Health Education for Women Released from Prison in Brazil: Barriers and Possibilities for Intervention

Comments

Responses

1: First, there is a dissociation between the stated purpose of the study and the outcomes. In the abstract, the authors state that "This study is an action research type of research that was carried out with the objective of building and validating educational material for this audience." I did not see anything related to the validation of educational material in the results or the discussion. I think this research would be better framed as formative research to identify the topics and issues that should be included in the educational material. 

This article is an excerpt from research related to the development and validation of educational technology to support women released from prison in the self-care process, as described in the abstract. However, we are in agreement with the reviewer regarding the fact that this was not well explained and created expectations of results relating to the construction of the educational material, so we have altered the text to comply with the formulated instructions (please see lines 8-9).

2: Second, the result method lacks evidence on the weight of each of the themes identified by the researchers. I suggest moving them from the discussion section to the results and providing some data (for example, what was the prevalence of the "Pain and health issues in prison" theme among the 20 participants?). I also encourage the authors to think about a classification of these themes that should guide the discussion (for example: social reintegration, health issues post-incarceration, family reintegration, etc.), so that there is a more logical flow to the discussion. 

We accepted the insightful suggestion to move the themes originating from qualitative research to the results section and reserve the organization of subjects by topic for the discussion section (please see line 240).

Moreover, we categorize the themes, which can be seen in: “4.1 Basic needs in dispute after release and individual barriers” (please see line 241); “4.2 The invisible marks of mental suffering after release” (please see line 319); “4.3 Institutional and political barriers (please see line 431).

To ensure that the discussion flows in a logical manner. As it was qualitative research, there was no quantitative observation regarding the number of women who identified each theme, but we reflected on the results again and tried to adapt them to the reviewer's suggestion (please see line 321-322; 442).

3: When presenting the sociodemographic characteristics of the participants, it would help to include some information about their time spent in jail and the time since release.

Information regarding the length of sentences and time since release was not the subject of our investigation and, therefore, was not collected. However, we would like to thank you for your note, but we will not be able to accept it because we do not have this information.

4: The authors write about the health literacy of participants. Was this measured? If so, how? Please provide additional details.

Health literacy was not measured in our study. Our objective was to develop educational material to support women's health care based on the demands we encountered, in this case, their fears or lack of care as described by them or reported by the healthcare professionals who cared for them. The relationship between low literacy and health losses in the criminal context was based on the findings of the literature review (Mital, Wolff, Carroll, 2020; Donelle, Hall, 2014; Valle Yanes et al., 2008; Williams et al., 2018; Wiersema et al., 2019).

5: I would suggest editing the manuscript to provide some more details about the role and function of the EFAC

More details about the role and function of the CAEF were given (please see lines 62-70).

6: More details on how the body maps were used to draw inferences about the proposed themes

Regarding the details of how body maps were used to make inferences about the proposed themes, this was duly clarified. Thank you for the suggestion, which will greatly enrich the presentation of the method (please see lines 190-193).

7: Clarify the paragraph between lines 140-142, 152 (what was the research hypothesis?) 

The paragraph between lines 152-153 was clarified.

- In line 152, there is not exactly a research hypothesis to be discussed, since this is a qualitative research study.

8: Enhance the discussion about the age of the sample of participants (190).

The discussion about the age of the sample of participants was enhanced, as suggested (please see lines 215-220).

9: Please provide some details about how participants were compensated for their time.

Study participants were not compensated for their time dedicated to the research, as their participation was voluntary and travel expenses were compensated by the researcher. A paragraph explaining this condition in the research was added to the text of the article, for which we are grateful for this important suggestion (please see lines 127-131).

10: Some of the published studies presented in the discussion section could be moved to the introduction or a different "Literature Review" section. 

Thank you very much for pointing this out!

Indeed, there were excerpts from the articles in the discussion that were more appropriately placed in the Introduction. As a result, we have repositioned some paragraphs (please see lines 31-34 and 41-43).