Dear reviewers and editors,
This author greatly appreciates the reviewers and the editors’ careful reading of my manuscript
and thoughtful comments. My responses are indicated below in red. Also, the changes made in
the text are marked in red as well.
Response to comments from Editor:
Please state in the manuscript whether informed consent was given to publish the data in Table
1. The informed consent included publishing findings of the research but not specific to the
data in the table 1. If editor feels the information on the table 1 is too specific, I am more than
happy to work with the editor.
Title page
Please include a title page at the front of your manuscript file. It should contain, at minimum,
the names, institutions, countries and email addresses of all authors, and the full postal address
of the submitting author. Please see the title page.
Abstract
Please format your abstract according to the instructions for authors. It should contain
Background, Methods, Results and Conclusions subsections. Potential referees will be asked
to review the manuscript having seen only the title and abstract, so it is important that these
are both informative and concise. We therefore ask the abstracts be no more than 350 words
long. Please see the attached Abstract.
Competing interests
Please include a 'Competing interests' section between the Conclusions and Authors'
contributions. If there are none to declare, please write 'The authors declare that they have no
competing interests'. Competing interests sections were included in the text.
Authors' contributions
Please include an Authors' contributions section before the Acknowledgements and Reference
list. The authors’ contributions section was included in the text.
Response to Reviewer #1’s comments:
1. Is the question posed by the authors well defined?
The aim of the study is defined in a more general sense which not fully accommodate to the
experience of the persons participating in the study. Most of the participating persons have a
parent/child relationship and the paper will improve by more specific focusing on this
relationship, both in aim and in title of the paper.
Please see the revised title, abstract, and methods section.
2. Are the methods appropriate and well described?
The method chosen, Interpretative phenomenological study/analysis is appropriate for the
purpose of the study and well described. The author has, both in the method section as well as in
the discussion section, to justify the small sample of only 5 participants, for the analysis.
In this study, a two stage sampling strategy was used: first, three participants were interviewed to
examine feasibility of recruitment strategies and the analytical frame. And then, we further
recruited more participants. Having very specific research questions and an analytical foreground
justify the small sample size of this study. Furthermore, as noted in the limitation section, the
heterogeneity of participants may have limited the variation in the patterns of caregiving
experience, limiting the need to recruit large number of participants. These points were added in
the methods section, the discussion section, and the limitation section.
The design section needs to be supplemented with some information of the patients situation, at
least with sex, age, and diagnoses. Please see the Table 1. The patient’s age and diagnoses were
provided. The gender of the patients was not provided because gender, age, and diagnosis may
make the patient and the caregiver identifiable.
In the procedure section in the second paragraph the authors tells us the interviews focused on
the habits and practices. I cannot find anything about habits in the aim. Please clarifie.
The term habits are used to highlight the actions the participants take in the context of taken-forgranted social mores (in this case, Confucian tradition of family caregiving).
3. Are the data sound?
The data seems partly sound. The authors have found three caregiving patterns discerned in this
parent/child sample: creating a small world, prioritizing education over the relationship and
reciprocating the sacrifice. Concerning the pattern creating a small world other framings might
also been used, as “Insulation from the outside world” and the patterns of prioritizing education
over the relation might be changed to “Prioritizing education over well-being” in order to adapt
to the findings shown in the paper. Indeed, the reviewer’s suggestions better capture my
understanding of the three patterns. Hence, the suggested framing was used. Please see text.
4. Does the manuscript adhere to the relevant standards for reporting and data deposition?
Yes
5. Are the discussion and conclusions well balanced and adequately supported by the data?
See p.2 above. Addressed
6. Are limitations of the work clearly stated?
Also see p.2 above Addressed
7. Do the authors clearly acknowledge any work upon which they are building, both published
and unpublished?
The introduction section holds different wording that need to be strengthened by references. For
instance the wording” in the first paragraph “Failure to provide culturally appropriate care may
have significant health consequences for minority groups in particular” and in the next paragraph
“Whereas some cultural groups may expect the patient’s family to be included in decision
making regarding treatment, others may consider such decision generally up to the patient”. In
the background section the figures of Korean American population needs to be updated later than
2000. The introduction section was revised slightly and references were updated.
8. Do the title and abstract accurately convey what has been found? See p. 1 above See revised
title and abstract
9. Is the writing acceptable?
The writing is acceptable, but a revision of the language will improve the paper, for instance in
the section procedure, the sentence starting with ”Verbatim data were …..” Please see the revised
text.
Level of interest: An article of importance in its field
Quality of written English: Needs some language corrections before being published. The
revised manuscript was reviewed by an editor for English language use.
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests: I declare that I have no competing interests
Response to Reviewer #2;
This was a qualitative study with a total of 6 family caregivers were being interviewed. The
study addressed an important topic in mental health care. However, the study could not be
published in its present format. Please find the following comments for major compulsory
revisions:
1. A total of 6 caregivers were interviewed. The authors could state the criteria for determining
the number of sample. Please see the revised methodology section
2. The caregivers were taking care of people with different diagnoses, e.g. schizophrenia and
dementia. The caregiving demands and experiences could be very different. I wonder
whether data saturation was reached in the study. The authors may have to explain why
interview such a diverse group which was not homogeneous.
Psychiatric diagnoses, as recurring and chronic illness, shares common characteristics in
terms of symptoms and management. Furthermore, managing mental illness shares common
characteristics with other chronic diseases, such as diabetes. In our study, we did not observe
a distinctive variation in caregiver practice by patient’s diagnosis. The finings of current
study are consistent with the literature on family caregivers of individuals with chronic
disease.
This findings, however, does not mean that we will not find such variation in our future study
with different participants. I agree with the reviewer that it would be a worthy endeavor to
examine if the patient’s diagnosis makes a difference in the caregiver’s experience. A larger
sample size and more specific diagnosis-based recruitment may allow us to see some
variation. We can examine this in a future study, building on our current analysis. This point
was already articulated in the discussion section.
In interpretive phenomenology, one does not seek saturation as in other phenomenological
traditions or in grounded theory. Rather, the analysis focuses on the differences and
commonalities among the participants’ experience. The commonality of the participants’
experience in this study is that they ‘organize the care of mentally ill family member based
on Confucian notion of family.’ This overarching commonality was further categorized in
three caregiving practices. Within these three caregiving practices, we observed variations.
3. The paper did not elaborate on the duration that the caregivers had engaged in taking care
of the person with mental illness. Duration of care has a great impact on caregivers' stress
and experience which was not discussed in the paper. Indeed, the duration of caregiving
may have a great impact on caregiver stress and on how caregivers organize their
activities. However these were not within the scope of analysis of this paper. This point
was added in the limitation section and suggested for a future study.
4. The study was condcuted in 2006-2007. Given that now is in Aug 2012 and the changes
in service provision, would the data still be relevant? The current study is very much
relevant to current mental health services in the U.S. For the past 5 years, there has been
little change in service provision for immigrants with mental illness and their families.
Furthermore, little improvement has been made in supporting family caregivers in
minority families. More importantly, the influence of Confucianism on East Asian
(including Koreans) and their descendents remains consistent.
4. Need to discuss the ethical considerations of the study.
The research study was approved by the University of California, San Francisco, Committee
on Human Research. Please see the last paragraph of the procedure section.
6. What were the limitations of the study? Please see the limitation section.
Level of interest: An article whose findings are important to those with closely related
research interests
Quality of written English: Needs some language corrections before being published
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
'I declare that I have no competing interests'