Does reporting behaviour bias the measurement of social inequalities in self-rated health in Indonesia? An anchoring vignette analysis

PURPOSE: Studies on self-rated health outcomes are fraught with problems when individuals’ reporting behaviour is systematically biased by demographic, socio-economic, or cultural factors. Analysing the data drawn from the Indonesia Family Life Survey 2007, this paper aims to investigate the extent of differential health reporting behaviour by demographic and socio-economic status among Indonesians aged 40 and older ([Formula: see text] ). METHODS: Interpersonal heterogeneity in reporting style is identified by asking respondents to rate a number of vignettes that describe varying levels of health status in targeted health domains (mobility, pain, cognition, sleep, depression, and breathing) using the same ordinal response scale that is applied to the self-report health question. A compound hierarchical ordered probit model is fitted to obtain health differences by demographic and socio-economic status. The obtained regression coefficients are then compared to the standard ordered probit model. RESULTS: We find that Indonesians with more education tend to rate a given health status in each domain more negatively than their less-educated counterparts. Allowing for such differential reporting behaviour results in relatively stronger positive education effects. CONCLUSION: There is a need to correct for differential reporting behaviour using vignettes when analysing self-rated health measures in older adults in Indonesia. Unless such an adjustment is made, the salutary effect of education will be underestimated.