title: Exploring self-rated health among adolescents: a think-aloud study.
abstract: BACKGROUND
  Despite extensive use of self-rated health questions in youth studies, little is known about what such questions capture among adolescents. Hence, the aim of this study was to explore how adolescents interpret and reason when answering a question about self-rated health.
  
  
  METHODS
  A qualitative study using think-aloud interviews explored the question, "How do you feel most of the time?", using five response options ("Very good", "Rather good", "Neither good, nor bad", "Rather bad", and "Very bad"). The study involved 58 adolescents (29 boys and 29 girls) in lower secondary school (7th grade) and upper secondary school (12th grade) in Sweden.
  
  
  RESULTS
  Respondents' interpretations of the question about how they felt included social, mental, and physical aspects. Gender differences were found primarily in that girls emphasized stressors, while age differences were reflected mainly in the older respondents' inclusion of a wider variety of influences on their assessments. The five response options all demonstrated differences in self-rated health, and the respondents' understanding of the middle option, "Neither good, nor bad", varied widely. In the answering of potential sensitive survey questions, rationales for providing honest or biased answers were described.
  
  
  CONCLUSIONS
  The use of a self-rated health question including the word 'feel' captured a holistic view of health among adolescents. Differences amongst response options should be acknowledged when analyzing self-rated health questions. If anonymity is not feasible when answering questions on self-rated health, a high level of privacy is recommended to increase the likelihood of reliability.
authors.affiliation: Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, SE-901 87, Sweden. junia.joffer@Ltdalarna.se.|Center for Clinical Research Dalarna-Uppsala University, Nissers väg 3, Falun, SE-791 82, Sweden. junia.joffer@Ltdalarna.se.
authors.forename: Junia
authors.initials: J
authors.lastname: Joffer
authors.affiliation: Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, SE-901 87, Sweden. lars.jerden@Ltdalarna.se.|Center for Clinical Research Dalarna-Uppsala University, Nissers väg 3, Falun, SE-791 82, Sweden. lars.jerden@Ltdalarna.se.|School of Education, Health and Social Studies, Dalarna University, Falun, SE-791 88, Sweden. lars.jerden@Ltdalarna.se.
authors.forename: Lars
authors.initials: L
authors.lastname: Jerdén
authors.affiliation: Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, SE-901 87, Sweden. ann.ohman@ucgs.umu.se.|Umeå Centre for Gender Studies, Umeå University, Umeå, SE-901 87, Sweden. ann.ohman@ucgs.umu.se.
authors.forename: Ann
authors.initials: A
authors.lastname: Öhman
authors.affiliation: School of Education, Health and Social Studies, Dalarna University, Falun, SE-791 88, Sweden. rfl@du.se.
authors.forename: Renée
authors.initials: R
authors.lastname: Flacking
mesh_terms: D000293:Adolescent; D032882:Comprehension; D059026:Diagnostic Self Evaluation; D004644:Emotions; D005260:Female; D006262:Health; D006304:Health Status; D006801:Humans; D008297:Male; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D013548:Sweden; D013850:Thinking