Review for 10.1186/1471-230X-11-11 (2011)

Reviewer's report
Title:Why do primary care patients with dyspepsia tend to deny upper
gastrointestinal endoscopy in Greece? Experiences gained from a qualitative
study on rural Greece
Version: 1Date:4 September 2010
Reviewer: Anna Gagliardi
Reviewer's report:
OVERALL
We lack information on how best to promote appropriate health care delivery,
partly because there are many influencing factors, including individual patient or
provider attribute, nature of the health care intervention, and organizational or
system level issues. This study is important because it focuses on how patient
factors including knowledge and attitudes influence their use of a health service,
and the investigators certainly collected a lot of data, and very appropriately used
a theoretical framework to guide data collection and analysis. However, the
importance of the topic could be better emphasized by including more
background information and justification, more carefully analyzing and reporting
the findings, and discussing the findings in the context of additional relevant
literature to suggest if and how the findings can be used, or what research is yet
required.
MAJOR COMPULSORY REVISIONS
TITLE
Suggest something like:
Upper gastrointestinal endoscopy for dyspepsia: Exploratory study of factors
influencing patient compliance in rural Greece
ABSTRACT
Qualitative thematic analysis is a method, factors influencing compliance would
be the outcome measure. Last sentence of Results subsection requires
rewording to clarify meaning. In Conclusion readers might not understand what
non-medical reasons means – either define, or simply mention that key issues
were fear and inconvenience
BACKGROUND
TPB is the theoretical framework that informed objectives, methods and analysis
for this study and should be introduced in the Methods section. Instead, readers
would benefit from more information about factors that influence patient
compliance with other clinical indications to highlight what we do not know about
patient compliance in general and for dyspepsia to better justify the need and
purpose of this investigation. Here it would be important to distinguish why
patient compliance is the issue (thereby focusing on the patient) rather than
physician communication with patients/shared decision making (with greater
focus on either the physician, or the physician-patient relationship). Also explain
why would academic and community-based practice differ? In the last paragraph
the authors say it was astounding to find that most patients refused endoscopy –
these are findings and should be reported in the Results
METHODS
A little more detail about both qualitative and quantitative analysis would be
helpful. It is quite unusual in a qualitative study to interview so many individuals –
one generally establishes saturation or informational redundancy as a way to
determine sample size and reliability/validity of the findings, and this is not
mentioned.
RESULTS
It would be helpful to see a table that defines the TPB constructs and
distinguishes themes/sub-themes revealed through grounded analysis. If number
of tables and figures is limited, then remove the map of Greece.
One does not usually quantify qualitative responses
Several of the quotes are vague and do not necessarily illustrate the theme or
sub-theme – further interview probing may have elicited more specific or detailed
responses, plus there appears to be overlap across themes, for example, fear is
placed under Attitude and under Inconvenience, and the cause and nature of
their fear is not thoroughly described, and perhaps due to lack of probing there is
some mininterpretation, for example, how is breathless translated to drowning?
For patients who had prior experience, it would be important to know more
details about that experience and what it is that deters them from doing it again
Formatting of the Results is difficult to read, consider distinguishing the quotes
from the text with italics or indenting, or putting exemplary quotes in a table along
with the definition of that theme/sub-theme
DISCUSSION
Findings could be better contextualized with reference to more literature.
Elaborate on the implications of these findings for policy and practice, and on
suggested future research
MINOR ESSENTIAL REVISIONS
Mention Table 2 earlier in the Results section, not as the last sentence, and
remove blank column for Missing Data from Table 2
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Not suitable for publication unless extensively edited
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests