Reviewer ’s report  
 
Title: Ups and downs of drug rehab a mong women: a qualitative study  
 
Version: 0 Date: 03 Dec 2019  
 
Reviewer: Wendee Wechsberg  
 
Reviewer's report:  
 
This paper covers a very important topic focused on substance use and rehabilitation among 
women in Iran. Limited literature exists reg arding Iranian women's substance use, and therefore 
adds value to the existing knowledge base. However, prior to being considered for publication, 
this manuscript will need to be revised.  
 
Revisions should include a very detailed edit, with specific attent ion to language to ensure 
cohesion and understanding. Certain terminology should also be avoided and revised throughout 
the manuscript based on USAID's current recommended terminology. For example, the authors 
refer to "addicted women" consistently through out the manuscript. When referring to specific 
statistics, the authors should be clear in if the citation is global or specific to an area or region, 
particularly in the background section. Additionally, there is a switch between referring to "focus 
groups " and "semi -structured interviews". Were both conducted or just one type? Consider 
revising for consistency. Detailed points regarding suggestion revisions are provided by section 
below.  
 
Abstract: The background section of the abstract presents an incomple te idea and sentence. 
Include the setting, where were the participants recruited from? (Iran)  It is not entirely 
clear as to how the researchers conducted their analysis. The abstract's concluding point goes 
against the manuscript's actual conclusion in th at "not all women's rehabilitation centers have 
helped women, in fact many have caused additional psychological or even physical harm"  
 
Intro/Background: It is not always clear where the authors are sharing statistics about, whether 
globally or regionally s pecific. For example, lines 42 -43 in the background do not clearly state 
whether this is global, specific to Shiraz, or another location.  
 
It is unclear that the author is speaking about a community in Iran until near the end of the 
background. Consider mak ing this more prominent earlier on in this section, and provided detail 
about the area, substance use behaviors, and tie into the discussion's points about gender 
inequality.  
 
Methods/Results: For a qualitative study, the methods are unclear and lacking imp ortant details, 
while providing too much information about noncritical details (e.g., not critical to explain what 
qualitative analysis is). Sentences in this section are also duplicative, sometimes in the same 
paragraph. The setting of the study is not cl eared defined, and instead speaks generally about an 
undescribed location. Consider adding more detail about the setting, especially about the region 
of Iran or type of community(ies). How were the exclusion criteria determined and defined? For 
example, ho w did the researchers determine if a potential participant had a "mental illness"? 
How was data saturation reached? How was this determined, what was the criteria and 
threshold?  It is unclear exactly how participants were recruited and/or selected. Was st reet 
outreach conducted, what exactly were the methods in finding potential participants?  What 
procedures were taken to ensure the privacy, confidentiality, and safety of the women 
participating in focus groups regarding their substance use?  Under the "i nstruments" subsection, 
the authors state that face to face semi -structured interviews were conducted with participants in 
counseling centers and women prisons. More detail should be provided about these locations, 
recruitment, and general procedures under  the "procedures" section above. What central themes 
did the focus group and interview questions focus on? Examples of the question probes are not 
necessary.  Additional detail on the actual qualitative analysis is needed. Provide a brief 
overview of the G raneheim and Lundman approach used. What data analysis program, if any, 
was used? What was the intercoder agreement score, if assessed? How many coders were there?  
 
Lines 59 -60 under the "Coding and analysis" section state that "all the descriptions and 
experiences of the participants were studied". How were they studied? What does this mean 
exactly? Define "open coding". Lines 1 -4 state on page 4 state that the coding/analysis process 
was repeated until the excerpts covered all experiences of participants i n the intent to rehab and 
its challenges. What were, if any, the themes and experiences of participants that the researchers 
were looking for ahead of time?  
 
How were the "multiple relationships between categories" identified, as mentioned in lines 26 -27 
on page 4? The relationship between the main codes and subcodes are not clearly stated or 
defined early in the results section. It is not immediately clear what exactly the subcodes/themes 
are or what they mean. Clearly define emancipation, ups and downs, a nd deviated path, etc. as it 
relates to findings.  
 
Discussion: The discussion section is long and could be reduced and also combined with the 
conclusion section.  At times the discussion section takes on a subjective view regarding religion 
and the partici pant's desire to seek religious education or guidance. There is a very strong and 
clear gender inequality component throughout this manuscript, though it is only sparingly 
mentioned in the end of the paper. Consider tying this into the background section e arlier on. It is 
not necessary to restate that participants were a group of "addicted" women, etc. in lines 24 -25 
on page 9, a stigmatizing label.   
 
Consider removing all subjective references to authors opinions or beliefs.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your com ments to the authors.  
 
Unable to assess  
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the qualit y of language in the manuscript:  
 
Not suitable for publication unless extensively edited  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1.  Have you in the past five years receive d reimbursements, f ees, funding, or salary 
from an organisation that may in any way gain or lose financial ly from the 
publication of this manuscript, either now or in the future?  
 
2.  Do you hold any stocks or shares in an organisation that may in any way ga in or 
lose financially from the publication of this manuscript, either now or in the 
future?  
 
3.  Do you hold or are you currently applying for any patents  relating to the content 
of the manuscript?  
 
4.  Have you re ceived reimbursements, fees, funding, or sala ry from an organization 
that holds or has applied for patents relating to the content of the manuscript?  
 
5.  Do you have any other financial competing interests?  
 
6.  Do you have any non -financial competing interests in relation to this paper?  
 
If you can answ er no to all of the above, write 'I declare that I have  no competing interest s' 
below. If your reply is yes to any, please give details below.  
 
I have no competing interests  
 
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