Reviewer’s report
Title: 
Barriers in access to healthcare for women with disabilities: A systematic review in qualitative
studies
Version: 
1 
Date: 
08 Oct 2020
Reviewer's report:
This paper presents a systematic review of qualitative studies to review access to health care services by
women with disabilities. Unfortunately there are a number of gaps in the process described by the authors
that will need to be addressed before this paper would be suitable for publication.
This review categorizes findings from the included studies based on a model to access health care
(Levesque et al 2013). Ideally the background section of the paper would have introduced this framework,
and would have provided a more coherent and structured approach to the introduction, rather than
introducing it part-way through the methods section. The authors state that based on this framework that
they "identified all cited barriers by a systematic review and then we categorized them into five dimensions
of approachability, acceptability, availability and accommodation, affordability,and appropriateness."
(p10-11, from lines 57) however the authors have failed to reference the systematic review used making it
impossible to confirm whether the developed categories are feasible.
A more robust screening method requires two authors to screen titles independently and to resolve
disagreements about inclusion and exclusion through consensus. In this study, a single author undertook
the screening, consulting a second author about any uncertainties. This increases the likelihood of bias in
study selection.
The authors have used COREQ to report a quality score for each paper, yet COREQ is a checklist for the
reporting qualitative research, not a quality appraisal tool. To obtain a score the authors used a 5-point
Likert scale for the 32-items in the checklist and only included those studies with an overall average of 3
or more. This process led to the exclusion of four studies. This approach assumes all items on the
checklist are of equal value. No justification for this is provided but would be helpful, particularly to
understand how such scores are expected to be interpreted. This isn't clear to me. There is no description
of how the analysis was performed other than the description of the categories used. These are included
under the sub-heading Quality Assessment. It would be difficult for others to replicate this review.
Results: it would be useful to include the different disability types that the included studies cover. This
would be helpful to understanding the different barriers identified. The findings are summarized
differently in the abstract than in the main document and more thought is needed in how to report these in
a meaningful way that will be useful to readers.
Minor issues include the need to address typographical errors, for example, the second sentence states
"The Word health Survey" when it should be World Health Survey.
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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?
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from the publication of this manuscript, either now or in the future?
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applied for patents relating to the content of the manuscript?
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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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Is the study design appropriate to answer the research question (including the use of appropriate controls),
and are the conclusions supported by the evidence presented?
No
Are the methods sufficiently described to allow the study to be repeated?
No
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free from apparent
manipulation?
Yes