Title: Developing a question prompt tool to prevent and manage early cardiovascular disease
after hypertensive pregnancy: Qualitative interviews with women and clinicians
Version: 1 Date: 24 Mar 2023
Reviewer's report:
I enjoyed reading this manuscript. The purpose is straightforward and important, with clear
relevance for practice and strong potential to inform the development of better QPT. Most
sections are well-written.
My most significant concerns about the study are methodological. Firstly it is incorrect to
state that qualitative description is an atheoretical research approach. All research is theoretical
(everyone has theory, whether they know it or not, and research that takes a qual descriptive
approach is certainly theoretically-informed).  This also struck me given you call in the
Discussion for theory-guided research.
Secondly and most importantly, there is no explanation or justification of why this approach
is the appropriate what for your study. What is it about this approach that makes it especially
suitable for achieving your study aims?
You state in the Sampling and Recruitment section that "in qualitative research, sampling is
concurrent with data collection and analysis to the point of thematic saturation (...)." This is
also untrue. This MAY be the case in some qualitative studies (indeed, many qual studies in
the health sciences that are carried out by clinicians and/or people trained in public health or
related disciplines), but this is by no means universal. Ethnographic research, phenomenological
research, participatory action research are all qualitative approaches that do not aim or claim
to achieve saturation. The writing here makes me worry that the research doesn't actually
understand the principles that underscore their research approach.
Relatedly, themes do not emerge. They are developed by you (and your team) through the
process of analysis. They are informed by theory (always). I strongly suggest consulting (Varpio,
Lara, et al. "Shedding the cobra effect: problematising thematic emergence, triangulation,
saturation and member checking." Medical education 51.1 (2017): 40-50.)
What was the role of reflexivity in your project?
The data is generally fine, however, the quotes need to be situated better within the text. I suggest
either putting them in text boxes (and then referring to the boxes), or introducing them with
clauses such as: "for example" or "the following quote is illustrative of this perspective".
Under the heading QPT Implementation: no example quote from a healthcare provider?  On that
note, I wonder whether you want to use a term like healthcare provider rather than clinician,
given midwives and NPs made up a large portion of those interviewed.
Quote p. 15 (under Enablers of Use heading): its not clear how the quote from the internist
relates to the theme.
The Discussion is generally quite good., especially page 17-18. I'd like to hear more about the
implications of your study being the first to explore the context of HDP among ethnoculturally-
diverse women (so important, and often missed in this kind of research), and less about what
has been found in previous research.
Minor writing issues:
P. 4 line 5. background: consider adding "certain" or "some" before "visible minorities. It is not
all visible minorities that are at higher risk (as an aside, to what extend is this biological and to
what extent is it social/socioeconomic?)
p. 7 line 4 (first paragraph under the Sampling and Recruitment heading): the second sentence
(which begins with "Eligible women " is unclear. Are you saying that the affect of North
American lifestyles on health becomes apparent after 10 years?