Title: The effect of a training program on maternal role adaptation and self-esteem of mothers
with preterm infants: a quasi-experimental study
Version: 3 Date: 02 Jun 2021
Reviewer's report:
The study by Sohrabi et al " The effect of a training program on maternal role adaptation and
self-esteem of mothers with preterm infants: a quasi-experimental study", assessed the effect
of training program on maternal role adaptation and self-esteem of mothers of preterm infants
admitted to the neonatal intensive care unit.
This is a quasi-experimental study conducted in 96 beds, in a level 3 NICU in Kerman Iran. The
study showed that the intervention improved the maternal role adaptability and self-esteem of
the mothers of preterm infants, thus improving the quality of maternal care and the condition
of the infants.
The study was conducted well, and its results emphasize the need for parental support in order
to improve the outcome of preterm infants.
Specific Remarks
Methods:
• It is not clear whether " All of the participants completed the study" or " the percentage of
the participants’ dropout was 5% " (sampling method #153-154). This discrepancy should be
cleared.
• The list of exclusion criteria given is in fact not exclusion criteria but rather a list of causes for
dropout of participants already enrolled in the study (#157-159). It should be clarified if indeed
there were patients eligible for the study which were not included in it due to predetermined
criteria, and if so what those criteria were.
.
• #161-163 consider revising the paragraph.  I suggest the following phrasing or equivalent: "The
study was done according to Helsinki guidelines, and approved by the local ethics committee.
Written informed consent was obtained from each participant".
• Please consider deleting # 164-166 (unnecessary details). Please add that the study population
were mothers of preterm infants that were born during 2020 and met inclusion criteria.
• Please clarify the randomization process. It was not clear whether a " a table of random
numbers" (#168) was used or " the first two infants on the top of the list were placed in the
intervention group and the next two in the control group" (#170). While the latter is less robust
it is most important to be transparent and consistent.
• Please explain "the two groups were selected from separate work shifts" (# 173). This would
heavily influence the validity of the results so once again transparency is called for.
• Please change the heading "Instruments" (#201). Consider using instead measurements or data
collection.
• Is there a reference for Haidarpour et al 2016? (#217).
Results
• Use the term comparable instead of " homogeneous" (237, #240).
• #246-250: " Besides, the results of the paired samples t-test showed that the mean scores of
maternal role adaptation and its subscales were statistically significant for the participants in
the control group before and 2 weeks after the intervention (P <0.001), indicating the scores of
maternal role adaptation and its subscales increased 2 weeks after the intervention compared to
the period before the intervention and this increase was significant (P <0.05).
It is not clear if the author refers to the control (according to table 4 there is a change in this group
too) or to the intervention group. Please clarify. This should be presented as a difference-in-
differences analysis- was the improvement in the intervention group greater than in the control
group?
• You might consider addressing differences in baseline measures between the groups and what
they might mean (for example participations in care between the groups) (#256-257).
Discussion
• Note a mistake in describing the intervention in the study of Gao et al (Ref 35) consisted of
two 90-min antenatal classes and a telephone follow-up within two weeks after delivery. Their
results showed a long-term effect and not effect of long-term intervention (#364).
Limitations
• The authors state they could not control for differences in personality traits and cultural
characteristics as these were not assessed. However, the randomization process should account
for differences such as these, so it would be much more meaningful to address how the study's
design- which is not a 'pure' RCT might effect their outcomes and the kinds of bias they think
may have been introduced into the study.
Tables
• Table 2: Pregnancy age: If the author means Gestational age, it should be weeks and not years.
• Table 3:
o Consider giving only the means for the infant characteristics' variables.
o Please clarify if "Admission days" meant enrolment day
• Table 4 & 5 consider presenting the results more clearly so that the focus is on the differences
between the intervention and control group and it is cleared what they were and if significant.