Reviewer ’s report  
 
Title: Factors influencing use of long -acting versus short -acting contraceptive methods among 
reproductive -age women in a resource -limited setting  
 
Version: 1 Date: 22 Jul 2016  
 
Reviewer: Brianna Magnusson  
 
Reviewer's report:  
 
The authors have been very responsive to the reviews and the man uscript is improved by these 
changes.  I have a few essential revisions and several stylistic suggestions to improve the 
presentation of results.   
1) Essential Analysis Revision - Overall, the change to bivariate comparisons only and 
stratification by ru ral vs. urban location improves the value of the manuscript.  However, it 
does not appear that any statistical tests were used to compare the differences between urban 
vs. rural population on any characteristic.  A simple chi -square test for the difference  of 
proportions would be helpful in identifying differences that are statistically significant.  It is 
not clear why these are omitted from the analysis.  I suspect that this will not change the 
overall conclusions, but recommend that the authors perform s tatistical tests, update the 
statistical analysis section of the manuscript to reflect this and indicate statistically significant 
differences on all tables.  
2) Results revision - Page 11 under "Knowledge of contraceptive methods" It would be useful 
to ad d a sentence reflecting the results in Table 3 currently listed under "Knowledge of 
methods".  Possible - "Awareness of contraceptive methods in both urban and rural 
participants was high.  Participants were less familiar with IUD and sterilization methods  
than other forms of contraception (Table 3)."  
3) Results -- Knowledge of methods - I am still unclear what you were trying to assess here.  
From the response to reviewers I would guess that the goal was to assess respondents 
understanding of how to use ea ch method (e.g. take a pill daily, get an inject every 3 months, 
have a health provider insert a device into the uterus etc.) as opposed to how each method 
works.  When I see "how each method works" I am thinking you are asking clients for details 
like thi s method works by suppressing ovulation or blocking implantation, but that does not 
seem to be the goal.  I would appreciation additional clarification in the manuscript on this. I 
think it's also important that it is clear that respondents self -reported t hat they understood 
how a method was used, rather then having that belief tested.  
4) Results Revision - Page 13; line 35 - Beginning in the paragraph "Factors associated with use 
of LARC methods" throughout this section you use the terms "less likely" and  "more likely" 
these imply a statistically significant difference which does not appear to be have been tested.  
If these hold after you have conducted your chi -square tests then no revisions are needed.  If 
these differences are not statistically signific ant, please revise. In that case it would be more 
appropriate to say a larger or smaller proportion of respondents...etc.  
 
Changes to the Tables:  
1) Re-title table 1 so that the table stands alone.  I would suggest the term response rates or 
participation  rates rather than acceptance rates. Include the population etc.  So something like 
"Participation rates among clients of public health clinics" **Add designations of statistical 
significance.  
2) Table 2 - Is there a reason for the bolded lines at the end of table 2? Retitle this table as well, 
"Characteristics of family planning and antenatal clinic clients participating in quantitative 
interviews" The n = 180 is not necessary as this is given in the column heads.   
 
I have a number of changes for Table 3:  
3) Re-title the table.  Again this needs to stand alone, so include information about who the 
participants are and the time of information included in the table.   
4) Please add the cell counts in additional to the percentages as you have done in Table 2.   
5) I would change "knowledge of methods" to "Awareness of methods".  
6) Spell out OC.  
7) Under knowledge of whether methods were long acting or short -acting change the word 
"listed" to "identified".  Also my understanding is that, for example, the 70.8%  of urban 
women identified ALL of the long -acting methods as long acting.  If this is accurate change 
the label to "Correctly identified all long -acting methods as such." The same for the short 
acting methods.  
8) Under knowledge of how methods work - If my supposition above are correct,  change this to 
"knowledge of how methods are used" in the label and category labels.  
9) The 3 variables dealing with current method use are outliers in this table, because they apply 
only to your non -pregnant respondents.  I would recommend 1 of 4 options to resolve this:  
a) Omit these numbers from the table and present in test alone  
b) Add additional column heads for these 3 questions as you did in Table 4 where the 
denominator changes.  
c) Put these 3 variables  in a separate table to the different denominators are more clear.  By 
titling this table to specifically indicate among current users the denominator should be 
clear.  Your percentages however will need to be  recalculated as these are c urrently based 
on a denominator of 120/60.  
d) If you leave them in this table, add an additional category that says, "No current use, due 
to pregnancy" so that your column percentages add to 100% and the entire table reflects 
the same denominator.  
 
