title: Semantics bias in cross-national comparative analyses: is it good or bad to have "fair" health?
abstract: The Health Behavior in School-aged Children is a cross-national study collecting data on social and health indicators on adolescents in 43 countries. The study provides comparable data on health behaviors and health outcomes through the use of a common protocol, which have been a back bone of the study sine its initiation in 1983. Recent years, researchers within the study have noticed a questionable comparability on the widely used item on self-rated health. One of the four response categories to the item "Would you say your health is….?" showed particular variation, as the response category "Fair" varied from 20 % in Latvia and Moldova to 3-4 % in Bulgaria and Macedonia. A qualitative mini-survey of the back-translations showed that the response category "Fair" had a negative slant in 25 countries, a positive slant in 10 countries and was considered neutral in 9 countries. This finding indicates that there are what may be called semantic issues affecting comparability in international studies, since the same original word (in an English original) is interpreted differently across countries and cultures. The paper test and discuss a few possible explanations to this, however, only leaving to future studies to hold a cautious approach to international comparisons if working with the self-rated health item with four response categories.
authors.affiliation: Department of Public Health, University of Copenhagen, P. O. Box 2099, Copenhagen, Denmark. cwsc@sund.ku.dk.
authors.forename: Christina W
authors.initials: CW
authors.lastname: Schnohr
authors.affiliation: Department of Public Health and Epidemiology, Riga Stradins University, Riga, Latvia.
authors.forename: Inese
authors.initials: I
authors.lastname: Gobina
authors.affiliation: William James Center for Research/Instituto Superior de Psicologia Aplicada-ISPA, Lisbon, Portugal.
authors.forename: Teresa
authors.initials: T
authors.lastname: Santos
authors.affiliation: Institute of Mother and Child, Kasprzaka 17a str., Warsaw, Poland.
authors.forename: Joanna
authors.initials: J
authors.lastname: Mazur
authors.affiliation: Department of Pediatrics, Cerrahpasa Medical Faculty, Istanbul University, 34 303, , Fatih, Istanbul, Turkey.
authors.forename: Mujgan
authors.initials: M
authors.lastname: Alikasifuglu
authors.affiliation: Department of Health Education, University of Jyväskylä, Jyväskylä, Finland.
authors.forename: Raili
authors.initials: R
authors.lastname: Välimaa
authors.affiliation: Folkhälsomyndigheten, 830140, Östersund, Sweden.
authors.forename: Maria
authors.initials: M
authors.lastname: Corell
authors.affiliation: Fakulteten för hälsa, natur- och teknikvetenskap, Karlstad University, 651 88, Karlstad, Sweden.
authors.forename: Curt
authors.initials: C
authors.lastname: Hagquist
authors.affiliation: Department of Public Health and Paediatrics School of Medicine, University of Torino, Via Santena, 10126, Turin, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Dalmasso
authors.affiliation: Arabkir Medical Centre-Institute of Child and Adolescent Health, Yerevan, 0014, Armenia.
authors.forename: Yeva
authors.initials: Y
authors.lastname: Movseyan
authors.affiliation: Department of Public Health and Paediatrics School of Medicine, University of Torino, Via Santena, 10126, Turin, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Cavallo
authors.affiliation: , P.O. Box 725, 3500, AS, Utrecht, The Netherlands.
authors.forename: Saskia
authors.initials: S
authors.lastname: van Dorsselaer
authors.affiliation: Institut for Samfunnspsykololgi, Kristie Bergiesgatan, Unversity of Bergen, Bergen, Norway.
authors.forename: Torbjørn
authors.initials: T
authors.lastname: Torsheim
mesh_terms: D000293:Adolescent; D015982:Bias; D002648:Child; D003431:Cross-Cultural Comparison; D005260:Female; D015438:Health Behavior; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D011788:Quality of Life; D015203:Reproducibility of Results; D012660:Semantics; D011795:Surveys and Questionnaires; D014177:Translations
keywords: Health Behavior in School-aged Children (HBSC); International comparison; Measurement variance; Self-rated health; Translation