Reviewer's report
Title:Quality of life, coping strategies and support in infertility: Women's needs
and experiences with Traditional Chinese Medicine in Australia: a mixed methods
approach
Version: 1Date:3 December 2012
Reviewer: Viju Thomas
Reviewer's report:
Perhaps the author would consider altering the title. The term "infertility" is
indeed used very broadly, as mentioned by the author, however, male factor
infertility was excluded. Furthermore, the "population" actually consists of women
with "poor obstetric history" and pregnancy failure" in addition to primary and
secondary infertility.
The population consists of a very heterogeneous group of women, with regard to
etiology. In my opinion, there is significant selection bias and the "golden thread"
among all subjects is that they all attended TCM treatment.
This study therefore reflects patients who have gone and sought help from TCM
healers. For purposes of the qualitative study undertaken, this is fine, however,
this is a "mixed study," as stated by the author and this population is too selective
to come to the conclusions at which they have reached regarding the quality of
life(QOL) and COPE questionnaires.
Conditions such as recurrent pregnancy losses and stillbirths have various other
etiologies, not necessarily linked to those of infertility. The author has not
commented on what types of medical investigations and management had been
offered to these women, prior to being included in the study. In fact, the author
states that only two thirds of all subjects sought help while the other one third
went directly to TCM centers.
As the authors calculated the means for the QOL data, I assume that the data
was normally distributed and parametric tests were done. The means of 18
women with primary infertility, in this study, were compared to 275 with women,
IN GERMANY (from another non-related study?), for an outcome. Are these
groups comparable? Are they similar? What tests were done in each group?
What are their demographics? How many cycles did each women undergo? This
data is not available. In my viewpoint 3 things are questionable:
1. Were 18 women adequate to do this comparison?
2. Was a sample size/power calculation done to arrive at this number? It appears
to me that sample size was calculated based on "thematic saturation" for the
qualitative aspect, rather than sample size calculation. This approach is only
adequate for the qualitative part of this "mixed methods" study.
3. Were the groups comparable?
I am also not sure about the ethnicity of this population. How many of them have
Chinese/asian ancestry? The authors comment that all subjects were born in
Australia, but I would think that families with Chinese ancestry have a higher
chance of being influenced positively by TCM. This brings an element of
selection bias.
The information retrieved from the qualitative work is informative and lends a
deep perspective to women's feelings and thoughts and will provide benefit to
health practitioners and patients alike.
Level of interest: An article of limited interest
Quality of written English: Acceptable
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
No conflict of interest.