Cultural Variability in the Effects of Question Design Features on Respondent Comprehension of Health Surveys

Purpose The aim is to identify the characteristics of common health survey questions that may be associated with cross-cultural variability in question comprehension. Methods Interviews with respondents representing four cultural subgroups in the United States were analyzed through behavior coding to identify survey question characteristics that may be associated with cross-cultural variability in comprehension. Using survey responses as the unit of analysis, nested within survey respondents and survey questions, hierarchical linear modeling was used to examine the effects of four questionnaire design features on cultural variations in comprehension difficulties. Results Respondent culture was found to moderate the effects of response format, question length, and reading levels. Conclusions Several question design strategies that reduce overall comprehension difficulty appear to also increase cross-cultural disparities.