Development of a self-report measure of living with cochlear implants (LivCI): a content evaluation

Objective: To develop items and evaluate content validity of a new patient-reported outcome measure, Living with Cochlear Implants (LivCI), designed to assess personal and psychosocial factors relevant to adult cochlear implant (CI) users and candidates. Design: The LivCI was developed following COSMIN best practice guidelines and involved extensive stakeholder engagement. Items (n = 87) were initially generated within five key themes: convenience and management, function and participation, stigma and identity, visibility and aesthetics, and psychosocial wellbeing. Study sample: Content validity was assessed via cognitive interviews with CI users (n = 7) and candidates (n = 7), and an online survey of CI professionals (n = 15) that evaluated item relevance, clarity and theme fit. Results: Lived experience participants found most items relevant and clear, with some revised or removed based on ambiguity or redundancy. Experts rated items highly (mean 3.6–3.9 out of 4), following removal of seven items and reclassification of several others. Readability scores met recommended standards for public-facing health measures. Further psychometric testing has reduced items and validated the LivCI. Conclusions: Content validity with stakeholders was a key stage in the development of the LivCI. The LivCI was shown to assess personal and psychosocial factors relevant to adult CI users and candidates.