Children Suspected for Developmental Coordination Disorder in Hong Kong and Associated Health-Related Functioning: A Survey Study

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

To who it may concern

The introduction is well written but it seems that the authors are at times not yet clear of the specific aim of the study. Make sure you keep in mind that the title, what you write in the introduction and your aim are all in line with each other. Furthermore, the authors makes a lot of statements without the appropriate sources and should add it. My main concern was also why use the DCDQ if the DCDQ'07 which is a newer version is available? Was it not available in your language?

 

Regarding the material and methods the participants were well described, you need to remember that although parents give consent for children to take part in research that children should also be asked if they want to take part, it is also their right to say no and therefor they need to provide assent to the researcher in order to take part.

Instruments was well elaborated on.

The results are my main concern. Regarding table 1, the authors on give information on the age group of children, nothing is mentioned on the sex, age group of parents, education of parent or the household monthly income. So why gather the information if it is not reported on?

Point 3.1 is a paragraph describing information, however, there is no figure or table illustrating the information or stating where to find the information. I think you need to add a table of some sort.

Regarding your prevalence, I am of the opinion that if you take this 18% and test them on a standarized test such as the MABC-2 and apply the DSM the number might change. You only used the perception of the parents which can be very subjective.

Maybe start 3.2 with Table 2 illustrates..... cause the reader are not sure where to find what he/she is looking for. In addition there is a lot more you can elaborate on in this table if needed.

In the discussion, you talk about studies, but you need to indicate who were the authors, what was the study, how many children, boys and girls, what was the age, where was the study and then the outcome. 

In your discussion you talk about the lower-income, but you did not have a table and discussion on those topics in the results section. You will need to add those topics in the results section and elaborate on them in order to discuss it in the discussion which is needed cause it is part of your study.

See other feedback on the article itself.

Thank you for the opportunity and good luck.

Kind regards

 

Comments for author File: Comments.pdf

Author Response

To who it may concern

1. The introduction is well written but it seems that the authors are at times not yet clear of the specific aim of the study. Make sure you keep in mind that the title, what you write in the introduction and your aim are all in line with each other. Furthermore, the authors makes many statements without the appropriate sources and should add them. My main concern was also why use the DCDQ if the DCDQ'07 which is a newer version is available? Was it not available in your language?

Thank you for the comments about our Introduction. In addressing further comments below, we believe that we are better able to establish consistency of the rest of the manuscript with our research aims. We clarified that the primary aim of the study is to estimate the prevalence of suspected DCD, whereas the secondary aim is to explore the association of motor difficulties with health-related daily functioning (see section 1, p. 3).

With respect to concerns related to the version of the DCDQ, we acknowledge that the DCDQ’07 is the updated version. However, the DCDQ was the version adapted for Chinese-speaking populations (Tseng et al., 2010) and was validated in a Hong Kong sample (Chung, 2018). We have made this clearer in the manuscript (see section 2.1, p.4).

2. Regarding the material and methods the participants were well described, you need to remember that although parents give consent for children to take part in research that children should also be asked if they want to take part, it is also their right to say no and therefor they need to provide assent to the researcher to take part.

We appreciate the reviewer’s comment regarding the need for child assent in research studies involving children. In our study, we focused solely on gathering information from parents through the DCDQ questionnaire, which assesses their children's developmental coordination. Since the children did not directly participate in any data collection, we did not seek their assent. This approach was reviewed and approved by the institutional research ethics committee. Nevertheless, we recognize the importance of child assent in research contexts where children are active participants. We have clarified in our methods (see section 2.1, p. 3) that the parents were the individuals we recruited and from whom we obtained informed consent. Thank you for highlighting this important ethical consideration.

3. The instruments used were well elaborated.

 Thank you for your comment.

4. The results are my main concern. Regarding table 1, the authors on give information on the age group of children, nothing is mentioned on the sex, age group of parents, education of parent or the household monthly income. So why gather the information if it is not reported on?

 We appreciate the reviewer's insightful comments regarding the Results section. To clarify, our intention in summarizing the data in Table 1 was to streamline the manuscript and encourage readers to refer directly to the table for detailed information. However, we understand the importance of providing a brief overview of key characteristics, including the sex of the children, age groups of parents, education levels, and household income. In response to your feedback, we added a concise paragraph that summarizes these aspects to enhance clarity and ensure that all relevant information is readily accessible to readers (see section 3, p.6). Thank you for your valuable input.

