Reviewer's report
Title:Comparison of health-related quality of life between housewives and
employed women in Zahedan City, Southeast Iran during 2009-2010 : A
cross-sectional study
Version: 6Date:14 May 2012
Reviewer: Maryam Tajvar
Reviewer's report:
The BioMed Central Editorial Team
Most of the following revisions are compulsory before I can make a decision on
the publication of the manuscript titled “Comparison of health-related quality of
life between housewives and employed women in Zahedan City, Southeast Iran”
in BMC Women's Health. In general, I think the authors need to do some
substantial improvements in the quality of their paper and presentation of their
data, in addition to significant improvements in the English of the paper.
INTRIDUCTION:
- Paragraph 2: in sentence “The recent national census in Iran implies that
Iranian women's share of work force is 11%, and currently we have about 2.1
million employed women (10) and 14 million housewives nationwide.”, Ref. No 10
is related to the US not Iran. Also what is the Ref. for 14 million? There is a need
for statistics of Iranian women from a sound relevant source. Also change “we” to
“Iran”.
- Paragraph 3: Ref 12 and 13 reports the information for Iran and Turkey only not
everywhere. Please mention this in the text.
- Paragraph 3: what is the evidence for “Employed women are significantly
happier and mentally healthier”? Please mention it.
- Paragraph 3: what do you mean by “the cultural differences”? Please explain it.
- Last sentence: you have claimed that “We wanted to find the different
challenges the women of this city face in order to promote their overall health”. It
seems that your study has not such an aim and so it is unrelated. I suggest
removing this from your paper.
- Minor revision: change “third world countries” to “developing countries”.
MATERIAL and METHODS:
Despite significant changes in the current version of the paper, the methods
section still is not satisfactory. Please address the following issues:
- English of this section is particularly poor.
- Your study is not “case-control”. It is just a cross-sectional study and you have
two groups of samples.
- Provide information on the sample size calculation.
- How 22 people from each centre have been selected? What was sampling
method to choose these people for the study?
- You have initially selected 220 people for your study and it seems that all 100 of
your samples have responded. This seems unrealistic. Please provide
information on your non-respondents and the response rate of your study.
- Paragraph 1: the sentence “The comparison group (housewives) was matched
for age and gravity.” needs clarification. What do you mean by matching in one
group only? Also what do you mean by gravity?
- Paragraph 2: your first inclusion criteria means that you have only studied
healthy women, which is not sensible and distorts your study objective.
- Paragraph 2: in the third inclusion criteria, why you have excluded “obese”
women?
- Which version of SF-36 has been used? The Iranian version is based on
version 1 or 2?
- The method of data collection in your study for illiterate people was interview
whereas for others it was self-completion method. This makes a bias in
responses between two groups, i.e. the interviewees are subject to the
interviewer bias. You have to justify this and at least report it as a limitation of
your study in the discussion section.
- Remove the last sentence.
- Add the information about the ethical approval of your study to the main text.
- Minor revisions: 1) remove “Material” from the title and keep only “Methods”. 2)
spell check is required 3) remove redundant words (Statistical methods were) in
the last paragraph.
RESULTS:
- Selected information of your Table 1 has to be reported in the text too.
- Table 2 provides only a raw comparison between the two groups. The
differences in the scores of SF-36 could be due to age or other potential
confounders. It would be best if you could do additional analyses (multivariable)
to control for the effect of these confounders.
- In Table 3, I am not clear why you have compared the HRQoL of your sample
with that of Iranian women. I think this is totally senseless, because the
information of Iranian women provided in your study is based on just one study
(Montazeri,….) and the samples in two studies could have different
characteristics and so not comparable. I suggest you remove all of this section
but it worth you keep it for discussion of your findings.
DISCUSSION:
- The cross-sectional design of your study is its main limitation, because in
cross-sectional studies you can not determine the cause-effect association. You
have to clearly explain it in your study.
CONCLUSION:
- As I said, because of the cross-sectional nature of your study you can not judge
about the effectiveness of employment on HRQoL. At most you can claim that
there may be an association between the aspects of HRQoL and employment.
- Social participation is a different concept that employment. You can not
recommend having more social participation to have better HRQoL based on
your findings. Instead, you could have more relevant recommendations based on
your findings.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Not suitable for publication unless extensively edited
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