Reviewer’s report
Title: 
Feasibility and acceptability of a culturally tailored physical activity
intervention for Arab-Australian women
Version: 
0 
Date: 
12 Nov 2020
Reviewer: 
Tam Truong Donnelly
Reviewer's report:
Abstract: 
This paper addresses a very important health issue for Arab-Australian women.
Structured abstract is well written. However, the "background" section needs
elaboration on reason for why physical activity interventions are needed for the
health of these Arab-Australian women. Regarding study aims, include "A
secondary aim, which was exploratory in nature, was to test the preliminary
efficacy of the intervention on physical activity levels, self-efficacy for physical
activity, and anthropometric outcomes." 
Table: 
- 
Self-exploratory. 
- Table 1: Change title to "Intervention schedule, topics and activities" 
- Table 2: Add label to column 2 as: n (%) and remove (n, %) for each variable. 
Background: 
-line 22-27 page 4: include other examples that illustrate your previous point
(line 15-22). There are more factors that influence physical activities of CALD
groups when in their country of origin, specifically, Arab population. 
-Line 34 page 4 and line 34 page 5: add information regarding level of physical
activity among Arab population. 
You might find lots of information in the articles listed here: 
1. Donnelly, T. T., Al-Thani, M. A., Benjamin. K., Al-Khater. A., Fung.T. F.,
Ahmedna. M., & Welch. A. (2018). Arab Female and Male Perceptions of
Factors Facilitating and Inhibiting Their Physical Activity: Findings from a
Qualitative Study in the Middle East. PLOS ONE.
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0199336
2. Donnelly, T. T, Fung, T. S, Al-Thani, Al-Anoud bint. M. (2018). Fostering
active living and healthy eating through understanding physical activity and
dietary behaviours of Arabic-speaking adults - a cross-sectional study from the
Middle East. British Medical Journal (BMJ) Open. 8 (4): 1-15.
http://bmjopen.bmj.com/cgi/content/full/bmjopen-2017-019980?
ijkey=6UqM1moA7zNBWsA&keytype=ref
3. Benjamin, K., & Donnelly, T. T. (2013). Barriers and Facilitators Influencing
the Physical Activity of Arabic Adults: A Literature Review. Avicenna. June,
2013. http://www.qscience.com/doi/pdfplus/10.5339/avi.2013.8
-Line 49 page 5 - line 15 page 6: authors describe existing intervention program
that "were all culturally tailored to meet the needs and preferences of the target
population, which included participatory methods to inform and tailor the
intervention 29, 31, culturally and gender-matched intervention personnel 28-30,
gender-exclusive settings for physical activity 29, 30, and culturally tailored
content (e.g., Arabic sayings and themes) 28-31." This describes culturally
acceptable and appropriate interventions for CALD/Arab populations. Thus
authors need to make a stronger argument for their assertion that "There is a
strong need for the development of robust interventions designed specifically for
Arab-Australians." (line 17-20 page 6). Do these mentioned interventions have
limitations which might be ineffective in promoting physical activities among
Arab populations? 
Methods
- "A secondary aim, which was exploratory in nature, was to test the preliminary
efficacy of the intervention on physical activity levels, self-efficacy for physical
activity, and anthropometric outcomes." This aim would be very difficult to
achieve since your intervention was only for 12 weeks with a total of only 6
sessions. Behaviour change will not be able to achieve and anthropometric will
not manifest. This, in addition to very small sample size will not give you
statistically significant changes results. 
-Participants inclusion criteria: Language criteria, Arabic or English? And level
of language efficiency to the language of instruction. 
-Formative Work: Please describe components/protocol of your developed
intervention program here.
- "Ethics Approval and Trial Registry" on page 14 should be on page 6, just
before the "Method" section 
-Line 10-14 page 12. Given that only one study was conducted among Arab-
Australia population, insights related to Arab population barrier and facilitators
to physical activities in studies mentioned above can be included. Also other
helpful information can be found in articles below:
1. Donnelly, T. T., Al Suwaidi, J., Albulushi, A., Al Enazi, N., Yassin, K.,
Rehman, A., Hassan, A., & Idris, Z. (2012). Opportunities and challenges to
engage in healthy lifestyle among Arabic women living with cardiovascular
diseases in Qatar. Health Care for Women International. 33(12), 1114-1134.
2. Donnelly, T. T., Al Suwaidi, J., Albulushi, A., Al Enazi, N., Yassin, K.,
Rehman, A., Hassan, A., & Idris, Z. (2011). The Influence of Cultural and Social
Factors on Healthy Lifestyle of Arabic Women. Avicenna. Dec 28, 2011.
http://www.qscience.com/doi/full/10.5339/avi.2011.3
-Line 7, page 13. Please include the 12 items survey questionnaire here. Also
indicate whether or not these questions are in Arabic or English. 
-As 13 participants spoke Arabic at home, 8 Arabic and English, one English
only, please specify your intervention language of instruction and material, and
measures that put in place to ensure that all participants understand the
educational material, intervention topics of discussion. 
- Data analysis: Line 54 page 13. Add information regarding who/which
researchers/statistician conducted the study data analysis. 
Results:
-on page 15, of all 15 participants retained post-intervention, how many were at
the first, second 
site? Is there a difference? what factors might have contributed
to the Recruitment and Retention of participants from each site? Then address
that in the discussion section. It would be very helpful to the readers.
-Line 8 page 16, regarding your report of result of the process evaluation,
explain what your mean rating scores communicate, before reporting mean
rating score for each component. 
-Page 17. Even though this section speaks more to the effectiveness of the
intervention program and not the Acceptability of it, please elaborate on the
result of "Health-Related Outcomes" prior to present table 4. 
Discussion: Very good discussion. 
-line 37-39 page 18: Authors stated "Given that some CALD populations may
not be aware of available services, greater efforts targeting those who do not
frequent community centres is required." Can authors gave some specific
recommendations on ways to reach out to those individuals? This would be very
useful to the readers. 
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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
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Yes
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Yes
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from apparent manipulation?
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