Reviewer ’s report  
 
Title:  Sowing the seeds of transformative practice to actualize women's rights to respectful 
maternity care: reflections from Kenya using the consolidated framework for implementation 
research  
 
Version: 1 Date: 07 Apr 2016 
 
Reviewer:  Cheryl  Moyer  
 
Reviewer’s report:  
 
The authors have presented a comprehensive analysis of a very complex set of interventions 
conducted in Kenya to address respectful maternity care. The manuscript is thorough, well -
written, and extremely comprehensive.  I believe thi s will be a strong addition to the published 
literature - my comments are mostly minor and editorial.   
 
 
Macro -level comments:  
 
I was curious about the discussion of counseling for the providers. Was there stigma or resistance 
associated with using those s ervices? A bit more on that would be helpful.  
 
On Page 19 the authors mention QITs referring providers committing D&A for counseling or 
disciplinary action… how were those providers identified? Was it only through client 
complaints? I would have appreciate d a paragraph on how providers committing D&A were 
identified, and what that process looked like.  
 
On page 26 the authors say that health managers feared the propagation of fear of facilities, 
which had implications for monitoring progress and disclosure to consortium partners. How? In 
what way?  
 
On page 34 the authors mention 'countrywide devolution' and then 'health sector devolution'. I 
am not familiar with that term. A short description would be helpful.  
 
On page 35, the authors suggest that more tim e is required for mediation efforts to be successful. 
I am not sure time is the only thing that is required. Will time alone make it so that people who 
complain don't need to fear retribution on their next clinic visit? How do we create a culture of 
accoun tability without the concomitant culture of blame? The issue of mediation is extremely 
dicey, and I am not sure time alone is sufficient to make it effective as the authors suggest.   
 
 
Minor Editorial Comments:  
 
Methods section of the abstract says "data from a broad range of project documents, reports, and 
qualitative data…"  This is not parallel structure, grammatically. It would be better to reword it 
to something like, "data from a broad range of project documents, reports, and interviews…"   
 
Methods section of the abstract says "themes in baseline" when I think the authors mean "themes 
at baseline"  
 
Page 5, there needs to be a second set of quotation marks after "dignity"  
 
Page 9, I would provide the reference for CFIR at the first mention.  
 
Page 10,  middle paragraph, reads: (i.e. e.) - the second e. needs to be removed.  
  
Page 13 is the first time that the package of interventions is mentioned, and refers to Figure 2. 
The text says "counseling for providers" but the figure says "caring for c arers" - leaving the 
reader a bit confused. Are those the same thing? If so, say so.  
 
Similarly the text refers to "maternity open days" but doesn't describe what they are.  Given that 
these will each be explained in greater detail later in the paper, I wou ld add a phrase (perhaps 
after "elements of the final package") that says something about "which will be described in 
greater detail in the following sections" or something similar.  
 
Page 15, first paragraph, 'follows up' ought to be 'follow up'  
 
Page 25, middle paragraph, "at not being unable" I think is supposed to read "at not being able" 
or "at being unable"  
 
Page 26, line 568, add the word 'with' after midwives  
 
Page 26, line 573, delete the word 'the' before propagate  
 
In Figure 2, in the box of "comm unity perspectives", there needs to be a closed quotation mark 
after 'demand'  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
Yes 
 
Are you able to assess any statistics in the manuscri pt or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an org anisation that may in any way gain 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 received reimbursem ents, fees, funding, or salary 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 thi s paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
I agree to the open peer review policy o f the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be i ncluded in my named report can be included as confidential comments 
to the editors, which will not be published.  
I agree to the open peer review policy of the journal