Table 1.

Example item-CVI scores for retained, revised and eliminated items

Sample item	Item-level CVI (n = 6)	Rationale/Revised item, if applicable
Retained items
Formula fed babies are more likely to be overfed than exclusively breast fed babies (IIF3)	1	Relevance of question undisputed among experts
I can always ensure that my baby is properly latched on for the whole feeding (BSE4)	1	Relevance of question undisputed among experts
Revised items
Breast milk is lacking in iron (IIF2).	0.66	This question was problematic among the content experts with four calling it highly relevant and two suggesting revision, not only due to the complexity of knowledge required but also the directionality of the stem. Given the complexity of knowledge within the question and the social context the question was revised to; “Breast milk is higher in nutrients than formula”. Despite this item scoring less than 0.83 content experts felt it was an important information item to include if the wording of the item was simplified.
I can always identify signs of mastitis and yeast or breast health problems (BSE16)	0.83	This item contained multiple breast health issues that were identified as most likely being unknown to our target population. was reworded; “I can always identify signs of breast health problems”.
Eliminated items
Because I am worried that other people might realize that I am HIV + if they notice me exclusively formula feeding or exclusively breastfeeding I do not feel confident practicing either choice (SN5)	0	The meaning behind this item was lost in its complexity and the content experts all suggested eliminating.