Reviewer's report
Title:"It's not Easy to Acknowledge That I'm Ill": A Qualitative Investigation into
the Health Seeking Behavior of Rural Palestinian Women
Version: 6Date:22 November 2012
Reviewer: Jocelyn DeJong
Reviewer's report:
This qualitative study explores an under-researched topic on health-care seeking
behavior of Palestinian women. It is based on a carefully executed study, is well
researched with relevant literature and well written. In general the methods are
well described and rigourous.
More contextualization would be helpful for a reader not familiar with the
Palestinian setting. For example, in referring to Governmental Health Insurance-
one assumes that this is the government of the Palestinian National Authority but
this needs to be made clear. More data on what type of services were available
and their associated cost would also be useful. Moreover, more could be said
about who is eligible to receive which services. For example, UNRWA services
are restricted presumably to refugees and how people pay for services.
There are no descriptors given for quotes – was this intentional? You could do so
without undermining confidentiality and it would be useful given the purposive
sampling methodology (two different groups of women interviewed).
It is not always clear from the quotes when they reflected consensus and when
they were individual comments. For example “Quality of care was defined in
terms of respectful provider-patient interactions, shorter waiting times, and good
reputation in the community.” Was that by all women or just some or only one?
This needs to be clearer to the reader.
There is evidence of some very good reflexivity on p. 15 about the research
processes and the insights brought by involving insiders and outsiders in the
research.
Minor comments:
On page 3, the first paragraph needs more precise referencing (it is difficult to
discern which references are for what aspects).
P. 5 – ‘revised’ instead or ‘reviewed’ version of Andersen’s model?
p. 6 – refer to ‘organizational structure of health service provision’ but does not
refer to the major political barriers (roadblocks etc.) that Palestinians face in
accessing health care. Although this comes up in the discussion, it should be in
the background as well. The fact that one finding was that women did not refer to
the political situation is a very interesting one and warrants further discussion.
Ramallah – and its proximity to Jerusalem – should be described in more detail.
It should also be explained that it is the district capital.
p. 8 – to ensure privacy not confidentiality (ethically speaking, privacy pertains to
the actual interview, whether confidentiality refers to data on individuals)
Avoid acronyms (e.g. GHI) unless absolutely necessary
Nice description of methods p. 9
The kind of traditional herbal remedies that women used should be further
described.
“Women seldom utilized preventive, including screening, and education health
services in spite of their wide availability in the villages.” -- what exactly was
available?
p. 11 – third paragraph ‘what expressed’ missing a word
p. 13 “Provider’s choice for curative care..” - do you mean women’s choice about
providers?