Title: Developing a question prompt tool to prevent and manage early cardiovascular disease
after hypertensive pregnancy: Qualitative interviews with women and clinicians
Version: 1 Date: 07 Apr 2023
Reviewer's report:
Thank you for the opportunity to review “Developing a question prompt tool to prevent
and manage early cardiovascular disease after hypertensive pregnancy: Qualitative interviews
with women and clinicians.” The authors should be commended for this informative and
well-articulated study. The manuscript is well written and provides useful information for
the development of educational tools to support the prevention of and rehabilitation from
cardiovascular disease in women with HDP. There are several strengths to the study, including
a diverse patient and clinician sample, strong rationale and situatedness within an intervention
development framework, and highly organized data and themes.
I have several minor comments and a few major comments that I would like to see addressed
before acceptance.
1. It is typical in qualitative research for researchers to situate themselves on the qualitative
research continuum, with some mention of epistemological stance (from my reading, it appears
that the researchers used qualitative methods to interpret the textual data but still hold more
objectivist perspectives of the data and its value).
2. I would have liked to have read more about the decision making behind the Implementation
Fidelity Framework that was used to guide the interview questions and subsequent analysis.
3. The interviews were quite short (19 minutes!) suggesting that some participants had very little
to say about this topic…some discussion of this in the limitations would be helpful.
4. Given your presumed objectivist stance on the qualitative research approaches used, why was
inter-rater reliability not sought? This seems inconsistent.
5. I think it would be important to know more about the CVD status of the women…simply
listing “yes” or “no” to a CVD status within the participant characteristics table feels insufficient.
Did this mean that women were formally diagnosed with a form of CVD or had risk factors?
What risk factors? I would think that the severity of CVD status may have an impact on what
these patients would want from a QPT. Also, did these women have other comorbidities relevant
to HDP? Might these comorbidities influence patients’ experiences using this tool?
6. Some of the quotes used within the body of the manuscript are not well chosen (in my
opinion!). Consider using some of the exemplar quotes (which have more descriptive depth) in
the actual manuscript, as many readers will not look at the table or supplemental file.
7. There are some areas where HDP and HPD are used interchangeably – I’m assuming just
a typo?
8. I thought the results could have been better compared/contrasted to extant literature. For
example, paragraph two of the discussion provides several examples of what was found in other
similar studies, but the results from your work are not explicitly connected (other than stating that
this study adds to the literature). Why might the results from your study be consistent or disparate
from previous work? What is it about your participants/the study context that may contribute to
these differences? Overall, I thought there needed to be more (and more meaningful) engagement
with previous work in the discussion.
9. Have you considered the use of a figure to illustrate the study’s main findings? (e.g., use,
design, barriers, and enablers etc.)
10. You compared the responses between patients and clinicians, but I was left to wonder
whether there were any meaningful differences among the categories of participants within
each group that you purposively selected for. In my experience as a qualitative researcher,
if participants are purposively selected to fulfill certain criteria, it is important to consider
the similarities/differences in responses based on these selections (i.e., are there qualitative
differences in responses made by women from rural vs urban locations? made by clinicians with
more or less experience?). If these selections were made for a qualitative reason (rather than to
obtain a more ‘representative sample’, for instance), I think it becomes important to highlight if
there were any important variations in opinions based on these selections.