Reviewer’s report
Title: 
Frequency of basic public health services utilization by married female
migrants in China: Associations of social support, discrimination and
sociodemographic factors
Version: 
0 
Date: 
24 Jun 2021
Reviewer's report:
The study in general is very useful. However, there are some issues in
organization and presentation of the analysis. Following are my suggestions to
reorganize the paper:
1. The introduction needs a major reconstruction. "According to the annual
survey …" is not the best way to begin with, as reader may wonder why one
would need to know about the finding of this survey without any context. The
first few sentences should set the context and relevant estimates (from surveys)
can follow to guide the reader further into the subject matter.
From my reading of the paper, it appears that the content in the first two
paragraphs in page 4 ("Despite the growing numbers of ….") are more fitting to
begin with as it describes the problem - health facilities for migrants, provided
by local governments, do not cover prevention and control of NCDs; and BPHS
is a likely solution to this problem. I suggest modifying these two paragraphs as
the opening paragraph of the paper. Then the "hukou" system could be briefly
described to provide readers a deeper understanding of the problem. And then the
current "first paragraph" could be put to illustrate the extent of the problem at the
population level.
2. The third paragraph in page 4 ("At present, China is actively …") may be
more suited in the discussion section than in the introduction.
3. I don't think a theoretical framework section is necessary for this paper. The
Andersen Behavioral Model is referred for the purpose of including social
structure factors as predisposing and enabling factors. No theoretical analyses on
"how social support or discrimination would impact the health care utilization of
the migrants" were provided. For example, this section doesn't inform the reader
about how the health care utilization would change as the degree of social
support changes. The rationale of including social factors will better fit in the
introduction and a sentence or two referring the Andersen Model will suffice.
I suggest dropping the "Theoretical Framework" section, and to incorporate the
specific aims (from the first paragraph in page 7) in the introduction.
4. The presentation of the sociodemographic characteristics in Table 1 is a bit
puzzling. It's confusing for the reader to see the mean and standard deviations
presented for some variables and count and share for other variables. I suggest
presenting the estimates uniformly for all characteristics. Characteristics, for
which N and % are presented, can be easily presented as dichotomous variables
(e.g., village = 0 if the migrant comes from village and 0 other wise). In that
case, the mean of the village variable will be 0.672 and the standard deviation
will be 0.470. The dichotomous variable could be multiplied by 100 as well to
report the mean and standard deviation as percentages (67.21 and 47.02
respectively). The range for these dichotomous variables will be (0-1). Thus,
there will be uniformity in presentation. Since the sample size (n=307) is already
mentioned, providing N for each characteristic is redundant as readers may easily
infer what is 67.2% of 307. Hence, I suggest dropping the N(%) column in Table
1 and present the estimates as suggested above.
5. Presentations in tables 2 and 3 is also problematic. Providing a column of "not
utilized" is redundant. For example, 23.5% utilization means, (100-23.7) or
76.5% of the respondents did not utilize the health facility. It makes no sense to
put both 23.5% and 76.5% in two columns. The chi-square results tell us
whether the utilization is different across two groups (e.g., village vs county). So
reporting the utilization rates and the chi-square results are all that the reader
needs to see in tables 2 and 3.
I suggest consolidating tables 2 and 3 in one table. Drop the "Not utilized"
columns. Consolidate the chi-square and p column to one column of chi-square
(p) - for example, 3.95 (.047)*. In that way, all four outcomes (health records
establishment, health education, basic contraceptive services, and cancer
screening) can be accommodated in one table.
6. Check the utilization % of basic contraceptive services for respondents from
county (in current Table 3). It should be 53.1% instead of 35.1%.
7. I don't think reporting beta coefficients in tables 4 and 5 are necessary. Since
the OR (i.e. exponentiated beta) are reported, there's no need to report beta,
which doesn't have any interpretation of its own. Also, it creates additional
confusion about the 95% CI (whether that is for the beta, or for the OR). I
suggest dropping the beta coefficients in tables 4 and 5.
8. In the "Strength and limitations" section it is stated that one of the strengths of
this analysis is using Andersen model as the theoretical framework. The analysis
presented in this paper, however, doesn't offer any theoretical predictions. I
believe a proper theoretical analysis is beyond the scope of this paper as well. I
suggest not to highlight application of Andersen Model as a strength of this
analysis. The strength indeed is incorporating the concept pf social support in an
empirical framework and assessing the relationship between social support and
health care utilization.
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Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes