Reviewer's report
Title:A Cross-Sectional Study on Health and Physical Functioning in Relation to
Coping Styles among Community-Dwelling, Ethnically Diverse Older Women
Version: 1Date:9 January 2010
Reviewer: Torill Christine C. Lindstrøm
Reviewer's report:
The article is very interesting and well written.
However, I have some comments to issues that ought to be corrected/changed.
1. Ethnocentricity. The statement: "Unfortunately, lack of health insurance and
related health impairments are a common occurrence among older women from
ethnic minority backgrounds." is problematic. It is relevant in a USA-context, and
perhaps in some other countries, but for example not in Scandinavia and other
countries where health services are free for all, and therefore "health insurances"
are non-existent or very rare. That ethnic minority groups are in lower social
positions is also not a rule all aver the world. For instance: people with European
ancestry living in Somalia are a minority group, but hardly among the poorest
inhabitants.
The authors must not be “blind” for these facts, and must explicitly state that the
background for their study is a particular cultural-political context, and describe it
for readers who live under other regimes and in other parts of the world. - This
also is relevant for the external validity of their findings. They may, strictly
speaking, only be generalizable to the USA. This should also be mentioned as a
limitation of the study in the discussion. Since income (financial situation), along
with age, was a main explanatory factor, this is quite relevant regarding the
health care system and health expenses.
2. Ethnic divisions. In the description of the sample and in table 1, “Armenian” is
a separate category. That is a bit strange. Although Armenia is located in Asia,
the Armenians and their language, are indo-European. It can therefore be argued
that they should be included in the group called “European-American”, and this
might influence the results. And why are they not called “Armenian-American”?
The other ethnic groups (except mixed ethnicity) are called “ ….-American”.
3. Page 4. The words coping “styles”, “strategies”, and “modalities” are stated to
be used interchangeably. That should not be done. - Only one term should be
used. “Coping style” is a generic term whereas “coping strategy” refers to a more
specific behaviour.
4. Page 4. The most essential coping strategies “self-distraction” and “behavioral
disengagement” must be explained. Not all readers are that familiar with Lazarus
& Folkman’s theory, and these terms are not completely self-explanatory.
5. Page 7. The paragraph: “Variables were selected based on Lazarus &
Folkman’s theoretical framework of the coping-somatic health status link
(extended to physical functioning, as no other theories were available regarding
this understudied health dimension)….……”. This: “no other theories” is simply
not true. There are several other theories (and connected research) linking
coping with health. For instance the contributions of Aron Antonovsky and of
Holger Ursin. The authors therefore must state that there are several other
theories, but that they have chosen, among others, the theory of Lazarus &
Folkman.
6. The main findings, that income and age were the most important factors, and
that they were interrelated, is not stated in the conclusion, but should absolutely
be. That there were no differences found with regard to coping or health between
European-Americans and Americans of other ethnicity, was a finding that was
not discussed properly. It should be put forth, - and should be explained, -
perhaps as a function of all participants being “Americanized”?
7. Just an idea: What if “age” was extracted from the hierarchical regression?
What factors would then have come forth as important? – The authors don’t have
to do this analysis, but I am intrigued by the idea.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
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 interets.
T.C. Lindstrøm