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In addition, we compared the percent of average positive responds of the patient safety climate factors with results of the US HSOPS 2010 comparative data base report.
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Cut-off values for positive responding probes were calculated as described by Rajilic-Stojanovic et al [20].
* Only positive responding T cells (≥ 10) were considered.
It is important to investigate further how positive responding affects the measurement of changes.
For example, commonly reported problems concern interpretation difficulties due to double-barrelled or ambiguous questions, and response tendencies such as positive responding and acquiescence.
Nonetheless, we expect that interpretation issues and positive responding pose a larger threat to the validity and feasibility of the measures.
We identified response issues for all items of the three measures, related to mapping of responses, interpretation of items or positive responding.
Another limitation of the study is that the think-aloud process and the presence of the interviewer may have affected the way in which respondents answer questions, specifically the amount of attention paid to questions and the occurrence of positive responding [ 22, 48– 50].
Howorka et al [ 17] found in a crossover study that patients who went back in the second phase from lispro to standard soluble insulin showed a decline in satisfaction on the retrospective measure, indicating that the DTSQc does not always invoke positive responding.
The results may also be influenced by GP recall and positive responding (particularly in regard to provision of a written asthma action plan by the intervention group); however, no statistically significant differences were found in the self reported provision of a written asthma action plan.
Positive responding due to these mechanisms is not necessarily considered misclassification bias, for example when it reflects a real adaptation in one's self-evaluation of QoL [ 47], but is a threat to validity when it occurs due to being reluctant to come across as overly negative or critical.
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CEO of Professional Science Editing for Scientists @ prosciediting.com