5. Point 3.1 is a paragraph describing information; however, there is no figure or table illustrating the information or stating where to find the information. I think you need to add a table of some sort.

Thank you for the suggestion. We have added a table summarizing the odds ratios (OR) to help the reader clearly see the factors that potentially contribute to being categorized as suspected for DCD (see Table 2).

6. Regarding your prevalence, I am of the opinion that if you take this 18% and test them on a standarized test such as the MABC-2 and apply the DSM the number might change. You only used the perception of the parents, which can be very subjective.

 We appreciate the reviewer’s valuable feedback regarding the prevalence findings in our study. We acknowledge that the use of standardized tests, such as the MABC-2, along with DSM-5 criteria, is necessary to establish the prevalence of diagnosed DCD. In our manuscript, we have included a discussion of this limitation in terms of strengths and limitations (see section 4.1, p.10), highlighting that our findings are based on parental perceptions through the DCDQ and that the instrument is only able to categorize children as suspects for or probably not DCD. We agree that further research incorporating standardized assessments is necessary to accurately determine the prevalence of DCD in children, and we acknowledge in the manuscript that such further assessments may reveal different prevalence rates. Thank you for your insightful comment.

7. Maybe start 3.2 with Table 2 illustrates..... cause the reader are not sure where to find what he/she is looking for. In addition, there is a lot more you can elaborate on in this table if needed.

 We appreciate the reviewer's suggestion regarding the introduction of section 3.2. In response, we have amended the paragraph to begin with a reference to Table 2, which enhances clarity and helps guide the reader to the relevant information (see p. 6).

8. In the discussion, you talk about studies, but you need to indicate who were the authors, what was the study, how many children, boys and girls, what was the age, where was the study and then the outcome.

Thank you for the comment. We revised the discussion significantly, and we now discuss our findings with reference to global estimates of the international clinical practice recommendations for DCD (Blank et al., 2019). We highlight that the current study established prevalence estimates for sDCD, which are expected to be higher than those for diagnosed DCD. We discussed other studies that used the DCDQ and estimated sDCD prevalence and now provide further details, such as the location and age range of the participants. This discussion illustrates that the range of sDCD prevalence estimates tends to be higher and wider than that of diagnosed DCD prevalence estimates (see section 4, p. 8).

9. In your discussion you talk about the lower-income, but you did not have a table and discussion on those topics in the results section. You will need to add those topics in the results section and elaborate on them in order to discuss it in the discussion which is needed cause it is part of your study.

We have added a paragraph in the Results section on the characteristics of the parents and their children, including household income (see section 3, p.6). We reported the contribution of income to the likelihood of being categorized as a suspect for DCD in the paragraph in section 3.1 (p.6). Table 2 (see p. 6) now further reports the results related to household income, which sets us up for the Discussion, as suggested by the reviewer.

Reviewer 2 Report

Comments and Suggestions for Authors

minor comments are as following:

1. Participants: could you please clarify the inclusion and exclusion criteria of participants? I only see the inclusion criteria. for example how about rater's educational level. 

2. Discussion: I noted that authors tried to explain the high prevalence of sDCD may be due to COVID-19 period. However, I am considering the other possible reasons such as rater's high expectation for their child's motor competence? do you conduct any motor performance tasks to identify child motor competence in daily context? 

Author Response

Minor comments are as following:

1. Participants: could you please clarify the inclusion and exclusion criteria of participants? I only see the inclusion criteria. for example, how about a rater's educational level.

Thank you for the clarification. Using quota sampling, we aimed to obtain a population-representative sample that reflected the distribution of children across the three major districts of Hong Kong and the proportions of male and female children. Our inclusion criteria were determined by the age cutoff for DCD diagnosis (i.e., 5 years) and residence in Hong Kong. Because the recruitment and administration were conducted through online platforms, parents who were unable to read/understand text on screens or who were not engaged with digital platforms were effectively excluded. We now state these exclusions in the manuscript (see section 2.1, p. 3). We also acknowledge in the Discussion that this poses a limitation to the generalisability of our findings (see section 4.1, p.10).

2. Discussion: I noted that authors tried to explain the high prevalence of sDCD may be due to COVID-19 period. However, I am considering other possible reasons, such as the rater's high expectation for their child's motor competence. Do you conduct any motor performance tasks to identify child motor competence in the daily context?

