Title: THE ROLE OF SOCIAL ROLE STRAIN, PSYCHOLOGICAL RESOURCES AND
PERCEIVING DIABETES AS A HEALTH PRIORITY WITH SELF-CARE IN WOMEN
WITH TYPE 2 DIABETES MELLITUS
Version: 2 Date: 14 Jun 2024
Reviewer's report:
First of all, thank you for the invitation to review your paper. I hope my suggestions will help
make your article suitable for publication.
1. Title: The title of the paper seems well-crafted and relevant to the main text.
2. Abstract: The abstract flows well but does not adequately highlight the innovation in the
research results.
3. Clarity, Conciseness, and Organization: Introduction: The paper is well-written.
Methods: The methods section is average, with some errors and areas that are not well-
constructed. For example, lines 195-196 state, "It is believed that individuals with diabetes can
achieve sufficient knowledge and skills to implement self-care after one year of diagnosis." This
text is not relevant to the inclusion criteria and should be removed if it does not fit.
(L199-202) The authors should detail how the sample size of 350 was calculated using G*Power
and explain how 403 participants were selected from the primary care center. For a clearer
understanding, it might be helpful to use a flow chart for data collection.
4. Errors, Misconceptions, and Ambiguity: Results Section: The multiple regression analysis
(MRA) examines the association between various factors and their impact on the dependent
variable. It identifies which factors are significantly associated with the outcome and quantifies
the strength and direction of these associations. As noted below Table 4, "The model fits
reasonably well; all model assumptions were met; there was no multicollinearity problem."
I suggest that the authors declare and explain the model and steps used in the MRA. This
explanation should include details on the model selection process, how assumptions were
checked and verified, and any steps taken to address potential issues like multicollinearity.
5. Results, Figures and Tables:
Results Parts: In section D (Lines 246-253), it states, "The total score is between 12 and 84,
with a higher score indicating better social support." However, this appears to conflict with the
figures in Table 2, which lists a Social Support mean (SD) of 5.37 (1.00). Please clarify why
the mean score is below the minimum possible score of 12. Additionally, the text categorizes
participants' perceptions of social support into three groups: 1 to 2.9 for low social support,
3 to 5 for moderate, and 5.1 to 7 for high support. In my opinion, the mean score should not
be derived from the categorical scores. Instead, the mean and standard deviation calculations
should be based on the original scores.
Lines 294-296 state, "social role strain, the mean score was 21.27 (SD 6.07), ... perceived
diabetes as a health priority, as shown by the mean score of 7.08 (SD 1.91)," as followed by
Table 2. However, these mean (SD) values (most of the affected independent variables were
2.81 (0.80)) do not match those in Table 4. The authors should provide further explanation to
help readers understand the discrepancies in the mentioned column's numbers. If the current
data inputs are not appropriate for the multiple regression analysis, the authors should revise all
data inputs accordingly.
In my opinion, ordinal variables, although numerically coded, represent categories with a
meaningful order but do not have equal intervals between them. This means that while they can
be used in regression models, calculating the mean and standard deviation for ordinal variables
is generally not appropriate from a strictly statistical standpoint because these statistics assume
interval or ratio-level measurement. However, in practice, people sometimes compute means
and standard deviations for ordinal variables for simplicity or convenience, especially if the
ordinal scale has many levels and behaves similarly to an interval scale. Yet, it's important to be
cautious and interpret these statistics with the understanding that they might not fully capture
the properties of ordinal data.
6. Discussion and Citations: The paper includes relevant citations; however, in the discussion
section on the association between self-care and the independent variables, the authors should
explain why and how these variables are associated with self-care, drawing from the subscales
of the study findings. I suggest reconstructing the discussion part by following this text in the
conclusion: “Based on our study, women with diabetes failed to perform self-care regularly due
to i) having a high social role strain ii) not perceiving diabetes as a priority iii) lack of problem-
focused coping iv) low education v) low income and vi) increased age.”
Overall Evaluation:
The paper presents a comprehensive study and has several strengths, such as a well-crafted title,
clear organization, and relevant citations, there are areas that require improvement, particularly
in the abstract, methods, results sections, and discussions.
Strengths:
1. Title: The title is well-crafted and relevant to the main text.
2. Organization: The paper is well-organized and easy to follow.
3. Citations: The paper includes relevant citations to support the study's context and findings.
Areas for Improvement and Recommendations for Revision:
1. Abstract: The abstract does not adequately highlight the innovation in the research results.
Revise the abstract to include specific findings
2. Methods: The methods section contains some errors and areas that are not well-constructed,
such as irrelevant text and lack of detail on sample size calculation and participant selection.
Provide more detail on sample size calculation, and participant selection, and use a flow chart
for a clearer understanding of data collection.
3. Results: There are discrepancies in the mean (SD) values presented in the text and tables,
particularly for ordinal variables. The authors should provide clarification and revise data inputs
accordingly.
4. Discussion: Should reorganize the sub-header following the study findings as suggested in (6).
Conclusion:
In conclusion, the paper has the potential to contribute significantly to the field; however,
revisions are needed to address the issues outlined above. With these revisions, the paper would
be more suitable for publication.