Effects of a Neutral Answer Choice on the Reliability and Validity of Attitude and Opinion Items

Abstract

Abstract: The objective of this study is to determine whether a middle alternative in the response choices to a questionnaire influences the reliability and validity of survey responses. A 32-item questionnaire regarding maternity care was administered to a sample of 1,390 persons consisting of 597 physicians, 723 nurses, and 70 midwives. The sample was randomly divided into two groups, one receiving a questionnaire with five answer choices, including a middle option, and the other receiving a similar questionnaire but without the middle option. Results showed that including a neutral option had little effect on overall reliability and validity; however, it did allow better psychometric coherence when the items were considered globally. The effect of the middle option also depends on the opinions the surveyed persons hold about the study issue.