Question context and priming meaning of health: Effect on differences in self-rated health between Hispanics and non-Hispanic Whites

Objectives: We examined the implications of the current recommended data collection practice of placing self-rated health (SRH) before specific healthrelated questions (hence, without a health context) to remove potential context effects, between Hispanics and non-Hispanics. Methods: We used 2 methodologically comparable surveys conducted in English and Spanish that asked SRH in different contexts: before and after specific health questions. Focusing on the elderly, we compared the influence of question contexts on SRH between Hispanics and non-Hispanics and between Spanish and English speakers. Results: The question context influenced SRH reports of Spanish speakers (and Hispanics) significantly but not of English speakers (and non-Hispanics). Specifically, on SRH within a health context, Hispanics reported more positive health, decreasing the gap with non-Hispanic Whites by two thirds, and the measurement utility of SRH was improved through more consistent mortality prediction across ethnic and linguistic groups. Conclusions: Contrary to the current recommendation, asking SRH within a health context enhanced measurement utility. Studies using SRH may result in erroneous conclusions when one does not consider its question context.