Choice of rating scale labels: implication for minimizing patient satisfaction response ceiling effect in telemedicine surveys.
BACKGROUND
Lack of response variability is problematic in surveys because of its detrimental effects on sensitivity and consequently reliability of the responses. In satisfaction surveys, this problem is caused by the ceiling effect resulting from high satisfaction ratings. A potential solution strategy is to manipulate the labels of the rating scale to create greater discrimination of responses on the high end of the response continuum. This study examined the effects of a positive-centered scale on the distribution and reliability of telemedicine satisfaction responses in a highly positive respondent population.


METHODS
In total, 216 telemedicine participants were randomly assigned to one of three experimental conditions as defined by the form of Likert scale: (1) 5-point Balanced Equal-Interval, (2) 5-point Positive-Packed, and (3) 5-point Positive-Centered Equal-Interval.


RESULTS
Although the study findings were not statistically significant, partially because of sample size, the distribution and internal consistency reliability of responses occurred in the direction hypothesized. Loading the rating scale with more positive labels appears to be a useful strategy for reducing the ceiling effect and increases the discrimination ability of survey responses.


CONCLUSIONS
The current research provides a survey design strategy to minimize ceiling effects. Although the findings provide some evidence suggesting the benefit of using rating scales loaded with positive labels, more research is needed to confirm this, as well as extend it to examine other types of rating scales and the interaction between rating scale formats and respondent characteristics.
1 Telehealth Program, UHN- University Health Network , Toronto, Ontario, Canada .
Caterina
C
Masino
Tony C M
TC
Lam
D015982:Bias; D006801:Humans; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011594:Psychometrics; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D017216:Telemedicine
Likert scale; agreement labels; ceiling effect; patient characteristics; patient satisfaction; positive responses; response bias; survey design; telemedicine