Reviewer's report
Title:Harnessing Information Technology to Improve Women's Health
Information: Evidence from Pakistan
Version:2Date:28 June 2014
Reviewer: Griffin Weber
Reviewer's report:
The authors describe the challenges of providing women in Pakistan with health
information. Even in cases when women have access to health information, there
are still cultural barriers (poverty, mistrust, traditional medical practices, etc.) that
make this information irrelevant. The authors therefore created an Information
and Communication Centre (ICC) in a village in Pakistan, where women could
come and not only access internet, TV, etc., but also discuss what they learned
with others they trust. Although the focus was health information, the topics
discussed at the ICC extended to many other issues facing these disadvantaged
women. Their evaluation of the ICC consisted of a survey given to three groups:
ICC attendees, women who received information from ICC attendees, and
women who had no direct or indirect ICC contact.
My background is in medical informatics, not women's health. Nonetheless, I
thought this was a fascinating article. I learned a great deal about the problems
women face in Pakistan (in general, not just in health care or in access to
technology). The ICC has tremendous potential to improve quality of life for these
women. I think this work should definitely be published, but there are some major
problems with their evaluation, which I hope can be fixed:
MAJOR COMPULSORY REVISIONS
1) How were women in the indirect and no contact groups identified and
contacted to participate in the questionnaire? How do you get a "random
selection", especially of the no contact group? How many people did you try to
contact in each group before you were able to find 380 participants? I'm trying to
figure out whether there were selection biases, but it is unclear how the
participants were selected.
2) How was the questionnaire administered? I assume many of the women were
illiterate. Was it done orally? If so, was it blinded in any way (for example, a
computer reading the questions vs a human)? Were women
worried/embarrassed about answering questions in a certain way if it wasn't
blinded?
3) There are so many differences between the two groups in Table 1 (age,
education, income, etc.) that it is impossible to interpret the results in Tables 2
and 3. For example, how do I know that the ICC is providing women with
information about contraceptive methods? It might simply be that the younger
women in the direct contact group are more interested in contraception and have
previously sought this information. Propensity score matching would be very
helpful, or at least partitioning the datasets by age and education.
4) I think the questions were simply asking women if they had information about
different topics. Did the authors assess whether the women had the correct
information? It might be better for a women to think she doesn't have information
than for a women to have incorrect information.
5) Is the underlying data (the responses for all 380 x 3 women) available? I
couldn't find this mentioned in the manuscript.
DISCRETIONARY REVISIONS
1) The ICC was done almost 5 years ago. Is there any follow-up information
about these women? Do the ICC attendees have better health now than the
other groups?
Level of interest: An article of importance in its field
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