Reviewer’s report
Title: Opportunistic domestic violence screening for pregnant and post-partum women by community  
based health care providers.
Version: 1 Date: 26 Sep 2017
Reviewer: Susan Jack
Reviewer's report:
Thank you for the opportunity to review your thoughtful paper.
My comments and suggestions are as follows:
1. In abstract, please identify specific type of mixed method design used (e.g sequential explanatory  
or sequential exploratory).
2. Language in this field is complex - domestic violence internationally is sometimes thought of as  
an "umbrella term" to describe all violence in a home (e.g. could be violence from a mother in  
law towards a daughter in law) and that intimate partner violence is a specific type of domestic  
violence. It would help international readers to understand clearly your definition of DV - and  
perhaps a note that "IPV" is most commonly referred to as DV in Australia.
3. Given the Australian context of this paper, and that rates of IPV tend to be much higher among  
Indigenous populations, it might be worth noting rates of physical /emotional abuse among  
Aboriginal and Torres Strait Islander Women in Australia - at the end of the first paragraph in  
the background section.
4. Page 5, lines  28-31. Becoming pregnant or "pregnancy"  as  a risk factor that "triggers" or  
Increases DV is a controversial and unfounded statement. There is mixed evidence - for some  
women, pregnancy is a period of protection (e.g. rates of IPV are decreased- you cite Shah &  
Shah - they even claim this  as  well  in  their  background  and  no where  do they say that  
pregnancy is  strong risk factor for DV) - whereas for other women (most typically those that  
were already experiencing severe IPV prior to pregnancy) - the violence continues. There is  
other evidence to suggest that pregnancy itself is not an indicator for initiation of abuse - I  
would strongly recommend you review Wathen et al (2007) Risk indicators to identify intimate  
partner violence in the emergency department. Open Medicine 1(2) E113. On page 6 of the  
article there is a nice discussion of pregnancy as a risk indicator. Overall, you need a much  
more nuanced discussion of this complex issue in your background - rather than a blanket  
statement that pregnancy increases IPV. Once you address this within the body of the paper - it  
will need to be addressed in abstract as well.
5. Page 5  -last paragraph - you make an argument that women are not being routinely screened for  
DV by all HCPs. It is important before making such a statement to summarize the evidence for  
universal screening for (asymptomatic) women for IPV by health care providers. All RCTs  
looking at this question have concluded there is no benefit to screening. In the most recent  
WHO guidelines for identification of IPV  
(http://www.who.int/reproductivehealth/publications/violence/9789241548595/en/) - universal  
screening is NOT recommended. However, there is evidence to support a case finding approach  
- e.g. to ask about experiences of abuse when women present with risk indicators (e.g. young  
age) or signs/symptoms. I would strongly recommend that you discuss the evidence related to  
screening. However, you may also then need to do some qualification for your country e.g.  
despite the best available evidence, is it mandated to screen (who) in Australia (and under what  
conditions) (I see you begin this on page 6 -paragraph starting at line 29). So in Australia - if  
screening is mandatory - what follow up is available and mandatory? Screening, from a public  
health perspective, should not be implemented unless you have effective treatments/programs to  
refer to.
6. Page 7, line 23 -- change to "the aim OF this study..." [given the two small typos already located,  
I would recommend a careful edit of full paper].
7. Methods - what is the overarching mixed method design, please briefly describe it to an audience  
not familiar with mixed methods. It would be helpful to have a section that describes the overall  
MM design, the three MM research questions being asked (e.g overarching qualitative question,  
overarching quantitative question, and overarching MM question), and then to clearly articulate  
the design used for the quantitative strand and be very clear about the qualitative tradition (e.g.  
you indicate that interviews were conducted - but this is a data collection strategy and not an  
overall research design such as case study, interpretive description, fundamental qualitative  
description, ethnography etc) used to guide purposeful sampling, data collection ,analysis for  
the qualitative component.
8. The abstract refers to a sequential MM design - yet on page 7 line 36 you refer to a MM survey  
(so would this not be a concurrent MM design?). It is unclear to me what a MM survey is. Did  
the survey have both scaled responses and open ended questions (thus "mixed") and then the  
survey was followed by more in-depth interviews?
9. The methods section could be better organized for clarity - start with describing sample needed,  
determination of sample size, inclusion criteria, recruitment strategies etc. It is unclear what is  
meant by a medical publishing company. There is NO description of the sampling for the  
qualitative component - if this was a sequential MM study - I am assuming that you interviewed  
people after the survey. How was purposeful sampling complete? What was the nature of the  
purposeful sample? How did you determine how many HCP to conduct in-depth interviews  
with? 
10. It might be journal preference - but it most journals, it would be the norm to present the  
characteristics of the study participants in the results section - not methods.
11. Page 5- line 56 - change "o" to "to"
12. Data collection section - completed omitted - what was on the survey? what was survey  
measuring? psychometric properties?  how  many items? For qualitative interviews - please  
provide copy/examples of questions, what was focus of interviews, how long were interviews,  
who conducted them? 
13. The data analysis section is weak and lacks details. In the methods you allude to doing in-depth  
interviews (qualitative) - how were these interviews coded, categorized, synthesized? What  
strategies to promote dependability were integrated? 
14. Small sample  size  for survey - please ensure limitations  of this  type  of data  are  clearly  
addressed in discussion. 
15. The presentation of lists of quotes and responses - is not a satisfactory or high quality manner  
for presenting qualitative findings.
16. Given the lack of evidence for screening - I do challenge the final recommendation that all  
NGOs (and abbreviations should be previously defined) should implement screening.
17. This study reports on findings from a survey and findings from the open ended responses - there  
is a lack of clarity of where the researchers "mixed" or explicitly linked the samples, data,  
analysis as would be expected in a high quality MM study.
18. Would be helpful to extend section on limitations/strengths to highlight a more comprehensive  
list of limitations related to mixed component and qualitative component; - as well as identify  
potential strengths of study that enhanced rigor, trustworthiness, validity etc.
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 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 manuscript 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.
I am able to assess the statistics
Quality of written English
Please indicate the quality of language in the manuscript:
Needs some language corrections before being published
Declaration of competing interests
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