Reviewer ’s report  
 
Title:  A QUALITATIVE STUDY OF DEVELOPING BELIEFS ABOUT HEALTH, ILLNESS 
AND HEALTHCARE IN MIGRANT AFRICAN WOMEN WITH GESTATIONAL 
DIABETES LIVING IN SWEDEN  
 
Version: 0 Date: 07 Nov 2017 
 
Reviewer:  Maree  Johnson  
 
Reviewer’s report:  
 
This is a very interesting study of Migrant African Women Living in Sweden with Gestational 
Diabetes.  
 
Title could be better described as a.. qualitative study of beliefs about.... Sweden.  
 
What is know section - needs substantial reworking and editing for correct meaning to be 
conveyed.  
 
What paper adds - needs to be reduced to major points, too inclusive.  
 
Abstract:  
 
line 7:  child, and are particularly relevant to migrant women and women of Afr ican origin.  
 
line 9 -10 .. with the new society and health system confronts...  
 
page 6 line 23.. may be [very shocking]  needs a more objective word.. ie., distressing to the 
woman??  
 
page 6 line 53.. Ex -Yugoslavia ? is this an acceptable term could you rephr ase.. 
 
page 8 line 2 ......in the 12th or 28th gestational week (order)  (in the case of a family history? of 
diabetes mellitus  
 
page 8 line 31... lay theory model??of illness causation.. (not sure of the meaning may require 
some further elaboration).  
 
line 4 1.. help -seeking behaviours (healthcare seeking?)  
 
page 8 line 58 Individual beliefs are learned through socialisation with others (x, x, x,) and 
influence attitudes to health -related behaviours  
 
page 9 line 21.. migrants within an acculturation process..  n ew sentence.. Trying to adapt to...   
new country, may result in stress that may influence..  
 
line 41.. ? meaning of authoritarian male culture??? Can you contextualise this further.  
 
page 10 line 27... Did you mean convenience?? rather than consecutive? oth erwise define 
consecutive please.  
 
Results  
 
page 12, line 48:  .. ages ranged from 23 to 40 years (mean 31 years, SD XX).   
 
line 51 All participants were refugees.. ties.  The median time  
 
line 58.. parous (n=8) and had been treated  
 
page 13 line 1.. with ab out half with limited educational experiences (<6..  
 
The use of footnotes for time of interview may not be the best way to present this.  Perhaps 
consider time of interview beside participant  (R33, Interview 1).  Note the numbering in the text 
to explain t his or use plain English in the quotes (R33, Interview During Pregnancy).   
 
Page 14 introduces the 'supernatural influence'  ?? whether this is the best term to use.. spiritual 
influence...?  religious beliefs influence  
 
Discussion  
 
page 22 - U-shaped relaps e (please define)  
 
page 24 line 1 .. 'calming perhaps supportive is a better term.  
 
page 25 line 21.. described health from a pathological perspective (? not pathogenetic?)  
 
page 25 2nd paragraph, very difficult to read and understand suggest limiting the ide as being 
conveyed and rewrite this section.  
 
page 26.. line 19.. Complete coping strategies ?? (not sure of the meaning of this perhaps the 
incorrect word is being used).  
 
page 26 is one long paragraph insert breaks and reduce where possible.  
 
The discussion is generally too long and at times unfocused.  The authors should select 4 -5 major 
point and present them rather than try and cover all issues identified.  
 
Study limitations and strengths  
 
This section is too long and limit to key issues. page  29 lines 1 -12 delete.  
 
Conclusions  
 
First sentence rewrite, ... changed to a limited extent prospectively does not seem to convey the 
importance of the work... did you mean .. changed to a limited extent through the period of 
acculturation?? .. irrelevant c oncerns?? worries ..  
 
page 29 line 29.. reciprocal relationship?  
 
line 41 to 46 presents as being very punitive.. and needs to be specific in its statements.. ie., 
competent staff... did you mean staff with skills and education specific to patient educatio n ??? 
or similar...  use of the term illness trajectory seems a little out of place when talking about 
pregnant women and gestational diabetes..  the trajectory of GDM and subsequent health issues.  
 
Thank you for the opportunity to review this paper, which  describes a very unique population of 
interest to the readers of BMC Women's Health.  
 
There are English expression issues throughout the manuscript that require attention.  
 
An additional reference that may be of interest to you.  
 
Jirojwong, S., Brownhill, S., Daheln, HG., Johnson, M., Schmied, V. (2017)  Going up, Going 
down:  the experience, control and management of gestational diabetes mellitus among Southeast 
Asian migrant women living in urban Australia.  Health Promotion Journal of Australia 28(2), 
123-131 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does 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.  
 
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.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Not suitable for publication unless extensively edited  
 
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 from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in a n organisation that may in any way gain or lose 
financially from the publication of 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 applied 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.  
 
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