Disjunctive Answer Options Complicate Communication – A Linguistic Analysis of the Danish EQ-5D (5L) Version

Background: EQ-5D is an internationally acknowledged tool for assessing health-related quality of life. Our aim was to examine how pragmatic dynamics may influence answers to the EQ-5D-5L and how the logical structure of answer options affects the communication of the questionnaire. Methods: We performed a 3-step linguistic analysis building on the seminal work of Grice, including 1) examination of the lexical meanings of the answer options, 2) considerations of how conversational maxims might affect the respondent’s interpretation of answer options when two or more answer options in an item are compatible, and 3) analysis of how the questionnaire’s context might counteract the problem of omissions of answer options by shifting the meaning of context-sensitive expressions. Results: All items exhibit compatibilities and omissions. In items 1 and 3, ordinary conversational norms provide sufficient guidance to determine how a respondent should decide between compatible answer options. In items 2, 4, and 5, the available answer options complicated the communicative task for some respondents. Conclusions: In items where answer options have a disjunctive structure, respondents relying on Gricean maxims of conversation will have to depend on their individual understanding of fine-grained details concerning the questionnaire’s purpose and may have to weigh how conflicting norms should be balanced.