Ineffectiveness of Reverse Wording of Questionnaire Items: Let’s Learn from Cows in the Rain Eric van Sonderen1*, Robbert Sanderman1, James C. Coyne1,2

1 Department of Health Sciences, Section Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands, 2 Department of

Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America

Abstract

Objective: We examined the effectiveness of reverse worded items as a means of reducing or preventing response bias. We first distinguished between several types of response bias that are often confused in literature. We next developed arguments why reversing items is probably never a good way to address response bias. We proposed testing whether reverse wording affects response bias with item-level data from the Multidimensional Fatigue Inventory (MFI-20), an instrument that contains reversed worded items.

Methods: With data from 700 respondents, we compared scores on items that were similar with respect either to content or to direction of wording. Psychometric properties of sets of these items worded in the same direction were compared with sets consisting of both straightforward and reversed worded items.

Results: We did not find evidence that ten reverse-worded items prevented response bias. Instead, the data suggest scores were contaminated by respondent inattention and confusion.

Conclusions: Using twenty items, balanced for scoring direction, to assess fatigue did not prevent respondents from inattentive or acquiescent answering. Rather, fewer mistakes are made with a 10-item instrument with items posed in the same direction. Such a format is preferable for both epidemiological and clinical studies.

Citation: Sonderen Ev, Sanderman R, Coyne JC (2013) Ineffectiveness of Reverse Wording of Questionnaire Items: Let’s Learn from Cows in the Rain. PLoS ONE 8(7): e68967. doi:10.1371/journal.pone.0068967

Editor: Hamid Reza Baradaran, Iran University of Medical Sciences, Iran (Republic of Islamic)

Received November 28, 2012; Accepted June 9, 2013; Published July 31, 2013

Copyright: ? 2013 Sonderen et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: The work was done as part of a regular appointment at the University Medical Center Groningen. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.