Title: ‘I don’t know what normal has been’: a Grounded Theory exploration of the journey to
endometriosis diagnosis
Version: 1 Date: 15 May 2025
Reviewer:  Lilian Donatti
Reviewer's report:
This study presents a valuable investigation into the experiences of women with endometriosis
and the factors contributing to diagnostic delay. The application of Constructivist Grounded
Theory (CGT) is apt and allows for a thorough exploration of the complexities involved. The
theoretical framework of the four contexts offers a promising new perspective on understanding
the diagnostic journey. However, certain limitations need addressing before the article can be
considered for publication.
Detailed Recommendation:
Conditional Approval: I recommend conditional approval of this article for publication, subject
to significant revisions addressing the following concerns:
1. Sample Size and Diversity: The primary limitation is the relatively small size and lack
of diversity in the sample. The authors should justify the sample size based on theoretical
saturation, but also acknowledge the limitations in generalising the findings. It's highly
recommended that the authors discuss how future studies could address this limitation, perhaps
with a multi-centre study including a more diverse sample.
2. Demographic Information: The lack of detailed demographic information makes it difficult to
contextualise the findings. The authors should include relevant demographic information, such
as average age, socio-economic status, and medical history of the participants, if available.
3. Psychometric Scales: The absence of psychometric scales is a missed opportunity to quantify
certain aspects of the participants' experiences. While CGT is a qualitative methodology, the
inclusion of quantitative measures could strengthen the validity and reliability of the results. The
authors should discuss why they opted not to use psychometric scales and how future studies
could integrate mixed methods.
4. Reflexivity: The researchers' reflexivity should be addressed more explicitly. The authors
should discuss how their own experiences, beliefs, and values may have influenced the research.
This is particularly important given that the study team included women with endometriosis.
5. Practical Implications: The practical implications of the study should be more clearly
articulated. The authors should provide specific recommendations for healthcare professionals.
6. Discussion of Limitations: The discussion of the study's limitations should be more thorough.
The authors should acknowledge the limitations in generalising the findings, the lack of
psychometric scales, and the potential influence of the researchers' reflexivity.
Justification for Recommendation:
Despite these limitations, the study offers a valuable contribution to understanding the diagnostic
journey of endometriosis. The theoretical framework of the four contexts is promising and could
help guide future research and clinical practice. However, the limitations need addressing to
ensure the study is rigorous, reliable, and relevant to a broad range of readers.
Conclusion:
If the authors address the concerns raised and make the necessary revisions, this article has the
potential to be a significant contribution to the literature on endometriosis and to have a positive
impact on the lives of women living with this condition. Therefore, I recommend conditional
approval for publication, subject to significant revisions.