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:19 August 2010
Reviewer: Aanand Naik
Reviewer's report:
• Major Compulsory Revisions (which the author must respond to before a
decision on publication can be reached)
1. The authors should better describe of The Theory of Planned Behavior, which
is the driving conceptual model for the survey questions. This is especially true
because I suspect the readership of BMC Gastroenterology will not be familiar
with behavioral models like TPB. I would suggest one of two approaches, a) a
figure demonstrating each of the conceptual elements of the theory with a short
definition of each construct or b) a sentence definition in the text that describes
each of the core elements.
2. The authors need to better clarify the qualitative methodology. I don’t believe
this was really grounded theory because the surveys do not appear to have been
conducted as in-depth interviews and the analysis did not use the constant
comparative method. It does seem more appropriate to call this content analysis
since the qualitative data seems to be drawn from interviews that were more
consistent with free-responses to open-ended surveys. Furthermore the
conceptual categories seem to be constructed using thematic analysis of
responses using the a priori categories within the TPB. In the end the analysis
performed seems to be structured, reproducible, and did result in novel,
conceptually coherent data. But the authors need to better describe their
methodology in a more consistent manner.
• Minor Essential Revisions (such as missing labels on figures, or the wrong use
of a term, which the author can be trusted to correct)
1. Second sentence of the second paragraph of the introduction, change “the
doctor patient’s relationship” to “the doctor-patient relationship”.
2. The first sentence of the second paragraph of the Participants subsection of
the methods should be rewritten as follows: “Patients were evaluated using a
Greek translation of the validated questionnaire, Identification of Dyspepsia in
General Population…”
3. The limitations section mentions something about “Affluent” population but
there is no economic data in the results section about the participants or on table
1.
4. In Table 1, I would suggest changing the percentiles for the education and
location variable to reflect column % rather than row %.
5. Page 11, First sentence after the Normative Beliefs heading should
read…”Patients’ beliefs regarding the necessity and importance of EGD for their
health…”
6. First sentence of the discussion should read…”This qualitative study
highlighted the main reasons why primary care patients did not comply with
upper…”
7. Page 14, middle sentence of the first full sentence should read…”Nevertheless
18% of them questioned their GPs’ recommendations raising issues of trust
within the doctor-patient relationship.”
8. The first sentence of the following paragraph (the one starting with “Patient’s
education about the examination…”) is confusing and difficult to follow. I would
suggest rewording for clarity.
9. An additional limitation should be included stating that the interviews only
reflect the perceptions of patients who refused endoscopy and cannot be
compared with the perceptions of patients who elected to undergo endoscopy.
• Discretionary Revisions (which are recommendations for improvement but
which the author can choose to ignore)
1. To improve clarity of the aims statement I suggest rewording the last sentence
of intro to:…”the findings of a qualitative study that describes patients’ reasons
for refusing to undergo an endoscopy…” I might then also suggest that the title
also use the term refuse rather than deny.
2. It would be helpful to readers not familiar with the cultural differences across
Greece to perhaps state in simple terms the cultural and socioeconomic
differences of the study populations from Macedonia versus Crete. This can be
done in the Setting section or as a figure legend to Figure 1.
3. An additional paragraph in the discussion section would be helpful. This
paragraph could describe potential interventions to enhance patient acceptance
of endoscopy. I would suggest again using examples from the colonoscopy
literature as numerous interventions have been attempted to enhance
compliance rates.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Needs some language corrections before being
published
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