Reviewer's report 
 Medication beliefs in inflammatory bowel disease patients reporting low quality of life: a qualitative Title: 
study 
 1  29 January 2007 Version: Date: 
 Toke S. Barfod Reviewer: 
Reviewer's report: 
General 
This is a nice piece of work. I believe it can help people who live with the IBD to take care of themselves, and certainly it can help health-care providers in caring for their patients as well. The findings are not very 
surprising, but that is not a big problem. I have a few suggestions for the paper, mainly to enhance its clarity. 
------------------------------------------------------------------------------- 
Major Compulsory Revisions (that the author must respond to before a decision on publication can be 
reached) 
1)Background: I do not think that there is larger variation in the adherence rates reported from IBD as compared to chronic disease in general. 2)Background: could it be a little more clear, what the overall purpose of the larger study was, which parts 
of this has been reported elsewhere, which parts are presented here, and how the two parts relate to each 
other? 
3)Method: please provide some description of the setting. Is this a group of poor peasants or do they live in a large city? Are they treated well at university-based clinic? Are they educated? Etc. 
4)Method: design and participants: 
a. Please elaborate on the meaning of the “lowest quartile of UKIBQ” (of which I am not familiar). I guess it is quite likely, that those with the lowest quality of life would be the ones with the lowest adherence. I guess that those with better adherence get at better quality of life? 
b. You anticipate that they would have the richest range of experience. But these people probably seldom 
feel that they have excellent quality of life – with their disease, and with their medication. c. You state that “The interview agenda covered individuals’ experience of… etc. etc.” Could you please make it perfectly clear, if this was the agenda of the entire study, or the agenda of this part of the results. (I 
guess the current paper is just one out of two papers made from the same interviews, right? Please make 
this clear to the reader). 5)Results: First paragraph: a. The most important suggestion for your paper is this: Please provide more consistency between the 
phrases of the overview in the first paragraph of the results section, the phrases of the abstract, the phrases 
of the headlines in the results section, the phrases of the titles of the boxes, the phrases of the figure, and 
the phrases of the first paragraph in the discussion section. It’s not that they should be exactly the same – but it should be very easy to grasp their relation to each other, which phrases are abbreviations of other 
phrases, and which ones are subcategories or extra categories. 
b. It would greatly enhance the clarity of the paper. c. As I read it, you have three factors (Acceptance/necessity/importance, fears/concerns, and illness impact), which all three influence one main outcome (medication related behaviour). 
d. Subcategories are that acceptance/fears/concerns differ between corticosteroids and other drugs, and 
that willingness to self-manage is an important part of medication related behaviour. e. I think you should rigidly maintain the same phrases/concepts throughout the paper, and their hierarchy throughout the various sections of the paper. Also the order in which they are presented, should be 
consistent: 
f. The “perceived impact…” headline is mentioned as number two headline, before the “medication fears and concerns”, whereas the “perceived impact…” is mentioned after the “fears and concerns…” in the first paragraph of the results. 
g. I do not understand the status of the headline “Complex drug regimes, drug interactions etc.” Why is this 
headline underscored while the others are in italics? Is it placed lower or higher in the hierarchy of concepts/headlines than the other headlines? 6)In my view, this study is not a “real” grounded theory (p.14.). In a grounded theory, there is a core 
category, and a theory described with consistent use of defined concepts. Please acknowledge that this 
study uses only part of the potential described in the Grounded Theory methodology. Grounded theories do 
not provide “in-depth description”. They provide concepts and theories. 
------------------------------------------------------------------------------- 
Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the author can be trusted to correct) 
7)You write: “I the end I got sick of doing it because it’s not natural to want to I am not being crude but 
sticking something like that up your backside regardless (if you are well or not”. (male, ulcerative colitis, 54 years) Individual perceptions…” 
8)Please insert an N (In the end…); remove a parenthesis (“…regardless if you are well..”); and remove one 
full stop (“…regardless if you are well or not” (male, ulcerative colitis, 54 years). Individual perceptions…”). 
