Title: Assessment of Water, Sanitation, and Hygiene Among Women Living in Precarious
Households in a Turkish Urban Area
Version: 1 Date: 13 Oct 2023
Reviewer's report:
OVERVIEW
This cross-sectional study was conducted to investigate the factors influencing water, sanitation,
and hygiene (WASH) behaviors among women residing in poor areas within the city of Izmir,
Turkey. The study's objectives also encompassed the identification of challenges related to
WASH and the development of an assessment scale for evaluating WASH behaviors and
conditions in these specific regions. The study's rationale is sound, as it strives to leverage
its findings to create a tool capable of gauging WASH behaviors through socio-economic
determinants. Furthermore, the authors of this study aim to underscore a critical point: improving
WASH conditions necessitates more than just changing behaviors. They argue that the primary
problem lies in WASH conditions, and unless these conditions are improved, individuals will
continue to exhibit suboptimal WASH behaviors. Despite the well-justified background and
rationale provided by the authors, the paper suffers from poor writing and numerous gaps in
the methodology, which cast doubt on the reliability of the study's results. These limitations are
outlined below:
GENERAL COMMENTS
• The abstract for this study is not well written, it belies the content in the main body of the study.
• The authors did not offer a clear rationale for their exclusive focus on women in their study.
Is their choice related to the assumption that women primarily manage household affairs and,
consequently, play a significant role in maintaining sanitary conditions within the home?
• The methods used in the study is not clear: a) First, the authors state that a methodological
design feature for scale development was included. However, they do not explain or show more
of what they mean by this; b) Second, the authors state that they created a border of 2667
households which was restricted to women, this statement is not vague; c) the authors attested
to the fact that they applied systematic sampling, however, this is not clear, the authors need to
give a good description of how the systematic sampling was carried out.
• Another thing that is not clear from the methodology is how the sample population size was
obtained. I am confused as to how the authors arrived at the size without stating anything about
the power, they used to arrive at the sample population size.  The authors also need to clearly
state who were included in the study, were they housewives?  The authors should also state
when the study was conducted.
• In the data analysis section, the authors state that they used a lot of tests ranging from student
t-test to ANOVA, it will be good if the authors can clearly specify which variables they used
each of these tests for.
• Another aspect of the data analysis that I grapple with is the fact that the authors make
use of simple linear regression to assess the relationship between WASH behavior and the
determinants. I would have expected that the authors would make use of multiple linear
regression as there was one dependent variable and multiple independent variables. Multi-linear
regression will enable determination of the influence different determinants have on WASH
behavior.
• Also, in the study, the authors provide and state the determinants of WASH behaviors and
conditions, but they did not state what the WASH behaviors and conditions are.
• As stated by the authors is to develop a scale that assesses WASH behaviors and conditions in
impoverished neighborhoods. The authors did not show anywhere in the paper or supplementary
files, the scale they developed.
• Also, the work has no numbering for the sections and subsections, the authors should provide
this in the work.
SPECIFIC COMMENTS
Line 97: The authors state that a methodological design feature needed for scale development
is included in the study, however, they do not show any methodological design feature.
Line 97: The authors stated that they obtained approval from the ethics community, it will be
good if the authors can specify which ethics committee this is.
Lines 99-103: In describing the study area, the authors state that Basmane area of Izmir province
is an extremely poor district in the center of the city. It will be good if the authors can provide
more details including statistics about the study area.
Lines 110-112: The authors stated that they interviewed a woman over the age of 18 who lives
in the household and is responsible for keeping the house clean. What woman is this and what is
her relevance to the study?  Do the authors mean “any woman” and not “a woman”, the authors
need to be clear on this.
Line 160-161: The authors state that they interviewed households based on the scale but do not
provide any scale.