Reviewer’ s report
Title: Effect of health education on knowledge and attitude of menopause among middle age
teachers
Version: 0Date: 11 Dec 2019
Reviewer: Nese Yuksel
Reviewer's report:
Thank you for the opportunity to review this manuscript. In this manuscript the authors describe
an evaluation of a patient education program on menopause on the knowledge and attitudes ofschool teachers in Asmara, Eritrea.Please see below for comments to help the authors with future revisions:
The manuscript requires major editing for the English language.Background:Line 56 - "also involved in various life events, one of them is menopause" - Menopause is a
natural life event, may want to revise statement as women are not "involved" in menopause.
Line 58 - include the context for the average age of menopause of 47 years (for example it is 51
years in North America).
Line 60/61 - revise grammar
Line 61 - 64 - revise grammar, currently a run on sentence
Line 66 - spelling "revealed"Line 81 - "This have ignored" - Who has ignored?Methods:Line 93 - "according to…" - according to what?Sampling - Sample size description is somewhat confusing. What is the effect you are measuring
to calculate sample size? Was it determined apriori? Suggest further clarity in describing samplesize.
Intervention - It is unclear what the teaching manual is referring to? Is the manual for the
presenters delivering the program? If not, how is this different than handout and brochure?Further description of the exact intervention would be helpful for reproducibility.
Line 117 - Over what time frame were the three sessions?
How was recruitment done for the teachers? Were there any exclusion/inclusion criteria? Were all
teachers included or only those in midlife?
Instruments
Were these administered by the nurses at the three data points (ie not self-administeredquestionnaires)? Why did you chose to collect data this way vs a self-administered questionnaireespecially when asking knowledge and attitude questions?
Describe how content validity was determined ie how many experts, backgrounds?
Did you look at face validity?
Line 143 - scoring of attitude questions is not very clear, please revise for clarity for the reader.Line 143 - "scores ranged", it is unclear what is meant by scores ranged? Is this how items were
rated positive or negative? How did you determine the weighting of what would be positive ornegative statement?
Results:Line 161 - How many teachers were approached and how many did not meet inclusion criteria/or
declined?
Line 173 - Did you look at total score changes - did general knowledge improve?Line 176 - "nine tenth" is difficult to interpret
Line 192 - What is meant by "quadratic" change?
Line 202 - What is the "time" referring to? "There was no significant interaction between age and
time" but unclear what "time" means in this setting?
Line 227 - What do you mean that the difference among mean scores was significant with time?
The numbers looked very similar.
Table 2:
The statements with "osteomalacia" are incorrect. This should be osteoporosis. In addition, justgoing into menopause does not increase osteoporosis, but menopause and the loss of estrogenswill lead to further bone loss which could increase the risk of osteoporosis in patients who haverisk factors. Early or premature menopause increases the risk of osteoporosis.
In Table 2 - it is difficult to interpret what the correct response would be for your knowledge
questions without the full questionnaire.
Did you have a knowledge question on management of symptoms?
Table 6:
Unclear how the questions included as attitude are truly attitude questions regarding menopause.Also difficult to interpret without the full questionnaire. A number of the questions may not begeneralizable to other settings (for example the questions regarding the "interest and attention ofwomen toward husband").
Discussion:
Line 251 - What evidence is being referred here? What are the references to support this?
Line 253 - Needs referenceLines 259 - 262 - Sentence is confusing, also difficult to interpret "three tenth"Line 261 - 262 - How do you know about this re low level of education? Seems like a generalized
statement.
Line 266 - Should not be "osteomalacia", this should be osteoporosis.Line 270 - What parameters are you talking about?Line 286 - Why do these teachers have more resources?Line 292 - Please provide evidence for this statement. In addition, reference 31 is a thesis not a
published work in a peer review journal, therefore should not be included as a reference.
Line 295 - 296 - unclear statement
Line 298 - What do you mean by effective - how do you know it was effective?Provide a limitations section in your discussion. There are a number of limitations with your
study, especially regarding the generalizability which should be discussed.
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
NoDoes the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
Unable to assess
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
NoAre you able to assess any statistics in the manuscript or would you recommend an
additional statistical review?If an additional statistical review is recommended, please specify what aspects require furtherassessment in your comments to the editors.
I recommend additional statistical review
Quality of written English
Please indicate the quality of language in the manuscript:
Not suitable for publication unless extensively editedDeclaration of competing interests
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