Self-rated health - what does it capture at 1 year after childbirth? Investigation of a survey question employing thinkaloud interviews

Aim: This paper reports an investigation of how the survey question 'How would you summarize your state of health at present' is interpreted and what it captures when asked at 1 year after childbirth. Background: Self-rated health measured by a single item question is a well-established patient outcome as it predicts morbidity and the use of health services. However, there is limited understanding of what the question captures in early motherhood. Method: A qualitative design combining data collection by means of a short form, concurrent and retrospective thinkaloud interviews, and a semi-structured interview, with 26 Swedish women during 2005 was employed. The text was analysed by qualitative content analysis. A theoretical framework describing four cognitive tasks usually performed when a respondent answers a survey question guided the analysis: interpretation of the question, retrieval of information, forming a judgement and giving a response. Findings: The questions of self-rated health left open for the new mothers to evaluate what was most important for her. It captured a woman's total life situation, such as family functioning and well-being, relationship with partner, combining motherhood and professional work, energy, physical symptoms and emotional problems affecting daily life, stressful life events, chronic disease with ongoing symptoms, body image, physical exercise and happiness. Neither childbirth-related events nor childbirth-related symptoms were included in the responses. Less than 'good' self-rated health represented a high burden of health problems. Conclusion: Our results showed that the question on self-rated health was a measure of women's general health and well-being in their present life situation, but it did not seem to measure recovery after childbirth specifically.