 We appreciate the reviewer’s thoughtful comments regarding the high prevalence of sDCD in our study. In response, we have included a paragraph in the discussion section addressing rater bias as a potential contributing factor. We acknowledge that parents' heightened expectations regarding their children's motor competence may influence their perceptions and assessments of motor difficulties (see section 4, p. 8).

 Additionally, we would like to clarify that our study did not include any motor performance tasks, as our primary objective was to estimate the prevalence of sDCD with a survey-based approach using the validated DCDQ. This design allowed us to gather data from a population-representative sample of parents who reported their perceptions of their children's motor abilities without direct assessment of motor skills. However, we acknowledge the limitations of our approach (see section 4.1, p.10) and recommend that future studies collect data through direct observations and assessments of motor competence to provide a more comprehensive understanding of children's abilities. Such research is underway, and we expect that this will help us validate the findings from our current study and further explore the relationship between perceived and actual motor skills.

Reviewer 3 Report

Comments and Suggestions for Authors

This study assesses the prevalence of DCD in Hong Kong using the Chinese version of the DCD-Q and also examines its relationship with other health indexes such as physical activity, global health, positive affect and cognitive functioning as well as with the demographic characteristics. Findings indicate a prevalence rate of”19% DCD suspects in Hong Kong which is more than the previously reported studies. They also found a positive correlation with the global health, positive affect and cognitive functioning but not with the PA levels. In addition, older age and lower income level were related to higher level of DCD suspects.

It is irrefutable that early assessment and intervention of DCD is extremely important and yet it is amongst some of the most overlooked developmental disorders in childhood worldwide. So, this study does contribute to the awareness and estimation of the prevalence of DCD in the Hong Kong area. The manuscript is overall well written and well executed. It does contribute to calling for a more vigorous assessment, followed by early intervention of the children that are at a higher risk of DCD, given DCD is not something that children just grow out of but in fact affects other domains of life. With that said, I also thing that the manuscript in its current form requires major revision and needs to address certain things before it can be accepted for publication. Below are my recommendations to the authors that could potentially help improve the manuscript.

Introduction and Literature Review:

1.      Overall introduction does capture important points and has good literature review. However, its structure can be improved to make it read more coherent and have a better flow. Certain paragraphs do not seem to transition well. For example, paragraph 2, 3 and 4 can be structured to have a better flow and transition.

2.      Authors mention that a previous study was conducted in Hong Kong for the validation of DCDQ. I think it is important to explain how this study is different from the previous one. Also, more importantly, why is this study needed if a validation study exists that has provided DCD estimation in Hong Kong? Authors should provide a more elaborate reasoning for the need of this study and how does it contribute to the existing literature.

Method and data analysis:

1.      The study main aim is to estimate prevalence of DCD in Hong Kong. Although, the sample size is large, it is important to know if the participants were concentrated from three districts or were from a more widespread area. The findings can be generalized, especially the prevalence rate, if the participants were from a widespread area of Hong Kong. Authors should provide more information on demographics of the participant pool as in how widespread the area covered was.

2.      In the method section first paragraph, it is mentioned that 632 was the final sample that had all the responses. However, in the result tables, missing response frequencies are reported. So, it is unclear if the data analysis was conducted only on participants that had complete responses or responses with missing entries was included. Missing data information is important to be reported. It is important to report the number of missing entries, how was missing data handled, what was the missing data pattern and subsequently how the data was analyzed. I suggest referring to the missing data study by Patel et al., 2021 and reporting the missing data information accordingly.

3.      How was the reliability testing conducted? Reliability testing is a critical aspect of survey-based assessments to assess the credibility of the participant responses. As the authors also mention that the survey results can often be biased by participants perceptions, reliability testing can help to make the results more credible. In case the reliability testing was not conducted, it is a major limitation and should be reported explicitly.

Results and Discussion:

1.      The results from this study should be analyzed and discussed in relation to the previously conducted validation study in Hong Kong. Authors do compare the prevalence rate but it needs to be explored and discussed in more depth. This is especially important since the prevalence rate was a lot higher in this study. Why was it higher? How were the two studies different that led to the difference in the rate? Was there a major difference in the areas that the participant pools were obtained for the two studies? All these aspects need to be discussed as both the studies provide an estimation of DCD prevalence and to get a clear idea on what prevalence rates are more generalizable.

