Author's response to reviews

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1 Author's response to reviews Title: Day care for dementia patients from a family caregiver's point of view: A questionnaire study on expected quality and predictors of utilization - Part II Authors: Carolin Donath (carolin.donath@uk-erlangen.de) Angelika Winkler (beratung@alzheimer-brandenburg.de) Elmar Graessel (elmar.graessel@uk-erlangen.de) Katharina Luttenberger (katharina.luttenberger@uk-erlangen.de) Version: 2 Date: 3 November 2010 Author's response to reviews: see over

2 MS: Research article Day care for dementia patients from a family caregiver s point of view: A questionnaire study on expected quality and predictors of utilization Part II Carolin Donath, Angelika Winkler, Elmar Graessel and Katharina Luttenberger BMC Health Services Research Dear Editor, Please find below all comments of the editor and the reviewers together with our answers. Both reviewers wanted a methods section to be part of the manuscript. We now replaced the link to the part I Manuscript by the original methods section. Obviously, the methods section is absolutely necessary to understand the results and the discussion of the article. We only had omitted the methods section after clearance with your colleagues Mr. Scott Raymonds and Mrs. Natali Pafitis who advised us in this way (see below). We hope that all misunderstandings are solved now and the manuscript is meeting your requirements. Dear Prof Graessel, Thank you for your submission to BMC Health Services Research. In light of the overlap between this and it's related manuscript (MS: ), we passed on your arguments (pasted below) about the differences between the two studies to associate editor, and after comparing the manuscripts they agreed with you that they can target slightly different audiences (although they felt that professionals such as occupational therapists may be likely to be interested in both papers equally). In light of this they felt it better to keep the two papers separate, but it would be neater to follow your suggestion of having part 1 and part 2, and the methods laid out only once in part 1. Best wishes, Scott Scott Edmunds PhD Senior Scientific Editor BMC-series Journals BioMed Central Floor 6, 236 Gray's Inn Road London, WC1X 8HL I. Editor s comments: Further requirements: 1. *Ethics - Experimental research that is reported in the manuscript must have been performed with the approval of an appropriate ethics committee. Research carried out on humans must be in compliance with the Helsinki Declaration ( and any experimental research on animals must follow internationally recognized guidelines. A statement to this effect must appear in the

3 Methods section of the manuscript, including the name of the body which gave approval, with a reference number where appropriate. In the Methods section the point Ethical considerations is discussed. 2. "Details about the methods are required". As mentioned above, the Methods section has been included in the manuscript. II. Reviewer 1 A) Major Compulsory Revisions 1. Despite the link to another manuscript, this manuscript needs a methods section of its own describing the participants, the procedure, questionnaires, response rate, etc. How did people provide requirement data in Table 3? Methods section is added, all instruments are described under the subheading Instruments. There the information of how the data in Table 3 were acquired can be found. B) Minor Essential Revisions 1. Roman numeral III is missing on the final page of the manuscript Erased. The number appeared automatically by the numbering-function of MS Word. 2. How do these findings generalize beyond Germany to other countries and other cultures? It is not justified by the study to generalize on the Health Care System of other countries. The data were only collected from caregivers living in Germany and thus living under the legislation of the Social Care Insurance which allows caregivers to get costs which relate to the usage of caregiver support respectively respite services refunded. This has also been amended to the discussion section. 3. This article seems to be written for owners of day care facilities as a sales pitch for how to encourage caregivers to use their agencies. What is the cost-effectiveness of utilizing Day Care services relative to receive a treatment for caregiver burden? Please sell the results to caregivers and health professionals, who must consider what is best for a variety of reasons. We carried out a survey of caregivers of dementia patients. We do not have any conflict of interest towards organizations offering day care. That has been included in the conflict of interest section. Caregivers throughout Germany had for the first time the opportunity to tell their wishes and requirements for day care facility. Therefore we indeed take the perspective of the caregivers and pledge to the agencies to take those quality wishes into account. Additionally, a section in the discussion was added, where the effect of usage of day care on institutionalization is described as other authors have found. This could help caregivers in their decision making if they should use day care. III. Reviewer 2 A. Minor Essential Revisions: 1. Either write utilisation OR utilization throughout the text. Utilization is now used throughout the text 2. Abstract: predictive variables for utilization of what? of day care is added

4 3. Suggestion for change in title: Day care for dementia patients from a family caregiver s point of view: A questionnaire study on expected quality and predictors of utilisation Title is changed as suggested. B Major Compulsory Revisions: 1. Methods: The Methods section is completely missing. Method section is now added again. Replacing the Methods section by a link to part I was the suggestion of BMC editors. (Scott Edmunds in May 2010, attached) 2. Methods: What is the Andersen model and what are the Andersen-model categories? The Andersen model has already been described in the Introduction (p. 4), and now more explicitly in the methods-sections (p.6). 3. Abstract/Methods: data were analysed using qualitative content analysis : I don t see any qualitative data, analysis or result in this paper. Content analysis refers to a method for analysing qualitative data like texts, interview transcripts or observations. In the results the authors report frequencies of various response options. This is a pure quantitative approach, no content analysis. Should be clearer now, as the questionnaire is described exactly in the methods sections. The answers of the caregivers on the open question What would you expect of a good day care were written freely without any response options as plain text. These answers were analysed by content analysis after Mayring. 4. Abstract: The conclusions are not justified by the reported results. The conclusion part of the abstract was reformulated to fit better the results. 5. Table 1/Methods: a. Table 1 heading does not fit: there are no characteristics given. Please add a table with basic sample characteristics. Justified. The table is replaced by the characteristics-table which was left out according to the advice of the BMC-editors. b. Table 1 assigns the constructs being assessed with the questionnaire to the 3 Andersen-model categories (the latter need to be explained in the Methods). In table 1 the basic sample characteristics are given now. Andersen model categories are now explained in the methods-sections (p.6) together with the link to the questionnaires used in the study. c. For better comprehension, Table 1 should contain the original items of the questionnaire (at least some examples), grouped for their construct and then for the Andersen-model category (see attachment for suggested table). See comment above. Explanation including original items is given in the methods section. 6. Table 2: shorten table: delete first four columns; the table can only be understood when the questionnaire has been explained in more detail before (in Methods section and in Table 1). Methods section for better understanding is provided now. 3 of the first 4 columns are deleted, the regression coefficient seems to be too important to be deleted as it indicates the direction of the interrelation. 7. Table 3/Methods: d. see table 2: better understandable with more information on questionnaire Information is provided in the methods section

5 e. The method for the classification of quality criteria has to be explained in the Methods. Information is provided in the methods section.