Title: Development and Validation of a Self-Management Self-Efficacy Scale for Premature
Birth Prevention (SMSE-PBP) for women of childbearing age
Version: 1 Date: 16 Nov 2023
Reviewer:  Francisco Javier Soriano-Vidal
Reviewer's report:
Thank you for the opportunity to review the manuscript. The authors have undertaken an
essential endeavor in creating a Self-Management Self-Efficacy Scale to enhance confidence
in managing pregnancy effectively and mitigate the risk of premature birth. While the research
holds promise, major revisions are necessary before considering it for publication in BMC
Women & Health.
The research presented within the publication has undoubtedly been conducted with meticulous
attention to detail; however, certain aspects call for a more comprehensive discussion to
contextualize the significance and implications of the validated tool.
The study could greatly benefit from a more explicit discussion delineating the precise
objectives, potential applications, and ethical considerations associated with the validated tool.
Addressing these nuances would enhance the study's comprehensibility and offer invaluable
insights into its international worldwide and clinical implications.
The crux of the matter lies in elucidating the tool's intended function and the overarching
objective behind its creation and validation. While the research delves into maternal factors
as risk indicators for preterm birth, it remains somewhat ambiguous whether the tool is
designed primarily for clinical utility or purely for investigative purposes. This distinction holds
considerable weight in understanding its potential impact on healthcare practices or the scope
of its applicability in research settings.
Undoubtedly, existing literature underscores the criticality of identifying modifiable maternal
factors associated with preterm birth, paving the way for early interventions to mitigate these
risks effectively. However, further clarity is warranted regarding the specific role envisaged for
the tool within this broader context. Again, does it serve as a screening instrument to guide
clinical interventions or as a research instrument aimed at unraveling underlying mechanisms?
Furthermore, an essential consideration, as highlighted in Cochrane reviews, pertains to the
healthcare system's influence on mitigating preterm birth risks. The significance of this tool
might be amplified by elucidating its alignment with healthcare practices, acknowledging the
interplay between maternal factors and healthcare interventions in preventing adverse birth
outcomes.
An additional point of concern pertains to the potential psychological implications on the women
or couples subjected to the questionnaire-based interventions. While such assessments might
aid in identifying risk factors, there is a need to delve into the potential emotional impact,
ensuring that these interventions do not inadvertently escalate stress or anxiety levels among
the participants.
Furthermore, considering the overwhelmingly positive psychometric outcomes, requesting
access to the dataset utilised in the study, as per journal protocol, would be advisable. Access
to this dataset would facilitate replication and further exploration, ultimately enhancing the
credibility and reliability of the reported results.
Considering the available sample and its composition, there exists an opportunity to fortify the
assessment of construct validity by employing hypothesis testing with known groups. Construct
validity could be reinforced by incorporating these results. This methodological approach would
provide additional insights into the tool's ability to differentiate between varying degrees of the
evaluated construct.
Addressing missing data is crucial in validating health-related tools. Detailed reporting on how
missing items were handled, reasons for non-responses, and strategies employed to manage
missing data are imperative for ensuring data integrity and reliability.
Moreover, the manuscript requires attention to certain aspects:
- The size and distribution of items across dimensions need balancing and coherence.
- Detailed justifications are required for retaining items with lower Content Validity Index scores
(i.e., dimension 2 and how it has been handled).
- Consideration should be given to re-evaluating modifications post cognitive interviews and
item reviews (i.e., Ensuring that the logic and coherence of the evaluated content supports the
removal or merging of items). Consider conducting a new assessment by experts to validate the
modifications made after cognitive interviews and item reviews.).
Additionally, improvements in the presentation of data tables and consistency in reported
percentages should be ensured (The percentages in some cases do not seem to match the totals.
For instance, in the category 'Risk of premature birth,' the sum of the percentages does not add
up to 100%. This might be an error in rounding or calculation in the data presentation.). Also,
consider the possible discrepancies between the sample sizes for exploratory and confirmatory
analyses, as they could impact the validity of the results if not adequately addressed.
I appreciate your consideration of these observations and suggestions, which I believe will
significantly enhance the manuscript's clarity, validity, and clinical applicability.