2.      Authors compare their prevalence rate with a few other DCD prevalence rates in other countries. However, the DCDQ has been validated and used to assess prevalence rate in so many other countries. Comparing findings with just a couple other countries could lead to a problem of selection bias and interfere with fully understanding the current study findings.

3.      In addition, there has been multiple studies conducted within the same country to assess prevalence rate in different areas. For example, authors compare their results with the Komal et al., 2014 study which was conducted in one part of India. It is not representative of the prevalence rate of DCD in India and reporting it so will be inaccurate. There are several other studies conducted in different parts of India to measure the prevalence rate, and the authors should consider all these studies.

4.      I agree with the authors that the higher prevalence rate especially in the older kids could be a result of the parents bias due to the COVID restrictions. I am wondering why a motor competency test was not conducted. A test on parental perceptions of their child's motor competency should help rule if the results were because of a perception bias or an actual lagging of motor skills in children. This could particularly help since positive correlation was not found with the PA levels.

5.      Overall, the discussion in its current state can be improved by comparing the findings with the existing literature. Currently, the authors report a few other studies, but a more comprehensive comparison and discussion is required. Authors do provide and discuss the different reasons for their findings but when it comes to estimating the prevalence rate for a large area, it is important to discuss these findings in relation to what is seen in different parts of the world. The whole idea of prevalence rate is to map out the state of DCD worldwide. And so, to generalize the current findings and make more meaning of it, the findings should be assessed from a more comprehensive perspective.

My comments are as well in the document attached.

Comments for author File: Comments.pdf

Author Response

Below are my recommendations to the authors that could help improve the manuscript.

Introduction and Literature Review

1. Overall introduction does capture important points and has good literature review. However, its structure can be improved to increase its coherence and improve flow. Certain paragraphs do not seem to transition well. For example, paragraphs 2, 3 and 4 can be structured to have a better flow and transition.

Thank you for your constructive feedback regarding the coherence and flow of the introduction. We appreciate your recognition of the important points and literature review presented in our work. In response to your comments, we have rearranged the information across paragraphs 1 to 5 to enhance the overall structure and improve the transitions between key ideas. Specifically, we organized the content to first introduce DCD and its prevalence, followed by diagnostic criteria and challenges, then discuss alternative screening methods, and finally contextualize these issues within Hong Kong. This restructuring aims to create a more logical progression of ideas and ensure that each paragraph flows smoothly into the next. We believe these revisions significantly enhance the clarity and coherence of the introduction. Thank you again for your valuable insights.

2. Authors mention that a previous study was conducted in Hong Kong for the validation of DCDQ. I think it is important to explain how this study is different from the previous one. Additionally,  more importantly, why is this study needed if a validation study exists that has provided DCD estimation in Hong Kong? Authors should provide a more elaborate reasoning for the need of this study and how does it contribute to the existing literature.

We reported the results of the validation study of the DCDQ in the Methods section in relation to the suitability of the instrument for Hong Kong participants. We acknowledge the reviewer’s point that we need to justify why our current study is needed despite the existence of this validation study. We have elaborated on this in the introduction (p.2), which explains that while previous studies in Hong Kong have reported percentages of children being categorized to have DCD (or sDCD), none of these studies specifically aimed to estimate prevalence rates and did not involve population-representative samples.

Methods and data analysis:

3. This study aims to estimate the prevalence of DCD in Hong Kong. Although the sample size is large, it is important to know whether the participants were concentrated from three districts or were from a more widespread area. The findings can be generalized, especially the prevalence rate, if the participants were from a widespread area of Hong Kong. Authors should provide more information on demographics of the participant pool as in how widespread the area covered was.

Thank you for the clarification. We adopted a quota sampling approach to recruit a population-representative sample that reflects the distribution of the target population in the three areas (i.e., Hong Kong Island, Kowloon, New Territories) across the territory of Hong Kong and the proportion of males and females. We wish to clarify that these three areas constitute the whole of Hong Kong. We have made this clearer in the manuscript (see section 2.1, p. 3).

4. In the Methods section of the first paragraph, 632 was the final sample that had all the responses. However, in the result tables, missing response frequencies are reported. Therefore, it is unclear if the data analysis was conducted only on participants who had complete responses or responses with missing entries included. Missing data information is important to be reported. It is important to report the number of missing entries, how was missing data handled, the missing data pattern and, subsequently, how the data were analyzed. I suggest referring to the missing data study by Patel et al., 2021 and reporting the missing data information accordingly.

