Intimate Partner Violence against Mastectomized Women: Victims’ Experiences

Round 1

Reviewer 1 Report

The authors conducted a qualitative study to examine the intimate partner violence experiences of women with mastectomy in Brazil. Despite the positive features of the study, there are some considerations to take care before the paper is published. The following points will summarise my major comments in your paper. I hope these comments help you further improve your study.

 

In the "Introduction" section, it is very good that you describe the economic, epidemic and social emotional burden of breast cancer. But since your topic is about the intimate partner violence experiences of those with mastectomy, it is recommended to highlight the vulnerability of women with mastectomy to intimate partner violence rather than just mention the wider population of breast cancer groups. In addition, it would be better if you could do a brief literature review to describe the research gap between this study and previous studies.

 

In your "Data Collection" part, you mentioned the participant would receive "a folder explaining the phenomenon of violence against women and the networks of protection", which I think is very helpful for those women who experienced violence. One thing I concern is, when conducting the interview, how to ensure each participant know the concept of intimate partner violence, especially if you wanted to collect the data from psychological, physical and sexual perspective. I feel that if some women do not realise that some of their experiences are intimate partner violence, you may miss some information. Do you have any interview guides or other instruments to help you with that? 

 

In addition, do you use any techniques (e.g., member checking, audit trail) to enhance the trustworthiness of your research?

 

The researcher's characteristics may influence the research. So it is recommended to add some information about the researcher's characteristics to your "Method" section, such as personal attributes, qualifications/experience, and relationship with participants.

 

In your "Results" section, you reported that "most had an incomplete elementary school education". I am sorry that I am not familiar with Brazil's education system. My concern is that just seeing the distribution of education attainment, it seems like a biased sample, and may not represent the wider women population in Brazil. If you used a biased sample, it is suggested to discuss the scope of generalizability of your findings.

Author Response

Response to the Reviewer 1

Comments and Suggestions for Authors

The authors conducted a qualitative study to examine the intimate partner violence experiences of women with mastectomy in Brazil. Despite the positive features of the study, there are some considerations to take care before the paper is published. The following points will summarise my major comments in your paper. I hope these comments help you further improve your study.

In the "Introduction" section, it is very good that you describe the economic, epidemic and social emotional burden of breast cancer. But since your topic is about the intimate partner violence experiences of those with mastectomy, it is recommended to highlight the vulnerability of women with mastectomy to intimate partner violence rather than just mention the wider population of breast cancer groups. In addition, it would be better if you could do a brief literature review to describe the research gap between this study and previous studies.

Response: Thank you for this kind suggestion! We have added more information on introduction section as per recommended.

In your "Data Collection" part, you mentioned the participant would receive "a folder explaining the phenomenon of violence against women and the networks of protection", which I think is very helpful for those women who experienced violence. One thing I concern is, when conducting the interview, how to ensure each participant know the concept of intimate partner violence, especially if you wanted to collect the data from psychological, physical and sexual perspective. I feel that if some women do not realise that some of their experiences are intimate partner violence, you may miss some information. Do you have any interview guides or other instruments to help you with that? 

Response: Thank you for your careful review and your important inquiry. In the present study, the objective was to understand the perception that the woman had of the phenomenon of violence, and for her to talk about her experiences, and thus, from her speech, data emerged that reflected the violence experienced and perceived by these women. There was no objective to ensure that each participant knew the concept of intimate partner violence, whether from a psychological, physical and/or sexual point of view, but rather, the perception of the grievance.

However, consequently, it is noted in the speeches that the reports go towards the description of these three diseases, and reveal how much the violence that leaves marks is still the one that is most evident among the victims. As for the loss of information, we believe that there was not, considering that the interviews were completed considering the saturation collection method, that is, as the data are repeated, the researcher concludes the data collection, without any harm for this research, as described in the methodology.

 

In addition, do you use any techniques (e.g., member checking, audit trail) to enhance the trustworthiness of your research?

Response: In order to increase the reliability of the data, we initially carried out a pilot test of the instrument, in order to qualify and clarify the questions. Regarding the analysis, we used the content analysis technique proposed by Bardin, which includes a set of systematic procedures to describe the content of messages in order to enable the inference of knowledge related to the conditions of production/reception of these messages, covering the stages of pre -analysis, exploration of the material, treatment of results and interpretation. These aspects are described in the method section.

The researcher's characteristics may influence the research. So it is recommended to add some information about the researcher's characteristics to your "Method" section, such as personal attributes, qualifications/experience, and relationship with participants.

Response: The interviews were conducted by female interviewers, health professionals, who were not part of PREMMA and who have extensive experience in qualitative studies.

 

In your "Results" section, you reported that "most had an incomplete elementary school education". I am sorry that I am not familiar with Brazil's education system. My concern is that just seeing the distribution of education attainment, it seems like a biased sample, and may not represent the wider women population in Brazil. If you used a biased sample, it is suggested to discuss the scope of generalizability of your findings.

Response: Indeed, the age group studied are women, on average, aged 50 years and over, and, unfortunately, the results are consistent with the education profile in Brazil, where the majority in this group are women with a low level of education, according to the last census carried out in the country.

Reviewer 2 Report

The study by Franciéle Marabotti Costa Leite et al., reveals the domestic violence in conducted in a semi-structured interview mode with 16 Mastectomized brazilian women. It emphasize the importance of health professionals in screening for the IPV during treatment.

1. In data collection section, pilot study sample size mentioned is 10, in the abstarct the sample size is 16. which is correct? is the data collection questions of the pilot study were different from actual research?

2. Did authors observe any correlation with Age or degree of education Vs degree of domestic violence?

3. is  degree of domestic violence is recorded before the cancer diagnosis? if yes any significant changes in frequency of domesdtic violence before and after Mastectomy

4. The sample size of the study is too small- limit the scale of the study.

Author Response

 

Response to the Reviewer 2

The study by Franciéle Marabotti Costa Leite et al., reveals the domestic violence in conducted in a semi-structured interview mode with 16 Mastectomized brazilian women. It emphasize the importance of health professionals in screening for the IPV during treatment.

1. In data collection section, pilot study sample size mentioned is 10, in the abstract the sample size is 16. which is correct? is the data collection questions of the pilot study were different from actual research?

Response: As described in the method, before the collection itself, a pilot test was carried out to qualify the question and better understand the questionnaire. The pilot test was applied to 10 women with characteristics similar to those surveyed. According to methodological recommendations, the population participating in the pilot test should not be part of the study sample, so the final sample of the study was the 16 women described in Table 1. As for the change in the questionnaire, after the pilot test there were small grammatical adjustments for better understanding of the questions.

 

2. Did authors observe any correlation with Age or degree of education Vs degree of domestic violence?

Response:  The authors cannot infer this, once the present study was not designed to test this hypothesis.

 

3. is  degree of domestic violence is recorded before the cancer diagnosis? if yes anysignificant changes in frequency of domestic violence before and afterMastectomy

Response: We do not have this measurement, since the guiding question focused on asking about after the diagnosis.

4. The sample size of the study is too small- limit the scale of the study.

Response: Since this is a study with a qualitative approach, the saturation technique was adopted, understanding that the n reached of 16 participants was enough to achieve the objective under study.

 

 

All co-authors have agreed to the resubmission with these revisions. The manuscript is consistent with the Guidelines for Authors of the Current Oncology.

We are looking forward to hearing from you soon, and we hope to have our manuscript accepted for publication in this renowned journal.

Yours Sincerely,

The authors

Round 2

Reviewer 1 Report

No further comment.

Reviewer 2 Report

The authors have clarified all my concerns. the revised manuscript is now accepteble for publication.