Reviewer’s report
Title: 
Eat Healthy, Be Active Community Workshops implemented with rural Hispanic women
Version: 
1 
Date: 
14 Jan 2020
Reviewer's report:
Review for BMC Women's Health Manuscript BMWH-D-19-00602B1 Eat Healthy, Be Active
Community Workshops Implemented with rural Hispanic Women
Strengths
There is enthusiasm for this work which examines the implementation of an evidence-based program in a
population of underserved women, who are at high risk for diabetes, cardiovascular disease and obesity.
The implementation of workshops using culturally relevant promotors is of merit.
Concerns
The manuscript as written is not in keeping with the intent of pilot study. 
Pilot studies are not a hypothesis
testing study per NIH policy https://nccih.nih.gov/grants/whatnccihfunds/pilot_studies 
and others [per
Whitehead et al (2014)] 
https://www.sciencedirect.com/science/article/pii/S1551714414000494 
Thus,
the manuscript focus on determining effectiveness of the EHBA workshops through statistical
significance does not appear appropriate. 
This work is of merit as it provides valuable information about the feasibility and acceptability of
implementing this EHBA workshop in the population of rural Hispanic Women. 
A revision is
recommended with the need to refocus the purpose and reporting throughout the manuscript (including
abstract) on feasibility and acceptability, which is primarily descriptive in nature, as appropriate for a pilot
study. 
If available, more fully describe the ability to recruit and retain women (by way of example - how many
women could be enrolled within a certain time frame, how many started the program and how many
dropped out, how many women expressed interest versus how many enrolled [of interest was 40% (n=21)
of women had no health insurance]. 
Under participant characteristics, 49 women participated - did that
many start the program or is that the number of completers (retention rate) as you noted 3 were not
available for followup ? Reporting the level of effort to recruit the women during the time period and the
number and % of women who attended all the sessions would be informative, if available. 
A focus of a pilot/feasibility study would be whether clinically meaningful changes were observed, as
opposed to statistically significant changes. 
Of interest was the observed increase in nutrition label
literacy. 
Citations are needed throughout the manuscript. 
A few examples
- noting the sample size of 50 is consistent with the literature for pilot studies, a citation is needed (p7 
line
47 ) 
- citation for EHBA workshop information (eg. p6, line 38 and page 6 line 51).
- for methods, please cite references for the questionnaires used - also include citations regarding validity
and reliability of the instruments/surveys used p 8 & 9 
- citation for CDC BMI ranges p 9 line 33
In the results and discussions, the authors report percentages, yet it is recommended that both n-sizes and
percentages are reported together [eg. 42% (n=21)} for reader interpretation due to the small sample size
of the study.
Discussion section: 
1) Needs commentary about issues of self-reporting weight
2) Need citations on weight loss expected in 6 weeks in a community-based program. The focus of the
education appears directed toward healthy eating with only 1 session on weight loss so it would seem
reasonable that no weight change occurred. 
3) Would benefit from commentary about the challenges to self-report activity. 
Conclusion (in abstract and text)
Stating the workshops are shown to be effective seems overreaching for this pilot study, as the study
appears to indicate feasibility of implementing the EHBA workshops in this population. 
Remove
statement aabout obesity-related changes not reaching statistical significance. 
Tables 
1) The data on Tables 2 and 3 for point estimates and CI are appropriate, yet please include n-sizes 
2) Consistent with pilot/feasibility study, the emphasis on p values is not needed and can be removed. 
3) Tables should be able to stand alone for interpretation, thus footnotes about the variables measured is
needed for explanation and clarity (eg. Sugary Drinks - what does 1.53 mean - 1.53 drinks per day? What
is 1.22 for eat at restaurants mean). 
Example - It was helpful that on Table 3, you noted F & V
consumption related to # cups per day 
4) Include units for all variables 
- for example for Table 3 Obese, are you referring to the percentage of
women who were obese (30.16) or does that number reflect the women's average BMI in kg/m2. 
Weight
change - labeling is needed - it appears to be measures of weight in pounds? 
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
No
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
Yes
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
No
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.
I recommend additional statistical review
Quality of written English
Please indicate the quality of language in the manuscript:
Needs some language corrections before being published
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 an 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.
I declare that I have no competing interests
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