Thank you for clarifying this. We erroneously wrote the numbers for the number of responses and the final sample, hence the discrepancy of numbers with the tables. We received 716 responses that met our inclusion criteria; N = 656 respondents completed the DCDQ and PROMIS questions, forming our final sample. We adopted a complete case analysis approach in the logistic regression analysis when demographic data were missing since they accounted for negligible portions of the sample (i.e., no more than n = 2 missing, 0.31% of the data). We reported this in the revised manuscript (see section 2.1, p. 3; section 2.3, p. 4--5). The correct sample sizes are also reported in the table and figure titles.

5. How was the reliability testing conducted? Reliability testing is a critical aspect of survey-based assessments to assess the credibility of participant responses. As the authors also mention that the survey results can often be biased by participant perceptions, reliability testing can help to make these results more credible. If reliability testing is not conducted, it is a major limitation and should be reported explicitly.

 We established acceptable levels of internal consistency for the DCDQ and the PROMIS scales. However, we acknowledge that no further tests of reliability were performed. We agree with the reviewer that this limitation of the study could be related to bias in the parents’ estimations of their children’s performance. We now explicitly acknowledge this in the limitations (see section 4.1, p. 10).

Results and Discussion

6. The results from this study should be analyzed and discussed in relation to the previously conducted validation study in Hong Kong. Authors do compare the prevalence rate but it needs to be explored and discussed in more depth. This is especially important since the prevalence rate was high in this study. Why was it higher? How were the two studies different that led to the difference in the rate? Was there a major difference in the areas in which the participant pools were obtained for the two studies? All these aspects needs to be discussed as both the studies provide an estimation of DCD prevalence and to get a clear idea on what prevalence rates are more generalizable.

Thank you for the suggestion. We explained in the Discussion (p. 8) that estimating the prevalence rate was not the primary goal of the validation study. As such, the study involved a relatively small convenience sample representing the prevalence among children aged 6--11 years. In contrast, our current study involves a sample representing the distribution of children aged 5--12 years across the territory of Hong Kong and the proportions of males and females. These differences in sample characteristics could account for the discrepancy in the observed prevalence estimates.

7. Authors compare their prevalence rate with a few other DCD prevalence rates in other countries. However, the DCDQ has been validated and used to assess the prevalence rate in many other countries. Comparing these findings with those of other countries could lead to a problem of selection bias and interfere with fully understanding the findings of the present study. In addition, multiple studies have been conducted within the same country to assess the prevalence rate in different areas. For example, the authors compare their results with those of the Komal et al. 2014 study, which was conducted in one part of India. It is not representative of the prevalence rate of DCD in India and will be inaccurate. Several other studies have been conducted in different parts of India to measure the prevalence rate, and the authors should consider all these studies.

We appreciate the reviewer’s suggestion to improve our discussion. In our revision, we referred to the prevalence estimates from the international clinical practice recommendations for DCD (Blank et al., 2019), as these estimates represent synthesized evidence from a global perspective. We now discuss that the sDCD prevalence estimates generated by our study from the DCDQ tend to be higher than the diagnosed DCD prevalence estimates that meet the DSM-5 criteria. We still refer to other studies that used the DCDQ, but mainly to highlight that prevalence estimates for sDCD tend to have a wider range than diagnosed DCD does. We also provided more detail now for those studies that we cited to provide a better context (see section 4, p. 8).

8. I agree with the authors that the higher prevalence rate especially in the older children could be a result of parent bias due to COVID restrictions. I am wonder why a motor competency test was not conducted. A test on parental perceptions of their child's motor competency should help rule whether the results were because of a perception bias or actual lag of motor skills in children. This could particularly help since a positive correlation was not found with the PA levels.

In this study, our primary objective was to estimate the prevalence of sDCD with a survey-based approach using the validated DCDQ. We did not conduct motor competence tests because the study design aimed to gather data from a population-representative sample of parents who could report their perceptions of their children's motor abilities without directly assessing motor skills. We acknowledge the limitations of our approach (see section 4.1, p.10) and recommend that future studies collect data through direct observations and assessments of motor competence to provide a more comprehensive understanding of children's abilities and to rule out the impact of COVID-19-related restrictions.

