across the two subgroups. Fit indexes proved to be closer to the ideal for the graduate group, but not for the nonreader group. Reducing the number of response categories improved the model exclusively for the nonreader sample. Nonreaders do not interpret the scale as a true five-category scale, but exhibit a response pattern indicative that only three categories are in fact considered.
  
  
  CONCLUSIONS
  These results confirm the hypothesis that a multiple-category response scale is not suitable for nonreaders. They suggest that a simpler response scale should be adopted to achieve a more reliable and satisfactory psychometric performance in this population. This effect seems to be stronger when more abstract and subjective constructs are involved.
authors.affiliation: Post-Graduate Program on Psychiatry, University Federal of Rio Grande do Sul, Rua Florencio Ygartua, 391/308, Porto Alegre - RS, CEP 90430-010, Brazil. echacha.ez@terra.com.br
authors.forename: Eduardo
authors.initials: E
authors.lastname: Chachamovich
authors.forename: Marcelo P
authors.initials: MP
authors.lastname: Fleck
authors.forename: Mick
authors.initials: M
authors.lastname: Power
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001076:Aptitude; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D004522:Educational Status; D005163:Factor Analysis, Statistical; D005260:Female; D014943:Global Health; D006801:Humans; D008297:Male; D008875:Middle Aged; D011594:Psychometrics / Q000379:methods*; D011932:Reading; D011795:Surveys and Questionnaires