Title: The effect of a training program on maternal role adaptation and self-esteem of mothers
with preterm infants: a quasi-experimental study
Version: 3 Date: 31 May 2021
Reviewer:  Kaboni Whitney Gondwe
Reviewer's report:
Abstract more than 350 words please be concise and follow the journal
guidelines on https://bmcwomenshealth.biomedcentral.com/submission-guidelines/preparing-
your-manuscript/research-article
Introduction
This is a great paper that tackles issues of maternal stress, mother-infant relationship, and
adaptation to motherhood. The paper highlights potential factors that have adverse effects of
adaptation to motherhood after birth
Check the formatting and it would benefit from revisions to make it clearer and more concise
Line 88, are the authors saying low-birth weight causes preterm birth or most low-birth weight
are as a result of preterm birth?
Line 104-107 – revise it is confusing you bring in so many factors and it is not clear if you are
talking of the family or mother then you finish it talking of the mother
Line 124-126 – what neonatal complications are as a result of maternal role maladaptation? Or
do you mean maternal complications? Or both? Anxiety/stress and maternal confidence are all
maternal issues and mother-infant interactions is a dyad
The aim of the study is to “explore the effect of implementing the training program on maternal
role adaptation and the self-esteem of mothers of preterm infants admitted to the neonatal
intensive care unit” What are your hypothesis?
Methods
The design of the study is appropriate for the study as the authors are testing the effects of a
training program
150-154 – check the formatting. How did you conduct the power analysis? Was any software
used to make the calculation?  Was the estimated 74 mothers a total or for each group. This
section does not clearly state these issues
Separate the intervention from ethical consideration and data collection that will give the authors
an opportunity to describe the intervention in-depth and fidelity and how it was administered to
prevent contamination between intervention and control group. Some of the information written
in this section also belong to the sampling and recruitment section such as lines 164-179. Try to
check CONSORT guidelines for a better clarification on your sections
In instruments use subsections to make it easier to read how each variable was measured. If you
add a clearer data collection section please clarify the time points
Data analysis – the study had two groups and pre and posttest (repeated measurement). How
did you compare the change over time between groups? T-test allows you to examine cross-
sectionally I am wondering if the statistician considered other statistical approaches to examine
between group differences and change over time while controlling for significant factors that
differed between the intervention and control groups. And you mention paired t-tests as well
which works for one group pre and posttest designs but you described this as between groups.
The following variables were significantly different between the two groups: age, how did you
control for this. Try to also look at percentage of first-time mothers versus multiparas. Did
you consider income as a continuous variable? Same with birthweight, days on mechanical
ventilation, length of stay,
In the tables you mention growth as an outcome but it is not mention on your specific aims – if
you add specific aims or hypothesis. You add in more variables that aren't highlighted in your
question. You need to either add specific aims and hypothesis to capture all relation including
the possible relationship between your outcome variables. Self esteem is a potential mediator
for role adaptation
References – missing DOIs please check the authors guidelines and they need to be presented as
a whole URL. Reference number 24 is formatted differently from the rest with al capital letters
Looking forward to reading a revised version if it is resubmitted