The SF-36 is a commonly used tool for measuring health status in a general population. Despite the overall moderate to high validity scores, certain communicative dynamics of the questionnaire deserve attention. Our aim was to examine how pragmatic dynamics, semantic context-sensitivity and epistemic reflection may influence answers to the SF-36. We applied a three-step Gricean analysis, including 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 assessment of whether the combined influence of linguistic context-sensitivity and pragmatic norms is benign. We found that the pragmatic dynamics of scalar implicatures are crucial to the interpretation of answer options but generally benign to its purpose. Regarding context, we raised concerns about the answer option ‘Ved ikke’ (Don’t know); rather than representing a neutral midpoint, the answer is compatible with both a positive and a negative answer option. Whereas scalar implicatures are helpful to the purpose of SF-36, other contextual effects appear to be more worrisome. However, since pragmatic norms of communication, semantic context-sensitivity, and attention to epistemic error possibilities can all be expected to shape answers to the SF-36, we think that all three factors belong in a description of how the questionnaire works.
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- Gricean pragmatics
- Short Form 36