Title: Family planning providers and contraceptive users in Rwanda employ strategies to prevent
discontinuation
Version: 2 Date: 12 Feb 2021
Reviewer's report:
Thank you for the opportunity to read such an interesting study!
It is of importance to Rwanda and other countries with similar socio-economic settings! Bravo
for doing this much work with it.
I'd like to suggest the following to make this paper stronger:
ABSTRACT
Background:
- Please clarify the research objective and research question at the very beginning and make sure
that all the sections are written in accordance with that.
-It would be good to have a bit more on the context of discontinuation…is it a global issue
or its only found in LMICs? Africa? Rwanda? Any further information on what may cause
discontinuation or any quick stats? This is an important part of the article and people need to
have a robust background on the issue and this is your chance to attract their attention to read
further into the paper so it is important to make sure that you don’t lose the readers at this very
beginning point.
-Results
- I would imagine a rather expanded finding on “how they navigate contraceptive
discontinuation”. The results reported here are a bit tangential to the aim of the study.
The results reported here suggest that the question asked was on the opinion of both providers
and users on discontinuation and not “the experiences’ of navigating the issue of discontinuation.
Also, the last two sentences suggest that discontinuation is not an issue in Rwanda. Please revise
the research question and see if the results are reported appropriately.
- Conclusion:
The conclusion does not seem to reflect the main objective of the study. Please revise and report
accordingly.
MAIN TEXT
- Background
Please provide information on what contraceptive methods were mostly used to understand the
context of their discontinuation for an opportunity to inform further studies on the topic.
It would be helpful for the reader to have more context on contraceptive use in Rwanda and
contraceptive discontinuation.
If there no enough data on Rwanda, maybe have a section on what is like in countries in the
region (Uganda, Kenya) or other similar settings where there could be more data on that and
draw on it to showcase how Rwanda positions for this topic.
Also, it would be important to give a bit of socio-demographic and politico-economic
background on the country and touch on things such as education/literacy, culture, demography,
genocide and how they relate to the increase in contraceptive use.
This section should also contain the objective and research question you’re seeking to answer.
- Methods
-Were these nurses from health centres or hospitals?
-What NGO and what gvt staff? Please expand to help the reader understand the role of them in
the recruitment process and connection with family planning users and providers.
-Please introduce the abbreviation for first use
-Please expand on the recruitment process.
-Please explain why you opted to use different methods (IDIs and FGDs) and why you
interviewed different groups (nurses, CHWs, users)
-Why six months of use for each method? Please explain more
-Please provide further information (location, population, socio-culture, beliefs) on the two
districts where data were collected to help those who are not familiar with Rwanda better
understand the results
-Please expand more on the settings where data were collected: was it in participants’ homes?
Health centres? Other locations? How were they chosen?
-Is this study part of an education program (master’s, phd, etc)? Please mention that to justify
why the ethics approval was gained from the ministry of education and not the ministry of health
-It should be mentioned earlier what demographic information was collected and why
Results
This section should contain further information on participants characteristics to helper the
readers better understand the results: for example, how old where participants (age range), how
long have they been using family planning methods, or working in the field, for users, were they
married, how many children did they have, etc. Any socio-demographic information that you
collected should be put here to better understand the contexts of discontinuation
Further comments on this section could be found through the text
Discussion
What could explain such differences between the two districts? Are they supplied with different
contraceptives? Or are there cultural differences in terms of tolerating side effects? Or education/
literacy? Or how they are informed about family planning? Fertility rates? Other resources
availability/ scarcity?
Even though this is often reported in the limitation section for various qualitative studies, it is
important to acknowledge that qualitative methods are not generalizable in nature. So qualitative
researchers, in general, should refrain from citing this as a limitation to the study :)