Abstract
Purpose The SF-36 is a commonly used tool for measuring health status in a general population. Despite the overall moderate to high validity scores, we believe that certain communicative dynamics of the questionnaire deserve more careful attention. Our aim was to examine how pragmatic dynamics and epistemic reflection may influence answers to the SF-36.Methods We applied a three-step Gricean analysis, which included identification of the items in which pragmatic dynamics are most likely to have a significant effect, examination of how Gricean maxims might affect the answers given to the items identified, and finally, assessment of whether the combined influence of linguistic context-sensitivity and pragmatic norms is benign.Results Items 6, 9a, 10 and 11a–d were included in the analysis. Regarding these items, our analysis showed that the pragmatic dynamics of scalar implicatures are crucial to the interpretation of answer options. In addition, we raised concerns specifically about the answer option ‘Ved ikke’; rather than representing a neutral midpoint, the answer is compatible with both a positive and a negative answer option. Nonetheless, we found that the communicative dynamics of the questionnaire are mostly benign.Conclusion Compared to the significance of scalar implicatures, the potential effects of epistemic reflection that we identified are minor because they concern only items with a ‘Don’t know’ answer option. However, we raised the concern that attention to epistemic error possibilities might prompt respondents to opt for a ‘Don’t know’ answer despite having evidence supporting a different answer. Therefore, although pragmatic norms of communication are far more significant than attention to epistemic error possibilities in shaping answers to the SF-36, we think that both factors belong in a description of how the questionnaire works.