Development, Cognitive Interview Testing, and Content Validation of the PERCH-BC Survey for Perceived Weight-Related Effects of Hormonal Contraception

Concerns about weight gain may influence hormonal contraception selection, satisfaction, and discontinuation, yet no validated patient-centered instrument assesses perceived weight-related effects across methods. We developed the Perceived Changes with Hormonal Birth Control (PERCH-BC) survey using sequential face-validity and content-validity phases. Initial items were informed by the literature, questionnaires, and expertise. Fifteen premenopausal women aged 20–45 years—purposively sampled across normal-weight, overweight, and obesity categories—evaluated Versions 1–3 over three rounds of cognitive interviews. Participants completed the survey before retrospective probing focused on comprehension, interpretation, response processes, response-option fit, format, and usability. Interviews were audio-recorded, transcribed, and qualitatively coded; round-specific findings informed sequential revisions. Participants found the survey understandable and acceptable. However, limited contraceptive-method familiarity, difficulty responding under uncertainty, and interpretation of items as factual knowledge questions reduced response confidence. Revisions included a contraceptive-method visual aid, uncertainty response options, belief- and experience-focused instructions, revised wording, and side-effect items. The resulting 25-item Version 4 underwent structured content review by eight interdisciplinary experts evaluating 27 prompts for relevance, clarity, and completeness. All prompts met the prespecified relevance threshold (item-level content validity index [I-CVI], 0.875–1.00); the scale-level average content validity index (S-CVI/Ave) was 0.98. Expert feedback informed minor refinements before subsequent quantitative psychometric validation.