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Reproductive Endocrinology

MON-121 - Patient-Informed Development of A Survey to Explore Perceived Weight-Related Health Effects of Hormonal Contraception: Steps in Item Generation and Face Validity

Monday, June 15, 2026
9:00 AM - 2:00 PM CT
Location: ENDOExpo; Poster Floor
Disclosure(s):
Adnin Zaman, MD: No financial relationships to disclose


Background: Perceived weight-related side effects of hormonal contraception (HC) influence contraception selection, satisfaction, and discontinuation. Existing instruments primarily assess overall satisfaction without fully capturing patient-centered perceptions of health-related effects across methods. Survey development grounded in patient experience is needed to inform clinical counseling and future research.

Methods: We conducted a multi-phase qualitative study using cognitive interviewing to develop and refine a novel survey assessing perceived weight- and health-related effects of HC methods among premenopausal women aged 20-45 years. Phase 1 involved item generation based on prior literature and clinical expertise. Phase 2 evaluated face validity through three iterative rounds of one-on-one cognitive interviews using a think-aloud approach. Eighteen interviews (six per round) were conducted with fifteen premenopausal women; three participants were interviewed twice to assess the clarity and relevance of survey revisions. Purposive sampling ensured inclusion of two participants per round in each BMI category (normal weight, overweight, obesity). Interviews were conducted via videoconference, audio-recorded, transcribed, and analyzed using qualitative analysis software (Dedoose). After each round, the study team met to review findings and revise survey content.

Results: Participants had a mean (SD) age of 32.8 (8.1) years and BMI 27.7 (5.0) kg/m². Cognitive interviews (mean duration 36.0 [10.3] minutes) informed four core domains shaping perceived health effects: global beliefs about HC and health; method-specific perceived health effects; perceived directionality and nature of effects; and weight-related concerns and behavioral impact. Participants noted unclear survey terminology in earlier iterations, limited familiarity with certain contraceptive methods, and difficulty distinguishing anticipated versus experienced effects. Iterative revisions improved conceptual clarity and enhanced alignment with participants’ lived experiences and response needs. Across versions, survey structure, item wording, and response options were refined to better capture uncertainty and variability. By the final round, participants consistently reported the survey length and response options to be clear and acceptable.

Conclusions: Qualitative face validity assessment strengthened the clarity, interpretability, and patient-centeredness of a novel survey assessing perceived weight-related effects of HC. This work complements existing contraceptive satisfaction instruments by addressing weight- and health-specific perceptions influencing decision-making across the BMI spectrum. The resulting instrument provides a foundation for subsequent content validation and psychometric testing and may support contraceptive counseling.

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