Possible bias from rating behavior when subjects rate both exposure and outcome by Toomingas A, Alfredsson L, Kilbom ÅThe following articles refer to this text: 2001;27(1): 30-40; 2002;28(5):293-303; 2004;30(1):56-63; 2008;34(4) Objectives In many epidemiologic studies the subjects rate both the exposure and the outcome, assigning numerical values to the variables according to their perceptions and judgments. Hypothetically, subjects who tend to overestimate, exaggerate, or use high numerical values in rating tasks would rate both exposure and outcorne higher than subjects who tend to underestimate, dissimulate, or use low numerical values. A range of such rating behaviors among the subjects would introduce uncontrollable bias to relative risk estimates, in most cases an overestimation. The aim of this study was to assess the possible presence of and effects on relative risk estimates of such high and low rating behavior among subjects in an epidemiologic study of n~usculoskeletal disorders. Methods Rating behavior was analyzed by intercoil-elating the ratings of 19 different stimuli. High positive correlations would indicate the presence of high and low rating behavior. Results The cosrelations were, however, both positive and negative and close to zero. Adjusting for rating behavior did not affect relative risk estimates, based on subjective ratings of both exposure and outcome. CO~C~US~OII There is no support in this study for the existence of a range of high and low rating behavior among subjects who rate neutral and nonaffective stimuli, such as time, weight, number and physical exposure, as well as pain and other symptoms. There is therefore no support for the idea of a bias to relative risk estimates from such rating behavior in studies where subjects rate both exposure and outcome variables of this kind.
Key terms individual differences, judgment, methods, response style, risk assessment, validity.In epidemiologic studies quantitative data about both exposure factors and outcome phenomena are often acquired by subjective judgments or ratings. In the science of psychometrics such rated phenomena are called "stimuli" and the resulting judgments or ratings are referred to as rating^".^ "Stimuli", in the context of epidemiology, include studied or confounding exposure factors (physical, psychosocial, etc) and outcome phenomena (sick leave, pain, well-being, etc). "Ratings" in the context of epidemiology would be the overt judgments or ratings of these phenomena as a result of a perceptual and cognitive process, which by its nature must be described as subjective. Such judgments or ratings could be given as verbal expressions ("very heavy", "now and then"), as free numerations ("23 kg", "5 timeslday") or as values on rating scales [Likert scales, VAS (visual analogue scales), etc].The relation between stimulus and rating magnitudes has been described as a power function by Stevens (1) and later modified by Ekman and others (algorithm 1) (2):where R = rating magnitude, S = stimulus magnitude,Such stimulus-rat...