Reviewer's report
Title:A comprehensive view of occurrence and diagnosis of endometriosis: A
qualitative study
Version:1Date:7 June 2014
Reviewer: Arnaud Fauconnier
Reviewer's report:
The interest of this article is the patients and physicians description of symptoms
of endometriosis in Iran, with a qualitative method. The interest and the originality
of the research lies in interview of Iranian women on their intimate real-life
experience. However, it seems that the cultural and religious aspects are not
enough analyzed and may have an influence on the results. This should be more
emphasize as it could be an important and original finding. For example, we
didn’t know if “perfect feminine identity”, “performing mother and performing wife”
are some women’s Iranian description or if it’s the author words. The author must
more define what those terms are. The author also talks about endometriosis
pain after marriage, but perhaps its concern the link between pain and sexuality
in endometriosis.
1.Is the question posed by the authors well defined?
The authors want to explore the perception and experience of endometriosis
patients and physicians about occurrence and diagnosis of endometriosis from a
holistic perspective, to develop non-surgical approaches for early detection of
endometriosis. We think that the author must more define what a holistic
perspective is.
2.Are the methods appropriate and well described?
-Method:
A qualitative method was appropriate for this study. However, the author doesn’t
make a reference to a particular qualitative method for the analysis of the
interview. The author talks about a thematic approach for the analysis but we
need more precisions. The method is well described but reference is needed.
-Population
Concerning the population, the author doesn’t specify if the patients are her
patients. It has to be to specify.
It's a pity that the study is multi-centrique for the physicians and not for the
patients
3. Are the data sound?
Data analysis from interviews produced 245 codes, 26 categories, and 7 themes.
We need some precisions about the 245 codes. It is the high number which
shows that the author has can be kept all the codes of 18 subjects, while she
would have of to keep the codes which find themselves at several patients and
physicians. There is no distinction between physicians and patients codes and
themes.
Seven themes emerged in the results:
1) Vulnerability and expressing discomfort from the varied and diffused pain,
2) Severity of pain and struggle for pain relief,
3) Feeling inability to play the role of femininity,
4) Reducing physical health,
5) Looking for a reliable diagnostic indicator,
6) Uncertainty of physical examination and
7) Disruption of social life. The name of the theme 1 “Vulnerability and
expressing discomfort from the varied and diffused pain” is too indistinct and
could be called “pain localization”,
Theme 7 should be after the 4.
In the Table 1 “An example of analysis process”, the examples do not seem
completed for the different column of the table (story, code, category, theme),
what question about the relevance of the validity of the analysis.
Finally, another table is necessary with the 7 themes and the 26 categories.
4. Does the manuscript adhere to the relevant standards for reporting and data
deposition?
Yes
5. Are the discussion and conclusions well balanced and adequately supported
by the data?
The discussion is well done but the way is presented the conclusion brings
nothing new for the research, with regard to the research already published on
the diagnosis of endometriosis by questionnaire. However, the research brings
new elements concerning the real-life experience and perception of
endometriosis by women and physicians in Iran. The cultural context is one of
key of the study.
6. Are limitations of the work clearly stated?
No limitation of the work appears clearly. The physician’s descriptions and the
role of the cultural background should be more emphasis.
7. Do the authors clearly acknowledge any work upon which they are building,
both published and unpublished?
Partially. Our work is missing (A. Fauconnier, 2013). It would have been
interesting to compare the results of the present study with our study, using the
same methodology in France.
8. Do the title and abstract accurately convey what has been found?
The abstract accurately convey what has been found but not the title. The words
such as “patients and physicians description” could be relevant. The author
should emphasis the role or Iran and cultural background concerning the study.
9. Is the writing acceptable?
Yes
Advice on publication.
- Major Compulsory Revisions (which the author must respond to before a
decision on publication can be reached).
Level of interest: An article of importance in its field
Quality of written English: Acceptable
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' below.