Detection of response shift in health-related quality of life studies: a systematic review
Open accessAbstract
Background: Response Shift (RS) refers to the idea that an individual may undergo changes in its health-related quality of life (HRQOL). If internal standard, values, or reconceptualization of HRQOL change over time, then answer to the same items by the same individuals may not be comparable over time. Traditional measures to evaluate RS is prone to bias and strong methodologies to study the existence of this phenomenon is required. The objective is to systematically identify, analyze, and synthesize the existing and recent evidence of statistical methods used for RS detection in HRQOL studies. Methods: The analysis of selected studies between January 2010 and July 2020 was performed through a systematic review in MEDLINE/PubMed, Scopus, Web of Science, PsycINFO and Google Scholar databases. The search strategy used the terms “Health-Related Quality of Life” and “Response Shift” using the filters “Humans”, “Journal Article”, “English” and “2010/01/01–2020/07/31”. The search was made in August 2020. Results: After considering the inclusion and exclusion criteria, from the total selected articles (675), 107 (15.9%) of the publications were included in the analysis. From these, 79 (71.0%) detected the existence of RS and 86 (80.4%) only used one detection method. The most used methods were Then Test (n = 41) and Oort’s Structural Equation Models (SEM) (n = 35). Other method used were Multiple Lineal Regression (n = 7), Mixed-Effect Regression (n = 6), Latent Trajectory Analysis (n = 6), Item Response Theory (n = 6), Logistics Regression (n = 5), Regression and Classification Trees (n = 4) and Relative Importance Method (n = 4). Most of these detected recalibration, including Then Test (n = 27), followed by Oort’s SEM that detected the higher combination of RS types: recalibration (n = 24), reprioritization (n = 13) and reconceptualization (n = 7). Conclusions: There is a continuous interest of studying RS detection. Oort’s SEM becomes the most versatile method in its capability for detecting RS in all different types. Despite results from previous systematic reviews, same methods have been used during the last years. We observed the need to explore other alternative methods allowing same detection capacity with robust and highly precise methodology. The investigation on RS detection and types requires more study, therefore new opportunity grows to continue attending this phenomenon through a multidisciplinary perspective.
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One possible explanation for the psychological outcomes is that participants in the Sit Less group may have become more aware of the challenges of replacing sedentary behavior with moderate levels of physical activity (response shift).
“One possible explanation is that participants in the Sit Less group may have become more aware of the challenges of replacing sedentary behavior with moderate levels of physical activity, a phenomenon known as response shift, which is commonly observed in self-reported outcomes in behavioral interventions [42].”
From Feasibility and Preliminary Efficacy of a “Sit Less” Program Leveraging Fitbit Tracking and Tailored Text Messages in Cardiometabolic Disease: Findings From 2 Parallel Randomized Controlled Trials in Coronary Artery Disease and Type 2 Diabetes (2026) · cites this paper as [42]
The Background (page not provided) defines response shift as a change in how a person evaluates their own quality of life, and the Results report that many reviewed studies detected it. The paper does not establish that becoming more aware of the difficulty of replacing sedentary behavior is itself a response shift, or that response shift is common specifically in behavioral interventions. (LLM, conf=0.84)
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Park, C., Dietrich, M. S., Larsen, B., Mayberry, L. S., Doyle, A., Ahn, S., Jean, J., Maquiling, K., Mogos, M. F., Muchira, J. M., et al. (2026) · JMIR mHealth and uHealth · doi:10.2196/56497
- Authors
- Ortega-Gómez, E., Vicente-Galindo, P., Martín-Rodero, H., & Galindo-Villardón, P.
- Affiliations
- Universidad de Panamá (PA)
- Corresponding author
- Ortega-Gómez, Estelina
- ORCID
- Venue
- Health and Quality of Life Outcomes
- Published
- 2022-02-05
- Volume
- 20
- Issue
- 1
- Pages
- 20-20
- ISSN
- 1477-7525 (ISSN-L)
- PMC
- PMC8818219
- OpenAlex
- W4210537888
- Cited by
- 30
- References
- 69
- Citations by year
- 2026: 11 · 2025: 9 · 2024: 3 · 2023: 5 · 2022: 2
- FWCI
- 0.87
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Health and Quality of Life Outcomes (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Keywords
- response shift, health-related quality of life, recalibration, reconceptualization, measurement bias, item response theory, mixed-effects regression
- MeSH terms
- Humans, Models, Theoretical, Quality of Life, Research Design
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