When Human Behavior Challenges the Data: Strategic Interaction and Response Shift as Threats o Validity in Clinical Research

Main Article Content

Marcelina Carretero

Abstract

In clinical research, the validity of results can be compromised by classical factors such as bias, confounding, and sampling error. However, there are  other elements related to human behavior that are not always considered and can also affect the conclusions. This article explores two such phenomena: strategic interaction and response shift. The former occurs when individuals adjust their behavior based on what they believe others will do. The latter refers to a change in how people evaluate their own health over time. Through everyday examples –such as penalty kicks in football, traffic decisions, or self-reported quality of life– we examine how these dynamics can impact the validity of clinical studies. Recognizing these mechanisms is essential for accurately interpreting results and  designing methodological strategies to minimize their influence.

Downloads

Download data is not yet available.

Article Details

Section

Notes on statistics and research

How to Cite

1.
Carretero M. When Human Behavior Challenges the Data: Strategic Interaction and Response Shift as Threats o Validity in Clinical Research. Rev Hosp Ital B.Aires [Internet]. 2025 Dec. 4 [cited 2026 Apr. 27];45(4):e0001270. Available from: https://ojs.hospitalitaliano.org.ar/index.php/revistahi/article/view/1270

References

Giunta DH. Bioestadística handbook: fundamentos básicos. Buenos Aires: Merck; 2018.

Zurita-Cruz JN, Villasís-Keever MÁ. Principales sesgos en la investigación clínica. Rev Alerg Mex. 2021 Oct-Dec;68(4):291-299. DOI: https://doi.org/10.29262/ram.v68i4.1003

Ortega-Gómez E, Vicente-Galindo P, Martín-Rodero H, et al. Detection of response shift in health-related quality of life studies: a systematic review. Health Qual Life Outcomes. 2022;20(1):20. DOI: https://doi.org/10.1186/s12955-022-01926-w

Camerer CF. Behavioral game theory: experiments in strategic interaction. Princeton, NJ: Princeton University Press; 2003.

Palacios-Huerta I. Professionals play minimax. Rev Econ Stud. 2003;70(2): 395-415. DOI: https://doi.org/10.1111/1467-937X.00249

Goddard K, Roudsari A, Wyatt JC. Automation bias: a systematic review of frequency, effect mediators, and mitigators. J Am Med Inform Assoc. 2012;19(1):121-127. DOI: https://doi.org/10.1136/amiajnl-2011-000089

Wagner B, Winkler T, Human S. Bias in geographic information systems: the case of Google Maps. Trabajo presentado en: 54th Hawaii International Conference on System Sciences (HICSS54); 2021 ene 5-8; Hawaii, USA. DOI: https://doi.org/10.24251/HICSS.2021.103

T13. Encuestas dan 4 puntos de diferencia a favor de Hillary Clinton [Internet]. Santiago, Chile: Señal T13; 2016 nov 7 [citado 2025 may 13]. Disponible en: https://www.t13.cl//noticia/mundo/encuestas-dan-4-puntos-diferencia-favor-hillary-clinton.

Boyle J, Dayton J, ZuWallack R, et al. The shy respondent and propensity to participate in surveys: a proof-of-concept study. Surv Pract. 2023;16(1):1-15. DOI: https://doi.org/10.29115/SP-2014-0026

Brownback A, Novotny A. Social desirability bias and polling errors in the 2016 presidential election.J. Behav Exp Econ. 2018;74:38-56. DOI: https://doi.org/10.1016/j.socec.2018.03.001

Sprangers MA, Schwartz CE. Integrating response shift into health-related quality of life research: a theoretical model. Soc Sci Med. 1999;48(11):1507-1515. DOI: https://doi.org/10.1016/S0277-9536(99)00045-3

Sprangers M, Hoogstraten J. Pretesting effects in retrospective pretest-posttest designs. J Appl Psychol. 1989;74(2):265-272. DOI: https://doi.org/10.1037//0021-9010.74.2.265

Andrykowski MA, Donovan KA, Jacobsen PB. Magnitude and correlates of response shift in fatigue ratings in women undergoing adjuvant therapy for breast cancer. J Pain Symptom Manage. 2009;37(3):341-351. DOI: https://doi.org/10.1016/j.jpainsymman.2008.03.015

Razmjou H, Schwartz CE, Yee A, et al. Traditional assessment of health outcome following total knee arthroplasty was confounded by response shift phenomenon. J Clin Epidemiol. 2009;62(1):91-96. DOI: https://doi.org/10.1016/j.jclinepi.2008.08.004

Wagner JA. Response shift and glycemic control in children with diabetes. Health Qual Life Outcomes. 2005;3:38. DOI: https://doi.org/10.1186/1477-7525-3-38

Most read articles by the same author(s)