Reviewer ’s report  
 
Title: "It has not occurred to me to see a doctor for that kind of feeling": A qualitative study of 
Filipina immigrants' perceptions of help seeking for mental health problems  
 
Version: 0 Date: 12 Apr 2017  
 
Reviewer: Josephine Pui -Hing Wong  
 
Reviewer's report:  
 
Overall, the paper was written with clear language.  A number of key issues, howe ver, need to be 
addressed.  
(1) How are "immigrant women" defined in this study?  Are they landed immigrants or 
temporary migrant workers?  
 
(2) The author stated that "Our analyses were informed by the post -colonial feminist 
perspective." However, there i s a lack of relevant reference about post -colonial feminist 
perspective.  The entire paragraph is vague.  It is important for the authors to clarify the 
following:  
 
a. Which post -colonial perspective? Authors need to provide a more informative description o f 
the post -colonial perspective.  
 
b. What theoretical framework was applied in design the entire research?  Was a post -colonial 
perspective only used for analysis or used throughout the research - from design to 
implementation, to data analysis and in writ ing up the research?  
 
(3) If the authors applied a post -colonial perspective for the entire study - then the authors need 
to address the following:  
 
a. The authors need to expand on the contextual information about Filipina women in Norway 
-  p 3 lines 44 to 49 "As well as fulfilling the demand for skilled care work such as nursing 
and unskilled, low paid domestic work, many Filipinas also become the wives of Norwegian 
men (Sandnes & Østby, 2015)" - the authors need provide more informatno on:  
 
 How are Fi lipina women brought to Norway as health workers or unskilled, low paid 
domestic workers? In North America, temporary Filipina women migrant workers are "de -
skilled" and hired into "low -skill" and "low paying" domestic work - not because they are 
unskilled . 
 
 What does "becoming wives of Norwegian men" mean in terms of power relations for these 
women? What are the trends or patterns in terms of structural determinants of these women 
becoming wives? How is the current situation of Filipina women marrying Nor wegian men 
related to the global system of "mail order brides"?   
 
b. Contradictions to post -colonial perspectives:  
 
 P. 19 - the statements "The first author conducted all the interviews and took a lead role in 
the analysis. As a British woman living in N orway, she shares some experiences with the 
informants in terms of being an immigrant woman. This may have made informants more 
comfortable in discussing…" This statement reflects a lack of critical reflexivity and analysis 
about how racialization and curr ent structural racism shape power relations in this context.  
 
 Other statements such as p.23 - "They did, however, indicate that there was a high level of 
stigma among Filipinos in general" - again suggests that data analysis and data interpretation 
presen ted in this paper are again contradictory to post -colonial perspective; the authors have 
simply presented the women's voices as "facts" and have not taken up a critical lens of 
resistance or question the dominant misperception and the dominant discourse th at "Western 
countries" that receive racialized immigrants are more progressive and the non -immigrant 
groups are less stigmatizing and open.  
 
 Another example - p. 17, "This model is in contrast to the traditional paternalistic model in 
the Philippines whe re the doctor decides the treatment plan on behalf of the patient." Again, 
this interpretation reflects the uncritical acceptance and perpetuation of the dominant North -
South discourse of low and middle income countries being less progressive, without 
considering how the current "paternalistic model" of medicine in the Philippines is also part 
of the colonial legacy.  
 
(4) Without truly applying a post -colonial perspective to the study results - this paper came 
across as mostly descriptive and does not offer new insights beyond what many studies 
around the world have described about access, language barriers, etc. However, if the 
authors take a post -colonial analysis seriously, new insights may be gained to inform future 
research and policy/practice implicatio n.  
 
Other minor changes to be considered:  
 Title of paper - need to insert colon to separate title and subtitle  
 
 p. 1, lines 14 -15 "due to the migration process and have low utilisation rates of health 
services for mental health problems" - suggestion: break up the two different ideas in this 
sentence so that it does not come across as saying that mental health pro blems is caused by 
low utilization rate of services - which kind of put the blame on immigrants and make 
invisible the other social determinants of mental health problems such as systemic 
discrimination, racism, lack of access to inclusive services, 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 con trols?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
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.  
 
Not relevant to this manuscript  
 
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, fees, funding, or salary from an  
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3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you receiv ed 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 i n relation to this paper?  
 
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