Reviewer’s report
Title: 
Diné (Navajo) female perspectives on mother-daughter communication
and cultural assets around the transition to womanhood: a cross-sectional survey
Version: 
1 
Date: 
20 Jun 2021
Reviewer's report:
This is a manuscript whose purpose was to explore AI women's cultural assets,
perspectives, and teachings, inform the development of a culturally grounded,
intergenerational intervention to prevent substance abuse and teenage pregnancy
among AI females.
The research was conducted in 2 indigenous communities as part of a formative
community-based participatory research project at the Johns Hopkins Center for
American Indian Health. The authors present the mother-daughter dyadic
strategies are specifically supported because of their bilateral health influence
and potential for sustained behavior change.
The methodological aspects, with ethical care, supported an unprecedented
survey featuring sampling points, sampling and data collection procedures
congruent with the proposed objectives.
Data analysis through descriptive statistics enabled the adequate and relevant
treatment of the data in line with the objectives outlined initially. The authors
highlight the points of discussion, the support for an intergenerational, the
extended family approach, with the confirmation that the Diné women surveyed
strongly value matrilineal networks, specifically the bond between girls and their
mothers, grandmothers, aunts, and older sisters.
Intervening in early adolescence. 
The importance of intervening during this time
period indicating early adolescence is a time in which caregivers are still very
engaged with youth and is also a critical time for establishing healthy behaviors
Supporting female caregivers as health educators in health education, the goal is
for mothers/caregivers to reinforce key concepts and support their daughters
towards healthier behaviors over the long-term Male sources of support during
puberty Thus, survey findings also support the inclusion of male health educators
to facilitator AI girls' health interventions with male sources of support.
They also verify the importance that support for culturally grounded curricula
and programming are necessary. This may be the first survey conducted to
understand Native females' experience related to culture and reproductive health
and to inform development of a culturally aligned AI female intergenerational
program.
It is noteworthy that, in addition to Western culture, findings support the design
of an intergenerational, culturally responsive intervention to prevent substance
use and teen pregnancy in Native communities and may be the beginning of an
international line of indigenous studies for health care given exposure to the risk
of contact with the values of a globalized society.
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Is the study design appropriate to answer the research question (including the use
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presented?
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