9)Generally, I think you could use more commas and lines in the quotes to make them more meaningful and 
easy to read, e.g. you write: “I know how serious it is now you see at first I didn’t at first I thought it was just a 
little thing that was passing…”. I believe you should write “I know how serious it is now. You see at first I 
didn’t - at first I thought it was just a little thing that was passing…” 
10)Put “” around the quote on page 12, or write in italics. (I don’t like taking drugs…). 
------------------------------------------------------------------------------- 
Discretionary Revisions (which the author can choose to ignore) 
11)Title: Personally, I feel the title is not very easy to read at a first glance. I would prefer “Medication beliefs 
in patients with inflammatory bowel disease who report low quality of life: a qualitative study. But – who am 
I, a foreigner, to correct an Englishman? 
12)Abstract: I do not see how the conclusion – that more in-depth understanding of the concerns… etc., can 
be deduced from the results. What if health carers have excellent understanding already? I think the 
conclusion should be about medications beliefs. 
13)I think the paper would be clearer, if you had only one text-box for each headline (some boxes could be 
merged). 14)I do not see how these results “… fit with findings which show that almost a quarter of patients are already treating relapses themselves” (p.14). 
 Accept after minor essential revisions What next?: 
 An article of importance in its field Level of interest: 
 Acceptable Quality of written English: 
 No, the manuscript does not need to be seen by a statistician. Statistical review: 
Declaration of competing interests: 
I declare that I have no competing interests 
Reviewer's report 
 Medication beliefs in inflammatory bowel disease patients reporting low quality of life: a qualitative Title: 
study 
 1  29 January 2007 Version: Date: 
 Toke S. Barfod Reviewer: 
Reviewer's report: 
General 
This is a nice piece of work. I believe it can help people who live with the IBD to take care of themselves, and certainly it can help health-care providers in caring for their patients as well. The findings are not very 
surprising, but that is not a big problem. I have a few suggestions for the paper, mainly to enhance its clarity. 
------------------------------------------------------------------------------- 
Major Compulsory Revisions (that the author must respond to before a decision on publication can be 
reached) 
1)Background: I do not think that there is larger variation in the adherence rates reported from IBD as compared to chronic disease in general. 2)Background: could it be a little more clear, what the overall purpose of the larger study was, which parts 
of this has been reported elsewhere, which parts are presented here, and how the two parts relate to each 
other? 
3)Method: please provide some description of the setting. Is this a group of poor peasants or do they live in a large city? Are they treated well at university-based clinic? Are they educated? Etc. 
4)Method: design and participants: 
a. Please elaborate on the meaning of the “lowest quartile of UKIBQ” (of which I am not familiar). I guess it is quite likely, that those with the lowest quality of life would be the ones with the lowest adherence. I guess that those with better adherence get at better quality of life? 
b. You anticipate that they would have the richest range of experience. But these people probably seldom 
feel that they have excellent quality of life – with their disease, and with their medication. c. You state that “The interview agenda covered individuals’ experience of… etc. etc.” Could you please make it perfectly clear, if this was the agenda of the entire study, or the agenda of this part of the results. (I 
guess the current paper is just one out of two papers made from the same interviews, right? Please make 
this clear to the reader). 5)Results: First paragraph: a. The most important suggestion for your paper is this: Please provide more consistency between the 
phrases of the overview in the first paragraph of the results section, the phrases of the abstract, the phrases 
of the headlines in the results section, the phrases of the titles of the boxes, the phrases of the figure, and 
the phrases of the first paragraph in the discussion section. It’s not that they should be exactly the same – but it should be very easy to grasp their relation to each other, which phrases are abbreviations of other 
phrases, and which ones are subcategories or extra categories. 
b. It would greatly enhance the clarity of the paper. c. As I read it, you have three factors (Acceptance/necessity/importance, fears/concerns, and illness impact), which all three influence one main outcome (medication related behaviour). 
d. Subcategories are that acceptance/fears/concerns differ between corticosteroids and other drugs, and 
that willingness to self-manage is an important part of medication related behaviour. e. I think you should rigidly maintain the same phrases/concepts throughout the paper, and their hierarchy throughout the various sections of the paper. Also the order in which they are presented, should be 
consistent: 
f. The “perceived impact…” headline is mentioned as number two headline, before the “medication fears and concerns”, whereas the “perceived impact…” is mentioned after the “fears and concerns…” in the first paragraph of the results. 
g. I do not understand the status of the headline “Complex drug regimes, drug interactions etc.” Why is this 
headline underscored while the others are in italics? Is it placed lower or higher in the hierarchy of concepts/headlines than the other headlines? 6)In my view, this study is not a “real” grounded theory (p.14.). In a grounded theory, there is a core 
category, and a theory described with consistent use of defined concepts. Please acknowledge that this 
study uses only part of the potential described in the Grounded Theory methodology. Grounded theories do 
not provide “in-depth description”. They provide concepts and theories. 
------------------------------------------------------------------------------- 
Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the author can be trusted to correct) 
7)You write: “I the end I got sick of doing it because it’s not natural to want to I am not being crude but 
sticking something like that up your backside regardless (if you are well or not”. (male, ulcerative colitis, 54 years) Individual perceptions…” 
8)Please insert an N (In the end…); remove a parenthesis (“…regardless if you are well..”); and remove one 
full stop (“…regardless if you are well or not” (male, ulcerative colitis, 54 years). Individual perceptions…”). 
9)Generally, I think you could use more commas and lines in the quotes to make them more meaningful and 
easy to read, e.g. you write: “I know how serious it is now you see at first I didn’t at first I thought it was just a 
little thing that was passing…”. I believe you should write “I know how serious it is now. You see at first I 
didn’t - at first I thought it was just a little thing that was passing…” 
10)Put “” around the quote on page 12, or write in italics. (I don’t like taking drugs…). 
------------------------------------------------------------------------------- 
Discretionary Revisions (which the author can choose to ignore) 
11)Title: Personally, I feel the title is not very easy to read at a first glance. I would prefer “Medication beliefs 
in patients with inflammatory bowel disease who report low quality of life: a qualitative study. But – who am 
I, a foreigner, to correct an Englishman? 
12)Abstract: I do not see how the conclusion – that more in-depth understanding of the concerns… etc., can 
be deduced from the results. What if health carers have excellent understanding already? I think the 
conclusion should be about medications beliefs. 
13)I think the paper would be clearer, if you had only one text-box for each headline (some boxes could be 
merged). 14)I do not see how these results “… fit with findings which show that almost a quarter of patients are already treating relapses themselves” (p.14). 
 Accept after minor essential revisions What next?: 
 An article of importance in its field Level of interest: 
 Acceptable Quality of written English: 
 No, the manuscript does not need to be seen by a statistician. Statistical review: 
Declaration of competing interests: 
I declare that I have no competing interests 
Please review this paper.
user
Reviewer's report 
 Medication beliefs in inflammatory bowel disease patients reporting low quality of life: a qualitative Title: 
study 
 1  29 January 2007 Version: Date: 
 Toke S. Barfod Reviewer: 
Reviewer's report: 
General 
This is a nice piece of work. I believe it can help people who live with the IBD to take care of themselves, and certainly it can help health-care providers in caring for their patients as well. The findings are not very 
surprising, but that is not a big problem. I have a few suggestions for the paper, mainly to enhance its clarity. 
------------------------------------------------------------------------------- 
Major Compulsory Revisions (that the author must respond to before a decision on publication can be 
reached) 
1)Background: I do not think that there is larger variation in the adherence rates reported from IBD as compared to chronic disease in general. 2)Background: could it be a little more clear, what the overall purpose of the larger study was, which parts 
of this has been reported elsewhere, which parts are presented here, and how the two parts relate to each 
other? 
3)Method: please provide some description of the setting. Is this a group of poor peasants or do they live in a large city? Are they treated well at university-based clinic? Are they educated? Etc. 
