The modification of the reverse Likert scale in the study did not have a significant effect on the data analysis process. This is because the Likert scale will be set as a nominal scale whose value cannot be calculated mathematically. However, the reverse scale will greatly affect the level of accuracy of the respondent's response in answering research questions. In general, a researcher will place a large value on a greater level of liking. So that the possible consequence is that respondents still consider that 1 is very dislike, and 5 is very like. My suggestion in making a questionnaire is to consider the ease of customers in understanding the questions and answers. And rather than reversing the scale on the questionnaire, it is better to reverse it during data preprocessing.

CMIIW

In my initial scale preparation stage I found that the Acquiescence bias can affect data quality. It was the reason to use the reverse order scale. Under some domains there was a positive kurtosis and skewness in the responses but it was seen in the similar studies. Thank you for the answer

Here are the pros and cons of using a reverse-order Likert scale in simple terms:

Pros:

- Helps reduce bias in responses

- Makes respondents think more carefully about their answers

- Can improve the accuracy of the results

Cons:

- Can be confusing for respondents if not explained clearly

- Can be harder for respondents to understand and answer

- Can make scoring and analysis more complicated

In short, reverse-order Likert scales can help improve the quality of responses, but may also cause confusion and make analysis more difficult. It's essential to weigh these points and consider your specific needs before deciding to use them.

Researchers sometimes intentionally use a mixture of orders in order to avoid a response set in which people always pick the same response without reading each question individually. From a statistical viewpoint, the order makes no difference. From a human behavior viewpoint, the question is whether respondents will pay sufficient attention so the response can be interpreted accurately. I suggest that you look for patterns of seemingly conflicting responses that might suggest that people were following a response set without reading the questions/labels carefully. (How you do that depends on what other information you have available.) Beyond that, document what you did and your reasons for doing so.

Using a reverse-order Likert scale (where 1 = "I completely agree" and 5 = "I completely disagree") offers both advantages and challenges when validating a tool, especially in assessing patient perspectives in primary care. The main benefits include reducing response bias by encouraging more thoughtful answers and balancing response patterns by diversifying scoring. This can lead to richer data and improved insights during validation, as inconsistencies between reverse and traditional scales can help identify comprehension issues. However, the reverse scale can increase cognitive load and complexity, particularly for respondents unfamiliar with this format. This may lead to errors, slower completion rates, and inconsistent responses. In terms of scoring and data interpretation, reverse coding is essential to avoid misleading results and ensure a logical flow in the analysis. To mitigate these risks, pilot testing is crucial to evaluate respondent reactions, and clear instructions should be provided. Proper reverse scoring during analysis is vital to maintain data integrity. Overall, while reverse-order Likert scales can enhance engagement and reduce bias, careful validation and precautions are necessary to ensure reliable outcomes.

Thank you for this