Title: Determinants of self-rated health among highly educated Ukrainian women refugees in
Czechia: analysis based on cross-sectional study in 2022
Version: 0 Date: 09 Feb 2024
Reviewer's report:
Dear authors,
I find your paper interesting for the readers to understand better the health profile of Ukrainian
women refugees of the russian-Ukrainian war.
While reading the paper, I have found several aspects which - in my opinion - require either
more explanations or revision:
1) According to methodology there is a limitation connected to the sample (N=1347), because
the sample was restricted to refugees registered in the Ministry of Labour and Social Affairs to
get humanitarian benefits. So, refugees who had already found jobs (at the time of the survey)
weren’t registered for humanitarian benefits and refugees who still were working online in
Ukraine didn’t register there too. Another limitation is connected to participants who have digital
skills to fill out questionnaires online. Probably, it should be mentioned in the Limitations part.
2) Social desirability bias - could the respondents indicate more socially desirable options for
the answers? Firstly, the survey was distributed by the Ministry of Labour and Social Affairs
among refugees who registered here to get humanitarian benefits. Secondly, Page 4 – ‘All
respondents identified were verified by phone during the recruitment phase’. Thirdly, Page 5 –
‘Participants were not compensated directly but a donation to a selected charity project assisting
people affected by the war in Ukraine was offered on behalf of respondents for each completed
questionnaire’.
And the last, self-reporting may have introduced some degree of social desirability bias too, so,
which appropriate measures were carried out to control for the effect? It is possible that, because
of social desirability, participants either over or under-reported different aspects.
3) In the Abstract you state that ‘Due to the national regulations not allowing most of the
Ukrainian men aged 16-60 to leave the country’ – it should be 18-60 – please check it with
reference
4) On page 4 you state that ‘The aim of this study was therefore to examine the self-rated
health status of the Ukrainian refugees in Czechia and to analyse its determinants related to
their objective health status, lifestyle, human and social capital, and economic characteristics
using unique data on Ukrainian refugees in Czechia collected in September 2022.’ – According
to scientific literature there is differentiated interpretation of the relationship between the
subjective health (based on self-rating) and the objective health (based on actual measured data)
approaches. I believe that all variable in this study is based on self-rating.
The same issue is with understanding the difference between health status and self-rated health
because health status in this study is self-reported.
‘The relationship between self-rated health and health status, lifestyle, social, economic, and
migration factors was analysed using binary logistic regression.
As it was expected, the declaration of poor health was by far the most strongly associated with
health status.
Unlike health status, lifestyle did not seem to play an important role for the self-rated health
among Ukrainian women refugees. – not sure that it is correct – all self-reported subjective health
Health status and lifestyle itself have important implications for self-rated health.
Apart from health status, social capital and economic factors found to be the essential
determinants of self-rated health among Ukrainian women refugees.’
5) What is the reason for the detailed description of the questionnaire (pages 5-7), if we can
find this information in ‘The characteristics of respondents are described in table 1’? If it is
important, it would be easy to read this information in an appendix.
6) Could you please provide the references for Ukrainian versions of PHQ-8 and CEFR? Have
you checked the general internal consistency (for example: Cronbach’s alpha) for these scales
in your sample? It is worth adding this information.
7) Could you please provide references on page 10 ‘Most of previous studies focused merely on
lifestyle neglecting economic or social characteristics’.
8) You stated that ‘However, our study did not find a statistically significant relationship between
self-rated health and the knowledge of Czech language. The explanation can probably be found
in the fact that the huge Ukrainian diaspora that arrived in a large number even before the Russian
aggression was and is to a large extent able to effectively help those who do not speak the
language to orient themselves and to function in Czech society without major handicaps [2]’. –
Probably one of the reasons is the Slavic language’s words similarity.