10) For both ever used LARC methods and Ever use of short -acting methods these are 
dichotomous.  You need only report the "yes"  
11) Under "Common ever -use short -acting methods" and "Common ever use LARC methods". 
As women could select multiple methods I would delete the overall labels "Common ever -
use short -acting methods" and "Common ever use LARC methods" abd change the category 
labels to "Ever used oral contraceptive pills"; Ever used injectable contraceptive, Ever used 
other short -acting methods (condoms, spermicides, moon beads), Ever used implant, and 
Ever used IUD.  
12) Add indicators of statistical significance  
13) Table 4 - Add the cell counts to maintain format from Table 2. Add indications of statistical 
significance. Add the n's to the column heads  
 
Minor Stylistic changes:  
From the manuscript text in order of appearance:  
Page 4; Lines 22 -29: This is a list of 3 classi fications of contraceptive methods, please number 
these 1) long acting reversible contraceptive (LARC)...., 2)Short -acting ..etc.  
Page 4; Line 36: Remove "in particular" begin the sentence with "The effectiveness of..."  
Page 5 Throughout the methods sectio n and the results there are a large number of abbreviations. 
HC, FP, ANC, FGD etc. To my knowledge these are not widely accepted abbreviations and I 
would suggest avoiding their use.  The manuscript does not have a word limit and using health 
center, famil y planning, antenatal etc. spelled out reduces the reader burden in trying to recall 
what the abbreviations stand for.  Other abbreviations like LARC and OC used in the manuscript 
are common in the literature and are acceptable.  
Page 6; Line 9 - The clini c hours are listed as 8 -2.  Based on your response to reviewers it 
appears that these are the clinic's operating hours.  However, in the manuscript it says 
"convenient working hours" and as written is implies that you are excluding some portion of the 
health center's clients.  If 8a -2p represent the hours the clinic was open and in which clients 
could receive care then I'm not sure you are really "excluding" anyone. I would clarify that these 
are clinic working hours.  Also in the response to reviewers you mention that you intentionally 
selected from public health centers.  I would explicitly state this, perhaps on page 5; line 26 "We 
conducted a mixed methods cross -sectional study at 6 PUBLIC health centers in Mbarara 
district..."  
Page 6; line 41 - where yo u have states "accepted to participate" please change to "agreed to 
participate". If this terminology appears elsewhere in the manuscript please update there as well.  
Page 9; line 6 - where you state "request them to participate in the FGD" please change to "ask 
them to participate" or "request their participation"  
Page 9; line 9 - conduct should be past tense conducted.  
Page 9; line 42 - "less children" should be changed to "fewer children".  Although these terms 
are often interchanged fewer should be us ed in cases of things that can be counted (like children) 
and less in cases of things that cannot be counted (like pain).  
Page 11; line 27 - there is a sentence structure issue here "able to how all the listed methods 
worked". I think there may be a missi ng word? Identify how all the listed methods work 
(perhaps?)  
Page 17; line 47 - there is an abbreviation in this quote "COCs" I am not familiar with this.  I 
know this is a quote, but perhaps you could insert the definition in square brackets which are 
typically used to indicated editorial changes to quotations.  
Page 24; line 35 - "subjected to future studies" should be changed to "the subject of future 
studies"  
Page 25; line 9 - Revise to read "Since we did not collect the data on such women, our results 
may not be generalizable to populations...etc."  
Are the methods appropriat e and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions dra wn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
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 further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscr ipt: 
 
Acceptable  
 
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