Reviewer's report
Title:Psychometric properties of the Confidence and Trust in Delivery
Questionnaire (CTDQ): A pilot study
Version: 2Date:18 September 2011
Reviewer: Heather Rowe
Reviewer's report:
There is in some places insufficient information in the cover letter to ascertain
whether the reviewers’ suggestions have been adequately addressed
1. Is the question posed by the authors well defined?
No. The authors have not provided sufficient justification for the use of the
questionnaire. It remains unclear how, if implemented, women’s questionnaire
results would modify clinical practice. How would women scoring high (or low) be
managed? There is growing evidence that women have mixed views about
whether they prefer to complete written questionnaires or be asked questions by
their care providers. The factor structure of the CTDQ suggests that 4 simple
questions might suffice, as long as the matters uncovered can be responded to in
a meaningful way so as to improve the experience of labour for the woman. It is
not clear how a questionnaire would improve on clinical questioning.
The authors now statement that “……Thus questionnaires may be used to detect
early problems of upcoming mothers with themselves which may result in
improved childbirth outcome” is not sufficiently informative. Authors’ response to
comment # 14 “We are quite aware of the practical implications (of using the
CTDQ as a screening instrument) but would like to leave the example as it is” is
unhelpful. Readers might not be aware.
2. Are the methods appropriate and well described?
Some problems remain. Most importantly, the proposal was not seen or
approved ay an institutional ethics committee. The article describes research in
which participants were asked to provide sensitive and personal information.
Participation in the research would not have had any direct benefit to participants
but potential unacknowledged harm (however unlikely). The authors have not
described any procedures that were in place to respond to or manage women
who returned high (or low) questionnaire scores, nor made clear whether or how
questionnaire results would modify clinical practice were the measure to be
implemented in the future. These are important limitations.
3. Are the data sound?
They appear to be but there are some problems with analysis and interpretation
4. Does the manuscript adhere to the relevant standards for reporting and data
deposition?
There is no significance texting in Table 4 , without which it is difficult to justify
some of the authors’ assertions. The use of confidence intervals is preferable to
standard deviation(?) as at present
5. Are the discussion and conclusions well balanced and adequately supported
by the data?
No always. See above. The results section makes much of the finding that the
two “subscales”: “partner support” and “trust in medical competence” are
correlated, but the authors do not offer any speculations as to why this might be,
other than that the finding “should be investigated further”. This finding might be
of clinical significance and warrants discussion.
6. Are limitations of the work clearly stated?
Elaboration of this matter has now been added but the question of selection bias
remains inadequately addressed. The final (elaborated) paragraph of the
discussion (Limitations) is unclear.
7. Do the authors clearly acknowledge any work upon which they are building,
both published and unpublished?
Background and discussion sections require further reference to the existing
literature to justify the need for a new measure and establish what this study
adds to existing knowledge.
8. Do the title and abstract accurately convey what has been found?
No. I would argue that it is not possible to establish the psychometric properties
of an instrument from a pilot study and am not sure why an apparently
systematically-recruited sample of 221 has been described as a “pilot”.
9. Is the writing acceptable?
New text is in need of editing and removal of repetition in places.
Level of interest: An article of limited interest
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests