Author's response to reviews

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1 Author's response to reviews Title: Comparison of health-related quality of life between housewives and employed women in Zahedan City, Southeast Iran during : A cross-sectional study Authors: Fatihe kermansaravi (Fkermansaravi@yahoo.com) Shahindokht Navvabi-Rigi (shahinnavabi@yahoo.com) Ali Montazeri (Alijdcord@jd.ac.ir) Ali Navidian (Alinavidian@gmail.com) Version: 6 Date: 28 February 2012 Author's response to reviews: see over

2 The BioMed Cental Editorial Team Thanks for advises.we tried modification base on your recommended. They note that the educational levels are very different between the housewife and employed groups. They are concerned that this has not been addressed and could account for the differences in quality of life scores between the two groups. Could you please revise your manuscript to take account of this. The comparison between the QOL scores of the employed women and the housewives according to educational level (Illiterate, High school, University degree) with T student showed tere ara not significant difference between two groups except General Health. Employed women had a higher QOL life than housewives in all aspects except General Health( in group of high school)that only differences score were significan.(table 4) move your methods from its current position after the conclusions section to before the results section. Please also remove your responses to us from the manuscript file to the cover letter. Revise Recommendation 1: One major issue is that the design of the study is not clear. For example, they sampled 26 medical settings and selected 11 women from each setting.

3 Diagram sampling(sout heast Iran) Zahedan North East South east center North West South west (Medical setting )= Hose wife = H Employe= E

4 Recommendation 2: Also, Table 1 is missing labels in the first column and should be stratified by employed and non-employed. Revised Table one base on groups. variable Total(n=220) Employed (%) Housewives (%) Age(year) (6.4) 20(18.2) (39.1) 42(38.2) (38.2) 29(26.4) 44 18(16.4) 10(9.1) Education Illiterate 3(2.7) 38(34.5) High school 37(33.6) 62(56.4) University degree 70(63.6) 10(9.1) Total

5 Recommendation 3:the randomization methods are not well-describedand expand your methods section to include greater detail For method sampling initially city divided into five sections (north, south, center, west, and east). Then, two health centers of each of these 5 sections (affiliated to Zahedan University of Medical Sciences) were selected, randomly (total 10 health center). After that, 11 housewives and 11 employed women (totally 22 women) were chosen of each of these health centers. Finally, 110 employed and 110 housewives were selected with multistage stratified cluster method selection, randomly. The comparison group (housewives) was matched for age and gravity. Following were the inclusion criteria for selection of the sample: i) women were enrolled in present study did not have a history of physical and mental illness. ii) At the time of study all women living with their husbands (divorcees, widow or who living apart from her husbands were excluded). iii) As well, women were not obese, pregnant, or afflicted by a special mental and psychological crisis at the time of interview. In the present study, the following hypothecs was proposed and tested that "employed women will be significantly higher than housewives women on quality of life (eight dimensions of quality of life)". The aims of the study were explained to the participants and their consent was obtained by health personnel. As well as, Health personnel asked mothers for their phone number. The scholar called the women, and time for the filling the questionnaire was arranged. Data were gathered through a questionnaire in the participants' homes. If a certain participant was illiterate, questionnaire was filled through interviews. Based on the aim of the study the questionnaire quality of life was made of two parts; part 1 was related to the women's personal information, and part 2 was short form health survey questionnaire (SF-36). The SF36 questionnaire for QOL is ageneric multidimensional instrument design for use in clinical practice and research,healt policy evaluation and general population survey.the instrument included 36 questions measuring eight dimensions of the quality of life: Physical function(10 items), Role limitation due to emotional problems (3 items),bodily pain(2 items), general health(5 items), vitality(4 items), social function problems(2 items), Role limitation due to physical health problems(4 items) and mental health(5 items).the SF36 also contain a single item that examines change in health. Each of the mentioned dimensions has a score of A higher score indicates a better QOL. The applied questionnaire had originally been designed to measure health-based life quality. The validity and reliability of its Iranian customized version has been certified (1). The data were analyzed using SPSS software, version 13 Statistical methods were. ANOVA was applied to test for different among employed women and housewives women on quality of life and its eight dimensions.t-test were computed to comparing the mean score of the eight dimensions of quality of life between employed women and housewives women with the results of another study that had done on Iranian women population (1).

