Title: Illuminating health aspects for immigrant Thai women in Swedish transnational marriages
Version: 3 Date: 27 Jul 2022
Reviewer:  Elina Turjanmaa
Reviewer's report:
The study explores the health and well-being of Thai women who are/have been married to
Swedish men in Sweden. Important issues related to marriage migration in this context are
discussed in the study. My main criticism concerns the vague definitions and use of the analytical
concepts, and the overall framing of the studied phenomenon.
The background section of the abstract could be revised to more specific. It is not only the
migration status that exposes Thai women to discrimination, sexual exploitation, trafficking,
and violence. Perhaps it could be stated, for example, that women marriage migrants are at
risk of being discriminated etc. I guess that a low socio-economic background of the women is
an essential part of the kind of marriage migration that is examined in this article. This could
be mentioned to address the vulnerable position (intertwined with gender, migrant status, and
socioeconomic background/poverty) of the women.
All in all, the phenomenon of marriage migration should be defined in detail. How does it
differ from any marriages between two persons from different countries, and what is entailed
to marriage migration from Thailand to Western/Nordic countries in particular? The traditional
Thai family culture could also be described shortly. I think it could be emphasized at some
point, even though probably self-evident, that not all the marriages between Thai women and
Scandinavian men are exploitative. Also, acculturative stress, introduced in the background
section, could be defined.
Systemic, broad understanding of the health and well-being fits well to this study. The role
of Neuman’s System Model in the analysis of the data and in the interpretation of the results
could be more specific. If (and when) the categories formed in the content analysis are the same
as in NSM, it could be more clearly stated that the critical health incidents were categorized
into these five categories, and that incidents representing all these five categories were found in
the analysis. As these five categories guide the analysis, they should be shortly defined in the
background section. The role of the definition sections b-f (within the definition of Neuman’s
harmony system, p.4) is also a bit unclear. Are all these dimensions somehow used in the
analysis, and if so, how? There’s a lot of concepts that would need more processing in the
text and further presenting what is their role in the analysis (for example, what are primary,
secondary, and tertiary prevention). Some of them (e.g., interpersonal systems, line of resistance)
are defined only in the discussion section.
The data collection and sample are well-defined. It is valuable that the participated women could
share their experiences with the native-speaking researchers on these intimate and sensitive
issues. The interview protocol/questions could be added as an appendix.
Table 2 is very good and informative. It could however be added to the description of the data
analysis process how the critical health incidents are understood in this study. Were any kind
of health-related descriptions categorized as critical health incidents? What is exactly meant
by the consequences could also be explicitly stated. Are the consequences the health-related
consequences for the individual? According to Table 2, the consequences are mostly described
as emotions. The clearer definitions and explicit writing could help to follow the result and
discussion sections and to distinguish between incidents and consequences.
Discussion section could be revised keeping in mind what has been presented in the results
section in order to avoid repeating the description of the results.
In the Strength and limitations section limitations of the study should be mentioned.
Discussion on research ethics should be added.
The last sentence of the Conclusion paragraph (a quite important one) is a bit unclear.
The article should be proofread.