4)Method: design and participants: 
a. Please elaborate on the meaning of the “lowest quartile of UKIBQ” (of which I am not familiar). I guess it is quite likely, that those with the lowest quality of life would be the ones with the lowest adherence. I guess that those with better adherence get at better quality of life? 
b. You anticipate that they would have the richest range of experience. But these people probably seldom 
feel that they have excellent quality of life – with their disease, and with their medication. c. You state that “The interview agenda covered individuals’ experience of… etc. etc.” Could you please make it perfectly clear, if this was the agenda of the entire study, or the agenda of this part of the results. (I 
guess the current paper is just one out of two papers made from the same interviews, right? Please make 
this clear to the reader). 5)Results: First paragraph: a. The most important suggestion for your paper is this: Please provide more consistency between the 
phrases of the overview in the first paragraph of the results section, the phrases of the abstract, the phrases 
of the headlines in the results section, the phrases of the titles of the boxes, the phrases of the figure, and 
the phrases of the first paragraph in the discussion section. It’s not that they should be exactly the same – but it should be very easy to grasp their relation to each other, which phrases are abbreviations of other 
phrases, and which ones are subcategories or extra categories. 
b. It would greatly enhance the clarity of the paper. c. As I read it, you have three factors (Acceptance/necessity/importance, fears/concerns, and illness impact), which all three influence one main outcome (medication related behaviour). 
d. Subcategories are that acceptance/fears/concerns differ between corticosteroids and other drugs, and 
that willingness to self-manage is an important part of medication related behaviour. e. I think you should rigidly maintain the same phrases/concepts throughout the paper, and their hierarchy throughout the various sections of the paper. Also the order in which they are presented, should be 
consistent: 
f. The “perceived impact…” headline is mentioned as number two headline, before the “medication fears and concerns”, whereas the “perceived impact…” is mentioned after the “fears and concerns…” in the first paragraph of the results. 
g. I do not understand the status of the headline “Complex drug regimes, drug interactions etc.” Why is this 
headline underscored while the others are in italics? Is it placed lower or higher in the hierarchy of concepts/headlines than the other headlines? 6)In my view, this study is not a “real” grounded theory (p.14.). In a grounded theory, there is a core 
category, and a theory described with consistent use of defined concepts. Please acknowledge that this 
study uses only part of the potential described in the Grounded Theory methodology. Grounded theories do 
not provide “in-depth description”. They provide concepts and theories. 
------------------------------------------------------------------------------- 
Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the author can be trusted to correct) 
7)You write: “I the end I got sick of doing it because it’s not natural to want to I am not being crude but 
sticking something like that up your backside regardless (if you are well or not”. (male, ulcerative colitis, 54 years) Individual perceptions…” 
8)Please insert an N (In the end…); remove a parenthesis (“…regardless if you are well..”); and remove one 
full stop (“…regardless if you are well or not” (male, ulcerative colitis, 54 years). Individual perceptions…”). 
9)Generally, I think you could use more commas and lines in the quotes to make them more meaningful and 
easy to read, e.g. you write: “I know how serious it is now you see at first I didn’t at first I thought it was just a 
little thing that was passing…”. I believe you should write “I know how serious it is now. You see at first I 
didn’t - at first I thought it was just a little thing that was passing…” 
10)Put “” around the quote on page 12, or write in italics. (I don’t like taking drugs…). 
------------------------------------------------------------------------------- 
Discretionary Revisions (which the author can choose to ignore) 
11)Title: Personally, I feel the title is not very easy to read at a first glance. I would prefer “Medication beliefs 
in patients with inflammatory bowel disease who report low quality of life: a qualitative study. But – who am 
I, a foreigner, to correct an Englishman? 
12)Abstract: I do not see how the conclusion – that more in-depth understanding of the concerns… etc., can 
be deduced from the results. What if health carers have excellent understanding already? I think the 
conclusion should be about medications beliefs. 
13)I think the paper would be clearer, if you had only one text-box for each headline (some boxes could be 
merged). 14)I do not see how these results “… fit with findings which show that almost a quarter of patients are already treating relapses themselves” (p.14). 
 Accept after minor essential revisions What next?: 
 An article of importance in its field Level of interest: 
 Acceptable Quality of written English: 
 No, the manuscript does not need to be seen by a statistician. Statistical review: 
Declaration of competing interests: 
I declare that I have no competing interests 
assistant