To assess whether it is clear to the respondents that the question asks about not taking medication [Einnahme des Medikaments] because of costs, an alternative proposed question wording was presented to the respondents to see whether or not the different wording would affect their responses. The alternative wording reads as follows: ‘Have you ever forgone taking any medication because you could not afford because of high cost?’ [“Haben Sie jemals auf die Einnahme von Medikamenten verzichtet, weil Sie sich diese aufgrund zu hoher Kosten nicht leisten konnten?”].
When comparing the two different wording versions we see that the wording does not affect the responses (at least in the case of our respondents): all respondents answered both questions identically. A further probe for this question asked specifically: ‘What is the difference between both question wording versions?’ Answers to this probe show that most respondents (6 respondents) did not see any difference:
- ‘The sense is the same. The core of the question remains the same, it asks whether I have forgone medication due to financial reasons.’ (respondent 03)
- ‘The content is the same, except for using different wording“ (respondent 04)
Three respondents (07, 08 and 09) see a difference in the word ‘needed’ [benötigen], which is not used in the German translation of the second version. Their responses focus on whether the medication is needed but not affordable (original wording) or whether it is not taken but also not needed urgently.
Only one respondent (09) had the feeling that the second wording was more precise because it explicitly referred to taking the medication. However, that person also referred to ‘needing’ the medication:
‘The wording of the second question takes ‘taking the medication’ into account while this aspect is missing in the first wording. The second question is more precise. […] In case of doubt, the second one is more precise. The first question implies that if medication is needed, taking the medication is necessarily included. And this is clarified more precisely in question two. Question two talks about taking the medication. The other (original wording) focuses on the need for medication. This does not mean that I really take it. But this is all just (playing with) words.’.
In contrast, another respondent stated that the alternative wording was either redundant or somewhat unclear:
‘The question is redundant. It sounds as: I purchased medication, but I have not taken them. For me, that means, I had had the medication but didn’t take it and that doesn’t make any sense. If a doctor says, you need to take [this drug] and I cannot pay for it, I can understand that.’ (respondent 10).
Although none of the respondents answered both questions differently, one should consider including a phrase referring to the actual taking of medication in order to avoid potential ambiguities. If the alternative wording is chosen, we recommend emphasizing, in the German translation, that the medication is (urgently) needed.
"Have you ever forgone taking medication you needed (urgently) because you could not afford it due to the costs?
[Haben Sie jemals auf die Einnahme von (dringend) benötigten Medikamenten verzichtet, weil Sie sich diese aufgrund zu hoher Kosten nicht leisten konnten?]"