9. Overall, the discussion in its current state can be improved by comparing the findings with the existing literature. Currently, the authors report a few other studies, but a more comprehensive comparison and discussion are needed. Authors do provide and discuss the different reasons for their findings but when it comes to estimate the prevalence rate for a large area, it is important to discuss these findings in relation to what is seen in different parts of the world. The whole idea of prevalence rate is to map out the state of DCD worldwide. Therefore, to generalize the current findings and increase the meaning of these findings, the findings should be assessed from a more comprehensive perspective.

Thank you very much for this commentary on the discussion of prevalence, which we considered. We revised our discussion extensively and now discuss our main findings with reference to a previous study in Hong Kong that did not have a population-representative sample. We also discuss the prevalence estimates for sDCD with reference to global prevalence estimates from international practice guidelines and to the DSM-5 criteria for DCD, which we are unable to assess given the limitations of the DCDQ. We believe that this approach allows us to place our findings in the context of the state of knowledge about DCD worldwide. We also acknowledge limitations more comprehensively and offer recommendations for future research.

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

Good morning

Well done on improving please take note, My main concern for the discussion of results is that the DCD Prevalence are compared to other research findings. However, for the health-related aspect no such comparisons are made. You just elaborate on what it is and how it affects children. It is like an introduction should be. You need to state who agree with you who do not agree with you and why you think that is the case.

Regards

Comments for author File: Comments.pdf

Author Response

Comment:

Well done on improving please take note, My main concern for the discussion of results is that the DCD Prevalence are compared to other research findings. However, for the health-related aspect no such comparisons are made. You just elaborate on what it is and how it affects children. It is like an introduction should be. You need to state who agree with you who do not agree with you and why you think that is the case.

Response:

Thank you for the remaining comments on our revised manuscript. We have now expanded the discussion of the health-related outcomes alongside other literature that addresses these outcomes in relation to DCD (see p.8). Specifically, we now discuss our findings on physical activity in relation to the wider inactivity problem in Hong Kong and Asia and the cognitive and affective outcomes in relation to previous research that have also highlighted the relationship of motor proficiency with these outcomes. We believe the revised discussion addresses the remaining concerns.  Please refer to the yellow colour highlighted text in the manuscript.

1. Have a look at your title that is the aim; suspected DCD keep the same terms

Response:

Thank you for the remaining comments on our revised manuscript. We have revised the aim to ensure the use of consistent terms (see p.2).

 

2. You need to provide the authors, you can't make statements without the supporting references

Response:

The appropriate reference has now been added.

 

3. Boys and girls you are working with children

Response:

We appreciate the appropriateness of using the terms “boys” and “girls” for children. However, we note that the variable of interest for us is the biological construct of sex hence our use of the terms “male” and “female” (Cartwright et al., 2022; Tannenbaum et al., 2016). Therefore, we prefer to retain the terminology we used in this regard.

 

4. Why is this info important did you use it to see if there is associations with sDCD?

Response:

Thank you for clarifying. We did use this information, and as reported in 3.1, parental age was not a significant predictor of the DCDQ category (see p.6).

 

5. Well done on improving please take note, my main concern for the discussion of results is that the DCD Prevalence are compared to other research findings. However, for the health-related aspect no such comparisons are made. You just elaborate on what it is and how it affects children. It is like an introduction should be. You need to state who agree with you who do not agree with you and why you think that is the case.

Response:

We have now expanded the discussion of the health-related outcomes alongside other literature that addresses these outcomes in relation to DCD (see p.9). Specifically, we now discuss our findings on physical activity in relation to the wider inactivity problem in Hong Kong and Asia and the cognitive and affective outcomes in relation to previous research that have also highlighted the relationship of motor proficiency with these outcomes. We believe the revised discussion addresses the remaining concerns.  Please refer to the yellow colour highlighted text in the manuscript.

 

References:

Cartwright, T., & Nancarrow, C. (2022). A Question of Gender: Gender classification in international research. International Journal of Market Research, 64(5), 575-593. https://doi.org/10.1177/14707853221108663

Tannenbaum, C., Greaves, L., Graham, I.D.. (2016) Why sex and gender matter in implementation research. BMC Med Res Methodol, 16(1):145. doi: 10.1186/s12874-016-0247-7.

 

Reviewer 3 Report

Comments and Suggestions for Authors

The authors have addressed all my comments and concerns. I have no further comments/concerns. 

Author Response

Comment:

The authors have addressed all my comments and concerns. I have no further comments/concerns. 

Response:

We thank you for the constructive comments, which we believe improved the quality of our paper.