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November 18, 1998

Why Patients Use Alternative Medicine

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor

JAMA. 1998;280(19):1659-1661. doi:10-1001/pubs.JAMA-ISSN-0098-7484-280-19-jbk1118

To the Editor.—The article by Dr Astin1 appears to contain a methodological error. Table 1 shows the independent variables used in the study, one of which measured general satisfaction and satisfaction with practitioners. The researchers note the use of a Likert scale for the response set for each question. However, in reading the table, it is clear that 2 of the items used a 4-point scale and 1 used a 5-point scale. Likert scales conventionally use the 5-point scale, which offers a neutral anchor point from which the respondent can select. The use of a 4-point scale infers the absence of such a neutral point and is often referred to as a forced-response Likert scale.Questions with different response sets should not be combined into a single scale. Any statistical analyses such as factor analysis and logistic regression done on questions with different scaling methods would be invalid.

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