Reviewer’ s report
Title: Women's views about physical activity as a treatment for vasomotor menopausal symptoms:
a qualitative study
Version: 0Date: 22 Apr 2020
Reviewer's report:
1. Original submission - BMWH-D-19-00098
Title: Patients' views about physical activity as a treatment for vasomotor menopausal symptoms:Qualitative study2. RecommendationMajor revisions3. Comments to author3.1 Overview and general recommendation:Thank you for the opportunity to review this manuscript. This paper addresses an important topicof non-pharmacological management of vasomotor symptoms in women. The paper is wellpresented and well written, and shows promise in reporting results of semi-structured interviews of17 participants enrolled in an exercise intervention.Unfortunately, the manuscript as submitted has some major limitations, in particular, it requires alot more work on the results/discussion sections with a deeper level of analysis and discussionrequired. I would encourage the authors to fully develop the manuscript to reflect the "rich" datacollected from participants in light of existing knowledge.3.2 Major commentsThis study was linked/embedded within a RCT which makes it part of a mixed methods study. Assuch, transferability of these qualitative results to general population of women is limited.
Although a substantial number of 60-90 minutes interviews were conducted, the analysis is largely
simply descriptive/thematic without deeper level of analysis of meaning and implications ofresults evident.Methodological issue - need clear explanation about theoretical/epistemological approach to in-depth qualitative analysis and why this was chosen. It appears that the approach was thematicanalysis/mixed with some quantitative measures - Kappa Analysis. Very unusual to include astatistical measure in a qualitative paper and suggests lack of understanding/experience inqualitative methods of assessing reliability.Unclear if second researcher involved in data analysis and coding and also how was research rigormaintained throughout the interview/analysis process given that interviewer was also involved inintervention trial and known to participants.Discussion needs development with development of themes, ideas, concepts and implications forpractice/future research.3.3 Minor commentsConsider other terminology, "menopausal hormone therapy" (MHT) versus "hormone replacementtherapy" (HRT)Word "menopausal" is not precise, suggest change word/term - eg. around menopause,experiencing symptoms related to menopause
there are different stages of menopause ie peri-menopause, menopause, post-menopause - with
vasomotor symptom onset often occurring during peri-menopause3.4 TitleRemove word "patient" - refer to "women", could be more impactful title. Suggest term"management" rather than "treatment" would be more appropriate.3.5 AbstractLines 47 - 50: Rather than just give descriptive statements, concisely state what is the likelysignificance/impact of the findings in relation to the intervention tested/usual care.3.6 Background
Seems quite brief, could be expanded to include more details about vasomotor symptoms and
onset of menopauseLine 54: Suggest re-word "seek medical advice for vasomotor symptoms of menopause (hotflushes and …
Line 58: replace "alternative" with 'non-pharmacological'Line 71: suggest re-word to 'women experiencing vasomotor symptoms'3.7 MethodsLine 85: one-to one consultations - what health professional deliveredLine 119 & 123: first person voice, change to third person to be consistent with rest of methodsLine 134: Data analysis - Need clear explanation about theoretical/epistemological approach toqualitative analysis and why this was chosen. It appears that the approach was thematic analysis/mixed with some quantitative measures - Kappa Analysis?Unclear if second researcher involved in analysis and also how was research rigor maintainedthroughout the interview process given that interviewer was also involved in intervention trial andknown to participants.Line 113: what criteria were used to determine data saturation.3.10 ResultsQualitative paper so consider combining results and discussion with deeper analysis and
discussion throughout. Quantitative format of manuscript not really appropriate for qualitative
study.3.11 DiscussionLine 368: previously stated it was purposive sampling which conflicts with this line "randomlyselected"Line 373 on: Comparison with other literatureDiscussion very descriptive in simply comparing these results to the literature. Deeperinterpretation of meaning of these results in light of the literature, and what this study adds isrequired. A lot of quantitative literature cited which doesn't really link well with the qualitativequestions posed.Line 425 on: Implications for practiceImplications are not clear, needs to be developed - what is the significance for women, for healthprofessionals, for future practice etc.Line 440: ConclusionsNeed to connect more with the aims of the study stated line 70
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 controls?
If not, please specify which controls are required in your comments to the authors.
YesAre 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 manuscript or would you recommend an
additional statistical review?If an additional statistical review is recommended, please specify what aspects require furtherassessment in your comments to the editors.
Not relevant to this manuscriptQuality of written English
Please indicate the quality of language in the manuscript:
AcceptableDeclaration of competing interests
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