Title: Exploring education preferences of Australian women regarding long-term health after
hypertensive disorders of pregnancy: a qualitative perspective
Version: 2 Date: 11 May 2021
Reviewer:  Ana Sjaus
Reviewer's report:
General summary of the manuscript:
The manuscript describes a qualitative study of semi-structured telephone interviews (of thirteen
women) with previous history of HDP/PE to explore their preferences regarding education
(content, format and access) about future cardiovascular risks.
This is an important subject, and the researchers work on it should be commended. My main
concerns are with the very limited, self-selected sample of subjects and a sparse description of
the analytical process. I would suggest several amendments to this work that may improve its
impact and generalizability. The cumulative extent may constitute a major revision.
The following observations include items from qualitative research evaluation checklist [Am
J Pharm Educ. 2010 Oct 11; 74(8): 141.] that were not sufficiently or at all addressed in the
manuscript.
Comments to address:
1. It is not clear whether ethics approval specifically for interviews was obtained, or if the
approval was extended from the previous survey (the ethics approval number is the same).
2. Details of who chose not to participate and why are not given. The researcher can use
demographic and other characteristics obtained in previous survey to describe who did not take
part.
3. Decision to stop data collection is not described – this is likely due to pre-limited sample size.
A statement regarding degree of thematic saturation that was seen and the need (or no need) for
further subjects should be included.
4. A-priori statements (low awareness, problems transitioning from hospital care, lines 77-83)
and survey results (lines 91-95) are mostly confirmed by the three qualitative outcome
categories. New, emerging knowledge was offered in mere glimpses (e.g. how psychological
sequalae of the diagnosis impact views of future risks, which I think is by far the most interesting
finding). I would suggest that the conclusion be reformulated to also reflect any notable novel
or contradictory findings.
5. The reason for choosing particular research methodology is not stated. Why was framework
analysis the most appropriate to answer these questions using this data?
6. The above goes to the heart of how framework analysis was performed. This is
described superficially and requires more substance and depth. In qualitative research, detailed
descriptions of the path to knowledge (which despite adherence to specific methodology is
unique to every qualitative study) will assure the audience of rigor and reliability.
7. Reflection of the influence of the researcher(s) on the data, including a consideration of
introduced bias to the results is not included.
8. Outlying or negative/deviant cases that do not fit with the central interpretation were not
presented. Given the small sample size and conclusions that are very much in line with what we
would think about these participants, I would encourage further discussion in these terms.
9. Line 292 may benefit from revision (tautology).
10. The author’s discussion of strengths and weaknesses is important and needs to be expanded
upon. Discussion of selection/information bias in the study should be extend to the conclusions.
Similar to extrapolating the characteristics of those who did not participate, a discussion of
how these findings may or may not be applicable to marginalized women, those of lower
socioeconomic status or members of visible minorities would be appropriate.
11. The statement that interviewees are representative of the target population is contradicted
in the next paragraph.
12. Discussion is well written and ties in the findings of this study to the published literature
which is mostly confirmed by the study. I would be more deliberate in highlighting and giving
details where this study contributes new knowledge.
13. Clearly, the findings will have an important role in authors’ future work locally. However,
in presenting the findings to an international audience, describe the broader context (health care
services available, current protocols, mix of rural/urban populations etc.) that readers outside of
Australia may not be familiar with.