Title: A Pioneering Health Education Strategy Based on the PRECEDE-PROCEED Model for
Women’s Health Challenges: A Systematic Review and Logic Framework
Version: 0 Date: 07 Jun 2025
Reviewer:  Grace K. Kyei
Reviewer's report:
General Comments
This systematic review addresses an important gap in women's health intervention research
by synthesizing PRECEDE-PROCEED model applications, but the small sample of included
studies (n=7) concentrated primarily in Asian countries significantly limits the generalizability
of findings to diverse populations and healthcare systems. While the proposed logic framework
offers a structured approach to intervention design, the manuscript's impact is diminished by
methodological weaknesses including retention of high-risk studies and lack of quantitative
synthesis. The overall contribution would be strengthened through expanded search criteria,
more rigorous quality assessment, and clearer articulation of the framework's novel elements
beyond existing PRECEDE-PROCEED components.
Major Issues:
• Limited sample size and geographic scope: Including only seven studies concentrated primarily
in Asian countries significantly limits the generalizability of findings to diverse populations and
healthcare systems globally.
• Inadequate quality assessment: The decision to retain two studies with "serious risk of bias"
without conducting sensitivity analysis undermines the reliability of the review's conclusions
about intervention effectiveness.
• Restricted search strategy: Limiting the search to only three databases and English-language
publications introduces potential selection bias that may have excluded relevant studies from
other regions and languages.
• Insufficient quantitative detail: The absence of standardized effect sizes and confidence
intervals makes it impossible to assess the magnitude of intervention effects or compare
outcomes meaningfully across studies.
• Poor data presentation: Table 2's complexity and disorganized structure obscure rather than
clarify key study characteristics, hindering readers' ability to evaluate individual study quality
and intervention components.
• Missing implementation details: Critical information such as dropout rates, intervention
fidelity, and adherence measures are absent, which limits the practical utility of findings for
healthcare practitioners and program planners.
• Limited theoretical contribution: The proposed "logic framework" appears to repackage
existing PRECEDE-PROCEED model components rather than offering genuine conceptual
innovation to the field.
• Weak mechanistic analysis: The discussion fails to explain why interventions were effective
or identify key mechanisms of action, missing opportunities to provide actionable insights for
future intervention development.
Minor Issues:
• Writing quality concerns: Grammatical errors and awkward phrasing throughout the
manuscript detract from professional presentation and may confuse readers trying to understand
complex methodological concepts.
• Vague abstract: The abstract lacks specificity about key quantitative findings, making it
difficult for readers to quickly assess the review's clinical significance.
• Formatting inconsistencies: Inconsistent reference formatting and unclear figure presentations
reduce the manuscript's overall scholarly quality and may impede peer review and publication
processes.
• Incomplete PRISMA reporting: Better documentation of PRISMA checklist adherence
and missing details about data extraction procedures and inter-rater reliability weaken
methodological transparency.