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• Response to: Inaccuracies in systematic review by Louise Condon, Emeritus Professor Swansea University
  Fiona Alderdice, Reem Malouf
  Published on: 20 December 2023
• Inaccuracies in systematic review
  Louise Condon
  Published on: 13 December 2023

• Published on: 20 December 2023

  Response to: Inaccuracies in systematic review by Louise Condon, Emeritus Professor Swansea University

  • Fiona Alderdice, Senior Social Scientist NPEU, University of Oxford
  • Other Contributors:
    • Reem Malouf, systematic reviewer

  Dear Editor,
  Thank you for drawing our attention to this rapid response by Condon L, which was published on the 6th December 2023.
  In response to the author’s comments on the inclusion of one of her studies - (Reference #52: Condon L, Rhodes C, Warren S, et al. ‘But is it a normal thing?’ Teenage mothers’ experiences of breastfeeding promotion and support. Health Education Journal 2013; 72: 156–62) in our review. We will take each point in turn.

  Comment: It is unclear why our article has been included in this systematic review. In their Methods section, Malouf et al. describe their study selection criteria as follows: “‘Studies were eligible for inclusion if they involved women with low-risk pregnancies [...] and gave birth in hospitals or birth centres in the UK’. Our study explored experiences of breastfeeding promotion and support among pregnant teenagers and teenage mothers, and does not provide information about risk in pregnancy or place of birth. Our study therefore does not meet the eligibility criteria and should not have been included.

  Response: We have clearly stated our approach to the eligibility criteria highlighted by Condon in our strengths and limitations sections:
  ‘Although we set out to review the literature relating to postnatal care for women at low risk of complications to explore routine practice, this was not always possible. Most of the studies reported results undifferentiated by risk and without excluding those wom...

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  Dear Editor,
  Thank you for drawing our attention to this rapid response by Condon L, which was published on the 6th December 2023.
  In response to the author’s comments on the inclusion of one of her studies - (Reference #52: Condon L, Rhodes C, Warren S, et al. ‘But is it a normal thing?’ Teenage mothers’ experiences of breastfeeding promotion and support. Health Education Journal 2013; 72: 156–62) in our review. We will take each point in turn.

  Comment: It is unclear why our article has been included in this systematic review. In their Methods section, Malouf et al. describe their study selection criteria as follows: “‘Studies were eligible for inclusion if they involved women with low-risk pregnancies [...] and gave birth in hospitals or birth centres in the UK’. Our study explored experiences of breastfeeding promotion and support among pregnant teenagers and teenage mothers, and does not provide information about risk in pregnancy or place of birth. Our study therefore does not meet the eligibility criteria and should not have been included.

  Response: We have clearly stated our approach to the eligibility criteria highlighted by Condon in our strengths and limitations sections:
  ‘Although we set out to review the literature relating to postnatal care for women at low risk of complications to explore routine practice, this was not always possible. Most of the studies reported results undifferentiated by risk and without excluding those women at high risk. Similarly, this review has focused on postnatal care in hospital, but for some outcomes, particularly those relating to infant feeding, it was not possible to separate hospital from community care. These studies were included for completeness.’ Malouf et al 2019

  The inclusion of the study in question was one that was discussed and decided on by the whole research team as the relevance of the study in regard to sample was unclear. We decided to include because one of the themes highlighted health professional care in hospital just after birth. For example under this theme the following statement was made:
  ‘Feeding decisions made in pregnancy were not necessarily followed through when the baby was born, demonstrating the influence of health professional promotion and support at birth. Despite wishing to breastfeed, one mother was directed towards the hospital stocks of formula milk and subsequently bottle fed her baby.’ Condon et al 2013
  This theme was deemed to be relevant to the review objectives to comprehensively report on women’s experiences of the immediate postnatal care received in hospitals and birth centres. Based on this information and in the absence of risk data or evidence of specialist services related to breast feeding around birth we decided to include.

  Comment: The erroneous inclusion of our article leads the authors to make inaccurate claims about the quality of our study. In Table 2, Malouf et al. list the characteristics of qualitative studies included in their review. For our study, the ‘Sample characteristics’ column states that details were not reported for the postnatal sample. This is misleading, as Table 1 of our article presents the characteristics for our overall sample of teenage mothers and pregnant teenagers; however, as laid out above, our study did not include a separate postnatal sample Furthermore, in their Results section, under the heading ‘Risk of bias in qualitative studies’, Malouf et al. have claimed that the study population was “not described” in our article, “limiting transferability”. This gives the impression that our article fails to appropriately disclose the sample characteristics, which is untrue.

  Response: These are statements of fact in regard to the description of the 23 teenage mothers in the sample. Such descriptions are common in systematic reviews and are not a judgement on the paper. They are included for complete transparency on what data could be extracted from the paper using our data extraction protocol.

