Reviewer's report
Title:The CHOICE study: women's perceptions and reasons for choosing the
pill, patch or ring
Version: 2Date:13 December 2012
Reviewer: Rebecca Say
Reviewer's report:
Major compulsory revisions
1. They should include the study design (i.e. cross-sectional survey) in the title
2. The aim of the paper should be made clearer by re-writing the final paragraph
of the introduction.
3. The authors should include information about how they developed, validated
and piloted the questionnaire.
4. The authors need to clarify how women’s interest in using a CHC was
ascertained and provide more information about how eligible women were
identified.
5. It is unclear how data regarding confounding factors was obtained. Were they
also collected in the questionnaire? The authors need to explain this and what
instruments were used.
6. Descriptive data should be included. For example, the authors state that there
was considerable variation in demographic variables between countries but do
not include the data. This should be included as should data on previous
contraceptive use which is also referred to.
7. Missing data should also be summarised.
8. Data should be summarised for each country, particularly as comparing
between countries was an aim of this paper. On pages 11 and 12 numerical data
should be included in relation to the most common reasons given for each
country.
9. In all the tables numerical data should be included as well as the percentages.
10. The authors state that knowledge of contraceptive methods appeared to be a
‘major relevant factor’ but data on prior knowledge does not appear to have been
collected. If it has this data should be summarised in the results or this should be
removed.
11. The authors’ assumption that women retain more knowledge about the
method they selected is not evidence-based. This should be removed or
supporting data provided
12. Generalisability should be addressed in the discussion. As women
considering other methods of contraception were also excluded I am unsure how
valid the study findings are as many women will want to at least consider other
methods, particularly long acting reversible methods, in order to make an
informed choice.
13. The authors should not conclude that providing structured information effects
decision making as there was no control group.
14. Limitations to the questionnaire should be considered.
15. The authors should comment on the ethics of not informing women about
these alternative methods. They suggest that including them would have made
counselling ‘too extensive and complicated’ but counselling about all options is
good practice (and essential to ensure women could make an informed choice)
and leaflets which cover all the options are available (and commonly used in the
UK).
16. It should be made clear if Merck, Sharp and Dohme had any role in the
design of the study.
17. The authors should adhere to the STROBE guidelines when re-drafting the
manuscript.
Discretionary Revisions
1. They should also include the questionnaire as an appendix to the study to
enable readers to evaluate it (major compulsory).
2. It would have been useful to include a qualitative component in the study to
explore women’s attitudes and preferences in-depth. Depending on how the
authors developed the questionnaire they may need to address this in the
limitations of the study (discretionary).
3. It would also have been useful to include the counselling leaflet as an
appendix to enable readers to evaluate it (discretionary).
4. It would have been useful to include a participant flow diagram and to describe
how many participants were eligible (and how many were excluded because they
wanted to consider other methods), recruited and completed the questionnaire.
5. The authors state that health professionals value particular characteristics of
CHCs but do not reference these.
6. The results suggest that counselling being evaluated may have been
unsatisfactory because of some of the beliefs women reported (for example,
perceiving that the methods would differ in relation to regular menstrual bleeding)
and they should comment on this.
Level of interest: An article of importance in its field
Quality of written English: Needs some language corrections before being
published
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.