Title: Inequality in healthcare-seeking behavior among women with pelvic organ prolapse: A
systematic review and narrative synthesis
Version: 1 Date: 04 Mar 2023
Reviewer's report:
1.The title follows the revision carried out.
2. The abstract reflects the study presented
3. Introduction: clear, in a logical sequence. It addresses the issue of prolapse and its impact
on women's physical health and QoL, emphasizes stigmatization, and presents the gap for not
having evidence on the search for health care. It points to data available in the literature on
access. However, old articles are presented – references 1 -24: only 5 of the last five years,
compromising the text. It is suggested to update the references.
4.  Objective: reflects the proposed study.
5. Material and methods: a systematic review with meta-synthesis - the authors present it as
a systematic review. However, they present a scoping review, including using the PRISMA
methodology for scoping – review.
Following the steps of Scoping are presented the items and questions related to each one.
1. Developing the title and question (developing the review question based on the PCC
mnemonic. The PCC mnemonic stands for the Population (or Participants), Concept, and
Context); - there is no description of the mnemonic
2. Creating an introduction supporting the research problem qualification – item answered
3. Defining the inclusion criteria (based on PCC mnemonic and study design) – does not present
the review question, the descriptors used in the search
4. Search strategy (sources, descriptors, and manual references from reading the selected
publications) – chooses only observational studies but does not justify the choice; because the
period from 1996 to 2022 was determined for selection, is there any reason? If so, should it be
justified? There are limits regarding language, as it cites only articles in English as a limitation
– would it be a limitation? Why do only those with access available online – not restrict the
search? When was the search done? Has a librarian validated it? Were Boolean operators used?
5. Source of evidence selection (examinator and protocol) – does it not justify the exclusion of
an article with a small sample size? What would this sample size be?
6. Article selection- process guided by the PRISMA-ScR statement flowchart – a flowchart is
misconfigured/uses old Prisma – current version from 2021 / uses the version from 2009 – it
is suggested to update
7. Data extraction according to variables recommended by the JBI for scoping reviews – consult
the JBI manual (ref.: Peters, M.D.J., Godfrey, C., McInerney, P., Munn, Z., Tricco, A.C., &
Khalil, H. (2020). Chapter 11: Scoping Reviews (2020 version). In: Aromataris, E., Munn, Z.
(Editors). JBI Manual for Evidence Synthesis, JBI. https://doi.org/10.46658/JBIMES -20-12)
8. Analysis of the evidence found – describes each study in detail, which does not allow viewing
the result as a whole. It is suggested to group the data and present each included article in tabular
form.
The reference to the JBI appraisal tools instrument is not presented, but a reference from other
authors (26) – does not present the unmet items. Describing the items in the table's header or
condensing which ones were not met in the last column is suggested.
9. Presentation of results by descriptive mapping and tabular form. – item was met. However,
to finalize the question: Was there a record of the review protocol?
Discussion – repeat in the first paragraph described in the results – it is suggested to remove it
from the results section.
Does not bring new references – only 1 – discusses with the result articles.
Evaluation: the article presents a relevant topic. However, it needs to update the references and
an important method revision, which compromises the other sections.