Reviewer ’s rep ort 
 
Title: Effect of health education on knowledge and attitud e of menopause among middle age 
teachers  
 
Version: 0 Date: 01 Dec 2019  
 
Reviewer's report:  
 
This is a study of a health educational intervention in Eritrea, u sing a single group design with 
three a ssessment points and a sample of 99 teachers; knowledg e and attitude toward menopause 
are the outcome variables.  
 
 
Abstract:  
This is clear but I would suggest including background informati on that is more relevant to the 
study rather than the meaning of the word menopause, e.g . the need research on attitude 
/knowledge.  
 
The language implies cause ...'The educational intervention had brought significant difference in  
the mean scores of attitude...' - perhaps just state that scores changed.  
 
 
Background:  
Age of me nopause - please mention global differences in age and whe re this reference (3) refers 
to on line 59.  
 
Lines 66 -68 - 'in menopause'...osteoporosis and cardiovascular disease affect women 'after the 
menopause' and are also associated with age.  
Also not all women experience these health problems so perhaps include ..'some women'...  
Line 80 - please specify which country here. It would be helpf ul to include inform ation about 
how menopause is typically treated in Eritrea and by whom.  
 
 
Methods:  
The i ntervention included three hourly sessions with lectures, discussion and brochure.  
Questionnaire was used to measure knowledge (22 items correct or i ncorrect) and attitude (9 
items on 5 point Likert scales reflecting degree of agreement). More information could be 
provided about the choice of items, as well as the potential overlap between attitudes and 
knowledge.  
 
The development and psychometric properties of the measures should be included.  
Table 2. many of the items are phrased as though all women are th e same..e.g. Women in 
menopause increases weight; Menopause increases extra hair on women's face and become  
obese;.. please discuss the impact of presenting questions in this way.  
Many of the items in the table associated with menopause also have other cau ses...hence the 
items themselves could impact on women's attitudes; i.e. encouraging th em to attribute 
symptoms purely to the menopause, rather than also to psychosocial factors.  
On Table 6 please indicate this items reflect positive and negative attitudes . 
 
 
Results and discussion:  
There were ceiling effects for some attitude items. Some of the di fferences between pre, post and 
followup scores seemed small though statistically significant. C ould the authors comment on the 
clinical or other relevance of the e xtent of the changes in scores.  
Study limitations such as lack of control group should be included.  
More discussion is need in relation to theory (attitude/knowledge /behaviour/QOL) and the 
context of these findings.  
 
The discussion could also provide some i nformation about  use of medical and non -medical 
approaches/options in Eritrea; a high proportion of w omen believed that they had the 
information/ abilities to care fo themselves through menopause - please discuss.  
 
 
 
Are the methods appropriate and well descr ibed?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are 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 further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some l anguage corrections before being published  
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary fr om an 
organisation that may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation t hat may in any way gain or lose 
financially from the publication o f this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents  relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has app lied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have  no competing interests' 
below. If your reply is yes to any, please give details below.  
 
None  
 
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