Cognitive interviewing is a method to develop culturally appropriate survey questions and scale items. We conducted two rounds of cognitive interviews with 24 pregnant women in Ethiopia and Kenya to assess the appropriateness, acceptability, and comprehension of general and micronutrient supplement adherence-specific social support scales. We stopped the first round of cognitive interviews after receiving negative feedback from interviewers and participants about their distressing and uncomfortable experiences with cognitive probes and challenges related to cultural perspectives on social support. Through an iterative process, we made substantial changes to the cognitive interview guides and items from both social support scales. In the second round, the revised cognitive interviewing process substantially improved interviewer and participant experiences and increased comprehension and appropriateness of both social support scales. This study confirms the importance of cultural adaptation of the cognitive interviewing process as well as social support scales.
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