6 Employed women Housewives Total Mean(95%CI) Dimensions P Value Mean(95%CI) Mean(95%CI) Physical Function 81.31(95%CI: ) 83.68(95%CI: ) 82.49(95%CI:73-90) 0.3 Role -emotional 54.84(95%CI: ) 45.45(95%CI: ) 50.15(95%CI: ) 0.09 bodily pain 65.57(95%CI:61-70) 62.72(95%CI: ) 64.15(95%CI: ) 0.4 General health 62.60(95%CI: ) 62.33(95%CI: ) 62.47(95%CI: ) 0.9 vitality 59.18(95%CI: ) 51.40(95%CI: ) 55.29(95%CI: ) 0.01 Social functioning 71.81(95%CI: ) 70.90(95%CI: ) 71.36(95%CI: ) 0.7 Role -physical 54.54(95%CI:47-62) 51.36±(95%CI: ) 52.95(95%CI: ) 0.5 Mental health 66.25(95%CI: ) 60±(95%CI: ) 63.12(95%CI: ) 0.02 Recommendation 4: Should standard errors and 95% confidence intervals be presented rather than standard deviations. In Table 2 wrote confidence intervals Table 2: A comparison of mean and 95%CI for eight dimensions of quality of life scores in employed women and housewives Recommendation 5: the quality of English needs substantial improvement. The mansucript edited by Edanz groups. Recommendation 6: clarify if ethical approval was required for your work and document this within your manuscript. Permission to carryout the study were obtained from participant and Zahedan University of Medical Science Science Etical Commitee

7 Recommendation 6:ensure full description of the tables used within your manuscript (for example please clarify why men are included in table 3 and what practitioner group means. In this study have done Comparing the mean scores and standard deviation of the eight dimensions of quality of life scores between employed women, housewives, and the Iranian women population in 2007(Reference 1,Study that have done by Montazeri,Goshtasebi and Vahdaninia With Best wishes Fatihe kermansaravi, Shahindokht Navvabi-Rigi, Dr Ali Montazeri,Dr Ali Navidian A comparison of mean and 95%CI for eight dimensions of quality of life scores in employed women and housewives basae on educational level Dimen sions Illiterate (n=41) Employed Women Mean (%95 CI) House wives Mean (%95 CI) High scool (n=99) Employed Women Mean (%95 CI) House wives Mean (%95 CI) Physical function 83/46(% 15/74-2/59) 55/24(% 24/67-7/43) 66/46(% 16/83-4) Roleemotion eal Bodilg pain 76/66(%95C I : -31/35-17/3) 16/66 (%95CI:- 80/71-21/94) 47/66 (%95CI:- 44/52-25/17) 83/68(%95 CI: -52/77-38/73) 46(% 89/87-31/10) 57/34(%95 CI: -56/39-37/04) 76/89(%95 CI: -15/51-2/33) 46/62(%95 CI: -24/51-7/27) 60/05(%95 CI: -17/13-4/30)

8 General Health 38/33 (% 43/12-4/79) Vitality 35 (% 46/22-13/85) Social function Role- Physical Mental Health 54/2 (%95CI : -43/60-15/09) 44/44 (%95CI:- 59/79-48/67) 48(% 40/23-21/50) 57/5(%95C I: -76/73-38/40) 51/2(%95C I: -87/03-54/66) 68/42(%95 CI: -81/25-52/74) 49/99(%95 CI: /89) 57/36(%95 CI: -63/98-45/24) 57/24[%95 CI: -16/15- (-0/49)] 57/02(%95 CI: -4/06-15/37) 67/9(%95CI : -13/27-3/12) 52/25(%95 CI: -4/77-28/63) 66/16(%95 CI: -3/50-13/63) 65/56[% 95CI :- 16/31-(- 0.33)] 51/37(9 5% CI :- 3/73-15/04) 72/98(% 13/34-3/18) 40/32(% 5/09-28/95) 61/09(% 3/04-13/17)

Author's response to reviews

Author's response to reviews Title: Comparison of health-related quality of life between housewives and employed women in Zahedan City, Southeast Iran during 2009-2010 : A cross-sectional study Authors: