Reviewer ’s report  
 
Title: Structural Equation Modeling of Psychosocial Determin ants of Health for the 
Empowerment of Iranian Women in Reproductive Decision Making  
 
Version: 3 Date: 05 Apr 2019  
 
Reviewer: Reviewer 2  
 
Reviewer's report:  
 
PEER REVIEWER ASSESSMENTS:  
 
OBJECTIVE - Full research articles: is there a clear objective that addresses one or several 
testable research questions? (Brie f or other article types: is there a clear objective?)  
 
No - there are major issues  
 
 
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for the 
objective?  
 
No - there are major issues  
 
 
EXECUTION - Are the experiments and  analyses performed with sufficient technical rigor to 
allow confidence in the results?  
 
No - there are minor issues  
 
 
STATISTICS - Is the use of statistics in the manuscript appropriate?  
 
No - there are issues with the statistics in the study  
 
 
INTERPRETATION  - Is the current interpretation/discussion of the results reasonable and not 
overstated?  
 
No - there are major issues  
 
 
OVERALL MANUSCRIPT POTENTIAL - Has the author addressed your concerns sufficiently 
for you to now recommend the work as a technically sou nd contribution? If not, can further 
revisions be made to make the work technically sound?  
 
Maybe - with major revisions  
 
 
PEER REVIEWER COMMENTS:  
 
GENERAL COMMENTS: I am pleased to review the revised version of this paper on 
reproductive decision making and women empowerment. The paper includes some interesting 
results, although the story it tells overall is still not especially interesting or at lea st not 
surprising. The authors responded adequately to each of the questions or concerns I raised in my 
comments. For instance, I suggested the author to clearly state the hypotheses. The authors made 
changes to reflect their responses in the manuscript it self; however, these changes are not 
satisfactorily.  
 
 
REQUESTED REVISIONS:  
 
The exact meaning of "psychosocial factors" and "structural determinants" should be clearly 
explained in the Introduction section. The terms psychosocial factors and structural de terminants 
are commonly used to refer to dozens of different variables.  
 
I still have some doubt theoretical novelty and contribution of your research. Overall, the 
author(s) did make a sufficiently convincing case for the objective. For instance, why did t he 
author (s) choose those specific psychosocial factors? Provide an introduction that focuses on a) 
what we already know from the literature; b) what new concepts this study can address that make 
a distinct contribution beyond the prior studies; and c) st ate the hypotheses of the research.  
 
It is not clear to me why attendees of health centers of the Shahid Beheshti University of Medical 
Sciences were chosen for this study. Reproductive decision making is important for all women, 
not only those attending h ealth centers.  
 
Please report the obtained internal consistency for all the measures included in this study.  
 
The appropriate sample size was calculated on the basis of a preliminary pilot study (no 
information was provided: what was done in this pilot stud y and how the information gathered in 
this pilot study was used to calculate sample size?) and an equation. It is not clear to me why this 
equation was used and what is the theoretical and empirical support for the use of this equation 
to calculate appropr iate sample size. To evaluate sample size requirements in SEMs, three major 
approaches have been proposed: (a) the Satorra and Saris (1985) method, in which the 
noncentrality parameter are used to estimate power; (b) the MacCallum, Browne, and Sugawara 
(1996) method, which determines the power of the model to obtain a root mean square error of 
approximation value that is consistent with good model fit; and (c) the Monte Carlo simulation 
method (Muthén &amp; Muthén, 2002). I am suggesting the use of the Mont e Carlo simulation 
method to estimate appropriate sample size.  
 
As I said previously, the limitations of the research are not acknowledged, and alternative 
explanations of the results are not addressed. This cross -sectional study cannot establish the 
direc tion of causality of the relationships. Also, the conclusions assert that there is a direction of 
causality (e.g., psychosocial factors affect empowerment), not vice versa. The study design 
cannot support that conclusion, though it may be suggestive.  
 
 
Refe rences  
 
MacCallum RC, Browne MW, Sugawara HM. Power analysis and determination of sample size 
for covariance structural modeling. Psychological Methods. 1996;1:130 -149. 
 
Muthén LK, Muthén BO. How to use a Monte Carlo study to decide on sample size and 
determ ine power. Structural Equation Modeling. 2002;4:599 -620. 
 
Satorra A, Saris WE. Power of the likelihood ratio test in covariance structure analysis. 
Psychometrika. 1985;50:83 -90. 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does t he work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I am ab le to assess the statistics  
 
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, f ees, funding, or salary 
from an organisation that may in any way gain or lose financial ly from the 
publication of this manuscript, either now or in the future?  
 
2.  Do you hold any stocks or shares  in an organisation t hat 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 recei ved reimbursements, 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 this 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.  
 
This reviewer has been recruited by a partner organization, Research Sq uare. Reviewers with 
declared or apparent competing interests are not utilized for t hese reviews. This reviewer has 
agreed to publication of their comments online under a Creat ive Commons Attribution License 
attributed to Research Square and was paid a sma ll honorarium for  completing the review within 
a specified timeframe. Honoraria for reviews such as this are paid regardless of the reviewer 
recommendation.  
 
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to the editors, which will not be published.  
 
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