Does God Work in All Things to the Good of Those Who Love Him? Family Caregivers of Persons with Early-Stage Dementia Share Their Spiritual Struggles
Round 1
Reviewer 1 Report
Although this is an interesting qualitative study, there are some points for improvement:
The theoretical part needs more references to focus on the differences of spirituality/religiousness and their influence on family members and caregivers of patients with Alzheimer’s Dementia. For example, there is no mention for data concerning Orthodox Christians patients and caregivers, apart from Protestants and Catholics. Please read relevant reviews such as: Gazing at Medusa: Alzheimer’s dementia through the lenses of spirituality and religion; Subjective Quality of Life, Religiousness, and Spiritual Experience in Greek Orthodox Christians: Data from Healthy Aging and Patients with Cardiovascular Disease. One additional major methodological issue is the cutoff for age 50 and older. Why is this age cutoff chosen? Maybe the authors should reconsider this point as in general bibliography there is no relevant age limit. There is no logical explanation. Also please explain what the study flyer contained. The DCI is not explained in detail and is unclear why it is appropriate. One final point that needs to be re-examined is why Thematic Analysis was chosen instead of Interpretative Phenomenological Analysis (IPA). I strongly recommend rerunning the analyses, following IPA as more appropriate.
Author Response
Thanks for your careful review. Our responses to your comments are below.
Comment: The theoretical part needs more references to focus on the differences of spirituality/religiousness and their influence on family members and caregivers of patients with Alzheimer’s Dementia. For example, there is no mention for data concerning Orthodox Christians patients and caregivers, apart from Protestants and Catholics
Response: In the research methods section, we noted that there were not any participants in this study who self-identified as Orthodox Christians (although there were Protestant and Roman Catholic participants). We also noted in limitations section that there may be differences among caregivers of persons with dementia from different historical branches of Christianity (e.g., Orthodox, Catholic, or Protestant) and among various denominations or sects within these branches. Further research needs to be conducted.
Comment: Please read relevant reviews such as: Gazing at Medusa: Alzheimer’s dementia through the lenses of spirituality and religion
Response: What a great article! We added relevant information to the manuscript that was relevant to our focus on informal/family caregivers of persons with dementia.
Comment: Subjective Quality of Life, Religiousness, and Spiritual Experience in Greek Orthodox Christians
Response: Although there was not representation from Greek Orthodox Christians in our sample, we noted this as a limitation of the current study. Additionally, we pointed out that further research needs to be conducted among caregivers from different branches of Christianity as well as denominations and sects—and other World religions, spiritual world views and life philosophies.
Comment: Data from Healthy Aging and Patients with Cardiovascular Disease.
Response: Given that the focus of the manuscript was caregivers of persons with early-stage dementia, we did not add any references on healthy aging or patients with cardiovascular disease.
Comment 5: One additional major methodological issue is the cutoff for age 50 and older. Why is this age cutoff chosen? Maybe the authors should reconsider this point as in general bibliography there is no relevant age limit. There is no logical explanation.
Response: To participate in the study, caregivers had to be in adulthood (which is over the age of 21 in the United States). We did not include child or adolescent caregivers in the study given our interest in adult caregivers.
All those who consented to participate in the study were over the age of 50.
Comment: Also please explain what the study flyer contained.
Response: This information was added to the methods section. All materials were reviewed by 2 IRBs before being used in the study.
Comment: The DCI is not explained in detail and is unclear why it is appropriate.
Response: This information was added to the methods section
Comment: One final point that needs to be re-examined is why Thematic Analysis was chosen instead of Interpretative Phenomenological Analysis (IPA). I strongly recommend rerunning the analyses, following IPA as more appropriate.
Response: Although we did not utilize the correct terminology, we did indeed utilize an IPA approach to conduct the study and analyze the data. Per Jonathan Smith, an IPA researcher, this is an excellent methodology for examining spiritual/religious issues in participants as well as health literature. This is reflected in a revision of the methodology section. We are grateful that you pointed this out to us.
Reviewer 2 Report
Dear Authors,
I thank you for giving me the opportunity to read this your manuscript, submitted for publication in Religions.
I have very few comments.
TITLE: I propose to modify as following: ......persons with early-stage dementia, because this newer title is more relevant to your Research Design and Methods.
REFERENCES: reference list should be expanded and updated.
Author Response
Thanks for your careful review. Our responses to your comments are below.
Comment: TITLE: I propose to modify as following: ......persons with early-stage dementia, because this newer title is more relevant to your Research Design and Methods.
Response: Thanks for suggesting the new and more descriptive title which more accurately represents our population of interest and the sample used in the study. We have changes the title to: “Does God work in all things to the good of those who love Him? Family caregivers of persons with early-stage dementia share their spiritual struggles"
Comment: reference list should be expanded and updated.
Response: The reference section was updated and expanded.
Reviewer 3 Report
Dear authors. I liked so much review your manuscript. It is a great study. However, I suggest sot make some improvements.
1) Section-Research Designs and Methods
You wrote, "there were more women (57.1%)". With the dimension of this sample, I doubt if this result is an absolute majority. Without the binomial test, you cannot make that assumption.
To describe the age, you use the average and SD. Did you make the normality evaluation to decide if you should use the average/SD or median/IQR? If yes, please write that in the text. If not, evaluate and determine which measures are the right.
In the inclusion criteria, you do not include the mentioned above in the subsection (participants)_"their loved one with dementia had formally diagnosed with dementia no longer than 2 years". Also, age as an inclusion criterion should be explained.
2) page 10, line 431
you have a small mistake which made a broken line
3) Conclusions
You use references in this section which is not correct. In conclusion, we only must see the answer to the research questions. As the analyses facing the references must come into the discussion. Please correct.
Congratulations
Author Response
Thanks for your careful review. Our responses to your comments are below.
Comment: You wrote, "there were more women (57.1%)". With the dimension of this sample, I doubt if this result is an absolute majority. Without the binomial test, you cannot make that assumption.
Response: This is a good point. We changed the text to reflect simply that the sample was comprised of approximately 60% women and 40% men. Given that the purpose of our study was not to compare women and men caregivers, we wanted the reader to know this general demographic.
Comment: To describe the age, you use the average and SD. Did you make the normality evaluation to decide if you should use the average/SD or median/IQR? If yes, please write that in the text. If not, evaluate and determine which measures are the right.
Response: There was not a normality evaluation conducted to specify whether the average/SD or median/IQR would be the most appropriate way to describe age in this study. We used the mean/SD given that age was a continuous (rather than categorical) variable in this study.
Comment: In the inclusion criteria, you do not include the mentioned above in the subsection (participants) "their loved one with dementia had formally diagnosed with dementia no longer than 2 years". Also, age as an inclusion criterion should be explained.
Response: We added this information to the participant section. Participants had to be 21 years of age or older to participate (given our focus on adult caregivers). All of the participants in this study, however, ended up being over the age of 50. This information was clarified in the manuscript.
Comment: You have a small mistake which made a broken line (page 10, line 431).
Response: Thank you for letting us know about the broken line. We have corrected this.
Comment: Conclusion section: You use references in this section which is not correct. In conclusion, we only must see the answer to the research questions. As the analyses facing the references must come into the discussion. Please correct.
Response: The citations that were included in the conclusions section for the first submission were removed to reflect only what we learned in this particular study. As appropriate, these citations were moved to the discussion section.