  Comment: Malouf et al. provide a quality assessment of the qualitative studies included in their review. In final column of this table, titled ‘Is the research valuable?’, it is unclear whether the authors are referring to the value of the research for their review, or to the field in general. Our study has been deemed not valuable, but the authors do not disclose the methodology used to reach this apparently subjective judgement. Of note, our study meets almost all of the quality assessment criteria listed in Table 4, while other studies considered valuable meet fewer of these criteria

  Response: To assess the study quality we used the CASP risk of bias assessment for qualitative studies. The CASP tool is widely used to quality assess qualitative studies in qualitative reviews and the reporting that we provided for each domain is standard. Condon’s study has performed well using this tool, with seven ‘yes’ ratings out of ten questions. This was a reflection on the clarity of the study aims, the appropriate qualitative methodology and design to achieve the study aims, the transparency of the study recruitment strategy, the adequacy of the data collection (focus group and interviews), sufficient details on the ethical approval and the explicit findings of Condon’s study. The study was rated ‘unclear’ on one question – ‘Was the data analysis sufficiently rigorous?’. We could not find enough information in the paper on the analysis process or sufficient details on how the coding for the thematic analysis was done and by whom (whether done by e.g. two researchers or independently). The final question on the CASP is ‘is the research valuable?’. The terminology used is that of CASP’s and not ours and we completely understand how this could cause offence and we agree that many of the questions can be subjective. A key component of this final question is whether the researchers findings can be transferred to the local/other populations. In this study a rating of ‘no’ was given as the study findings cannot be transferred to other similar populations. This was stated by the authors in their study’s limitations section– ‘rates of breastfeeding initiation and continuation were higher among the study sample than nationally’ and ‘study sample may have been highly atypical of pregnant teenagers and teenage mothers in other UK cities’. The ‘no’ rating is for this one domain and is not a global assessment of study quality which is why other studies could be considered ‘valuable’ but did not perform well on other domains.

  Comment: We recognise that this systematic review has been published for some time; however, it has recently been brought to our attention, and based on the points laid out above we would consider it appropriate for the article to be corrected to remove the misleading claims regarding our work. Furthermore, we strongly recommend that the authors consider whether the study selection and eligibility criteria have been correctly applied across all studies included in their review, and how this might affect the credibility of their findings.

  Response: This review followed a rigorous methodology, decision making and reporting process. We greatly value the contribution of Condon et al’s paper in this review on this particularly under researched group. We do not believe that the data included in the review misrepresents the study within the context of the review question. We stand over our decision to include the paper in the review, the data extracted from the paper and quality assessment made.

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  Conflict of Interest:
  None declared.

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• Published on: 13 December 2023

  Inaccuracies in systematic review

  • Louise Condon, Emeritus Professor Swansea University

  Dear Editor,

  I am the lead author of an article cited in this systematic review (Reference #52: Condon L, Rhodes C, Warren S, et al. ‘But is it a normal thing?’ Teenage mothers’ experiences of breastfeeding promotion and support. Health Education Journal 2013;72:156–62.) and would like to draw your attention to the inaccurate and misleading way in which the authors have presented our work.

  It is unclear why our article has been included in this systematic review. In their Methods section, Malouf et al. describe their study selection criteria as follows: “‘Studies were eligible for inclusion if they involved women with low-risk pregnancies [...] and gave birth in hospitals or birth centres in the UK’. Our study explored experiences of breastfeeding promotion and support among pregnant teenagers and teenage mothers, and does not provide information about risk in pregnancy or place of birth. Our study therefore does not meet the eligibility criteria and should not have been included.

  The erroneous inclusion of our article leads the authors to make inaccurate claims about the quality of our study. In Table 2, Malouf et al. list the characteristics of qualitative studies included in their review. For our study, the ‘Sample characteristics’ column states that details were not reported for the postnatal sample. This is misleading, as Table 1 of our article presents the characteristics for our overall sample of teenage mothers and pregnant teenagers; however,...

  Show More

  Dear Editor,

  I am the lead author of an article cited in this systematic review (Reference #52: Condon L, Rhodes C, Warren S, et al. ‘But is it a normal thing?’ Teenage mothers’ experiences of breastfeeding promotion and support. Health Education Journal 2013;72:156–62.) and would like to draw your attention to the inaccurate and misleading way in which the authors have presented our work.

  It is unclear why our article has been included in this systematic review. In their Methods section, Malouf et al. describe their study selection criteria as follows: “‘Studies were eligible for inclusion if they involved women with low-risk pregnancies [...] and gave birth in hospitals or birth centres in the UK’. Our study explored experiences of breastfeeding promotion and support among pregnant teenagers and teenage mothers, and does not provide information about risk in pregnancy or place of birth. Our study therefore does not meet the eligibility criteria and should not have been included.

  The erroneous inclusion of our article leads the authors to make inaccurate claims about the quality of our study. In Table 2, Malouf et al. list the characteristics of qualitative studies included in their review. For our study, the ‘Sample characteristics’ column states that details were not reported for the postnatal sample. This is misleading, as Table 1 of our article presents the characteristics for our overall sample of teenage mothers and pregnant teenagers; however, as laid out above, our study did not include a separate postnatal sample. Furthermore, in their Results section, under the heading ‘Risk of bias in qualitative studies’, Malouf et al. have claimed that the study population was “not described” in our article, “limiting transferability”. This gives the impression that our article fails to appropriately disclose the sample characteristics, which is untrue.

  In Table 4, Malouf et al. provide a quality assessment of the qualitative studies included in their review. In final column of this table, titled ‘Is the research valuable?’, it is unclear whether the authors are referring to the value of the research for their review, or to the field in general. Our study has been deemed not valuable, but the authors do not disclose the methodology used to reach this apparently subjective judgement. Of note, our study meets almost all of the quality assessment criteria listed in Table 4, while other studies considered valuable meet fewer of these criteria.

  We recognise that this systematic review has been published for some time; however, it has recently been brought to our attention, and based on the points laid out above we would consider it appropriate for the article to be corrected to remove the misleading claims regarding our work. Furthermore, we strongly recommend that the authors consider whether the study selection and eligibility criteria have been correctly applied across all studies included in their review, and how this might affect the credibility of their findings.

  Show Less

  Conflict of Interest:
  None declared.

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