Reviewer's report
Title:Digging over that old ground: an Australian perspective of women's
experience of psychosocial assessment and depression screening in pregnancy
and following birth
Version: 2Date:8 January 2013
Reviewer: Susan Ayers
Reviewer's report:
Thank you for the opportunity to review this paper, which reports a study of
women’s experiences of psychosocial assessment and screening in pregnancy
and after birth. The strength of the study is the mixed method, longitudinal
approach. The authors carried out observations of women’s nonverbal and verbal
behaviour during psychosocial assessments, as well as in-depth interviews a few
weeks afterwards. Both observational and interview measures were carried out in
pregnancy and postpartum. The initial sample (n=34) is relatively large for a
qualitative and observational study, although there is variation in women who
participate at different time points, with significant drop out for the postnatal
observations (n=20).
Overall, I thoroughly enjoyed reading this paper, which provides some additional
insight into women’s responses to psychosocial screening and has a lot of
potential. I provide my recommendations for the authors below.
Major compulsory revisions
Following on from the above, the main challenge for the authors is to analyse
and write up such a complex study in a way that (1) makes the methodology and
analytic approach clear to readers, and (2) does justice to the complexity and
depth of the data collected. The authors have done a good job of the former but
less so on the latter so this needs to be addressed. The approach to analysis
seems fairly simplistic, although this may just need clarifying. As far as I
understand it, the authors treated observational and interview data from all time
points similarly and analysed emergent themes over all these data. There is no
information on the order in which data were considered. For example, if the
observational data in pregnancy were analysed first and used to determine the
majority of themes then this observational data will be overly represented in the
authors’ results and conclusions. Similarly, there is no information on reliability of
coding (e.g. inter-rater reliability), or trustworthiness of the data, which need to be
added.
I personally think it is a great shame that there is no comparison of themes
between assessment methods and time points. For me, this is one of the most
exciting possibilities of the data from this study. The observational data provides
information on nonverbal responses and behaviour at the time of assessment,
whereas the self-report data provides retrospective evaluation of women’s
subjective responses to assessment. The similarities and differences between
these methods of measurement could provide interesting insight into women’s
behavioural and subjective responses to psychosocial assessment. Similarly,
women are likely to evaluate screening and assessment differently in pregnancy
and postpartum – this is even supported by the authors’ theme ‘a bit out of the
blue’.
I realise this approach may require some re-analysis but think it would provide an
incredibly interesting and novel addition to the literature on perinatal
psychological assessment. I would therefore love to see a more detailed,
separate analysis of the different types of measurement and some comparison
between these across time. In its current form, the broad-brush approach to
analysis provides results that, as the authors acknowledge in the discussion, is
consistent with previous studies of women’s views of psychosocial screening. It
is therefore not clear how this study adds novel information to we already know. I
think this is a great shame, given the potential of this study.
Minor Essential Revisions
p26. “if a woman feels nurses consider her needs…” is a common mistake but
please be careful not to use ‘feel’ when you mean ‘think’
The referencing in the discussion needs changing so the author’s names are
given when you state “As [32] describe….”
p27 you state that home versus the clinic did not appear to make a difference to
women’s comfort but you do not report any analysis or results for this in the
paper.
p28 “(Rollans et al b)” is not consistent with Vancouver referencing used in the
rest of the paper.
In the discussion one of your main conclusions is about the importance of
healthcare professionals build trusting relationships with women. However, at no
point in your results section to you or the quotes from women refer to trust, so
this is not an appropriate label. This is easily dealt with by removing reference to
‘trusting’ relationships and just referring to good relationships.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests