title: Semantic primes theory may be helpful in designing questionnaires such as to prevent response shift.
abstract: OBJECTIVE
  The purpose of randomized control trials (RCTs) can be the assessment of the direct effect of treatment on health-related quality of life (HRQL). Response shift (RS) theory considers that a change in HRQL scores observed over time cannot be explained solely by a direct effect of a medical condition, it may also result from a change in the way people appraise their HRQL. The RS effect is a potential bias that is liable to compromise efficient assessment of the effect of treatment on HRQL.
  
  
  METHODS
  We hypothesize a link between the RS effect on HRQL scores and the level of complexity of HRQL conceptualization.
  
  
  RESULTS
  We discuss how the impact of reconceptualization on scores depends on the complexity of the linguistic definition of a subjective construct and how for reprioritization the impact depends on the dimensionality. The linguistic theory of semantic primes is used to help identify how subjective constructs can be classified according to the complexity of their definitions.
  
  
  CONCLUSIONS
  Finally, we suggest that the impact of the RS effect on HRQL scores could be avoided (or lessened) if questionnaires were designed with a rule of "the least semantic and psychometric complexity" in mind.
authors.affiliation: U669 PSIGIAM, INSERM, 97 Boulevard de Port Royal, 75679 Paris Cedex 14, France; EA4275 "Biostatistics, Pharmacoepidemiology and Subjective Measures in Health Sciences", University of Nantes, 1 rue Gaston Veil, 44035 Nantes Cedex 1, France; Department of Biostatistics, UPMC Univ. Paris 06, 91 Boulevard de l'hôpital, 75013, Paris, France; Department of Biostatistics Public Health and Medical Informatics, AP-HP University Hospitals Pitié-Salpêtrière Charles-Foix, 47-83 Boulevard de l'hôpital, 75651 Paris Cedex 13, France. Electronic address: antoine.vanier@psl.aphp.fr.
authors.forename: Antoine
authors.initials: A
authors.lastname: Vanier
authors.affiliation: Department of History and Philosophy of Sciences, Sorbonne Paris Cité, Université Paris Diderot, 4 rue Elsa Morante, 75205 Paris Cedex 13, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Leplège
authors.affiliation: EA4275 "Biostatistics, Pharmacoepidemiology and Subjective Measures in Health Sciences", University of Nantes, 1 rue Gaston Veil, 44035 Nantes Cedex 1, France.
authors.forename: Jean-Benoit
authors.initials: JB
authors.lastname: Hardouin
authors.affiliation: EA4275 "Biostatistics, Pharmacoepidemiology and Subjective Measures in Health Sciences", University of Nantes, 1 rue Gaston Veil, 44035 Nantes Cedex 1, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Sébille
authors.affiliation: U669 PSIGIAM, INSERM, 97 Boulevard de Port Royal, 75679 Paris Cedex 14, France; Université Paris-Sud and Université Paris-Descartes, 63, rue Gabriel Péri, 94276 Le Kremlin-Bicêtre Cedex, France; Department of Public Health, APHP University Hospitals Paris-Sud, 78 Rue de la Division du Général Leclerc, 94270 Le Kremlin-Bicêtre, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Falissard
mesh_terms: D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic / Q000295:instrumentation* / Q000379:methods; D012107:Research Design; D012660:Semantics; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires
keywords: Health-related quality of life; Methodology; Patient-reported outcomes; Psychometrics; Randomized control trials; Response shift