Breastfeeding Perceptions and Decisions among Hispanic Participants in the Special Supplemental Nutrition Program for Women, Infants, and Children: A Qualitative Study

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The article by Fisher et al. addresses, from a qualitative perspective, the decision to exclusively breastfeed or formula feed in women who are pregnant, or during the postpartum period, but whose sociocultural context of gestation is not the mother's native one.  It knows that the social pressures affect breastfeeding. This data shows that support, even if it is linguistic, for mothers helps critically to promote breastfeeding and health services have to echo these data. 

My comments are minor:

- In the material and methods could mention which questions were asked in the interview, and give more information about the coding in the 3 stages (line 130).

- Is there some kind of statistical analysis between age, rural/urban context, etc.?

- When reading the material and methods, it is not mentioned that sociodemographic variables such as age, socioeconomic level, educational level, or marital status were collected and then reported in the results.

- Table 1 is repetitive with the data in the previous text. 

- Line 206 does not mention that it is the acronym BF. 

- Lines 317 - 323 could be moved to discussion.  

Author Response

Responses to the Reviewers

 

Reviewer 1

• The article by Fisher et al. addresses, from a qualitative perspective, the decision to exclusively breastfeed or formula feed in women who are pregnant, or during the postpartum period, but whose sociocultural context of gestation is not the mother's native one.  It knows that the social pressures affect breastfeeding. This data shows that support, even if it is linguistic, for mothers helps critically to promote breastfeeding and health services have to echo these data. 

Responses: We appreciate the reviewer’s positive comments.

• In the material and methodscould mention which questions were asked in the interview, and give more information about the coding in the 3 stages (line 130).

Responses: As suggested, we provided more information about the interview questions and coding (Lines 123-138, 147-158).

• Is there some kind of statistical analysis between age, rural/urban context, etc.?

 

Response: Since this is a qualitative study with a small sample, we didn’t conduct any additional statistical analyses, which won’t be informative.

 

• When reading the material and methods, it is not mentioned that sociodemographic variables such as age, socioeconomic level, educational level, or marital status were collected and then reported in the results.

 

Response: Thank the reviewer for the comments. We’ve added more details about the data collection (Lines 106-111).

 

• Table 1 is repetitive with the data in the previous text.

Response: We removed the repetitive text.  

 

• Line 206 does not mention that it is the acronym BF. 

Response: We spelled out the BF (Line 226).

 

• Lines 317 - 323 could be moved to discussion.  

Response: We appreciate the reviewer’s suggestion. Since some statements are the interview results, we condensed the sentences and moved some implications to the discussion (Lines 326-328, 466-468).

Reviewer 2 Report

Comments and Suggestions for Authors

I have read this paper with great interest and value the efforts made. However, I do have some mainly method section related comments

Perhaps this reads somewhat bizar, but how has 'Hispanics' been defined ? It does not seem (cfr results) language, with beyond second generation, i assume that the 'country of origin' also is a difficult issue. How has this been defined within the WIC program, and within the study. Is this self declared race ? 

On the recruitment, there seems to be - in my reading - a conflict between line 107-108 (postpartum, 6 months) to line 118 and the subsequent recruitment (pregnant and postpartum). I'm more than fine in recruiting both pregnant and postpartum women, but i do not yet fully understand this section. 

related to section 3.1. (perhaps for the discussion): how 'representative' are the recruited participants to the relevant to the topic Hispanic community included in the WIC program (socioeconomic, setting)

Editing: the abbreviation should be in full in the title as WIC program is likely unknown to the international readership. 

Author Response

 

• I have read this paper with great interest and value the efforts made. However, I do have some mainly method section related comments.

 

Response: We appreciated the reviewer’s positive comments.

 

• Perhaps this reads somewhat bizar, but how has 'Hispanics' been defined? It does not seem (cfr results) language, with beyond second generation, i assume that the 'country of origin' also is a difficult issue. How has this been defined within the WIC program, and within the study. Is this self declared race? 

 

Response: Hispanic is a self-reported ethnicity, which is defined by the U.S. Census Bureau as “a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race. We clarified it in the manuscript (line 106).

 

• On the recruitment, there seems to be - in my reading - a conflict between line 107-108 (postpartum, 6 months) to line 118 and the subsequent recruitment (pregnant and postpartum). I'm more than fine in recruiting both pregnant and postpartum women, but i do not yet fully understand this section. 

 

Response: Sorry for the confusion. We significantly revised the section and hoped to clarify the recruitment procedure (Lines 106-113).

 

• related to section 3.1. (perhaps for the discussion): how 'representative' are the recruited participants to the relevant to the topic Hispanic community included in the WIC program (socioeconomic, setting)

 

Response: Since this is a convenient small sample for a qualitative study, we are not seeking representativeness as in a large quantitative study.

 

• Editing: the abbreviation should be in full in the title as WIC program is likely unknown to the international readership. 

 

Response:  We revised the title as suggested. Thank the reviewer for the comments.

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

the revision has been made along the suggestions provided

no additional comments