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, 13 (3), 585-601

Frames of Reference in Self-Reports of Health, Well-being, Fatigue, and Pain: A Qualitative Examination


Frames of Reference in Self-Reports of Health, Well-being, Fatigue, and Pain: A Qualitative Examination

Doerte U Junghaenel et al. Appl Res Qual Life.


Objectives: Self-reports in survey research can be affected by internal comparison standards, or Frames of Reference (FoRs), that people apply when making their ratings. The goal of this study was to determine which FoRs people naturally use when rating their health, subjective well-being, fatigue, and pain. We further examined whether FoRs varied by content domain and age group.

Methods: One hundred adults from a community sample of the US general population participated in individual semi-structured qualitative interviews. Participants provided self-report ratings on two of the four content domains and were then systematically queried about FoRs. Interview responses were summarized and coded into broad FoR categories.

Results: Four broad FoR categories emerged: References to (1) Other People, (2) an Earlier Time in Life, (3) an Important Event in the Past, and (4) a Hypothetical Situation. FoRs were reported in the majority (80.5%) of responses and multiple FoRs were reported in 34% of responses. The reporting of FoRs was evident for all domains, but was more prevalent for well-being compared to pain. References to a Hypothetical Situation were only mentioned in the well-being and health domains. For health, references to Other People were more frequently reported at older compared to younger ages.

Discussion: Our results extend prior work by demonstrating that participants' reporting of FoRs is evident in ratings of various content domains. They further suggest that a limited number of FoRs are used and that their identification holds promise for understanding and controlling systematic group differences in FoRs.

Conflict of interest statement

Conflict of interest: A.A.S. is a Senior Scientist with the Gallup Organization. K.P.McC., L.M.S., and S.C.K. are employees of Health Research Associates (HRA), which was contracted as a research partner for the qualitative interviews for this project.

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