Summary of the article

In this article, Bjerregaard et al. examined the perception of parents of hospitalized children to a brief intervention by nursing staff regarding their alcohol consumption patterns. Using a motivational interviewing technique, they were able to assess not only the perceptions of the interventions, but also how these interventions influenced long-term behavioural changes in the parents. This is a very interesting study that addresses an area of clinical concern that is relevant to a wide audience. Overall, the article is well written and presented, and the results are immediately applicable to the clinical setting. In this critique, I would like to discuss the strengths of this paper, as well as a few areas where I feel it could have been improved or expanded slightly.

Structure and content

When writing a manuscript, it’s important to ensure that it has good structure. This helps you organize your ideas to ensure that you are presenting information in a logical manner and also helps the reader by providing them with consistency in what they are reading. Overall, I felt that this article was well structured and easy to understand; however, I have a few comments on how the content could be improved slightly.

The Abstract of this paper clearly outlines the study and the findings are presented in an order that is consistent with the text. However, I feel that the Background section might be better placed before the Aims of the study. Explaining first that little is known about parents’ feelings towards alcohol intervention by nursing staff would then lead more logically into the specific aims of this study.

The Background section provided a good description of the global burden of alcohol abuse as well as how this can put children at high risk. While it is known that a significant percentage of parents of hospitalized children have problems with alcohol use, we also learn that there are barriers to dealing with this, particularly with nursing staff untrained on the issue or personal bias. The subsequent background on brief interventions and motivational interviewing was short, but adequate for the introduction section, and this provided a good transition into the aims of the study.

The Methods section was well organized and made good use of subsections to help explain the study design and methods used. It was very clear how the authors carried out the interview training for nurses and how the participants were involved. The data analysis section was slightly confusing, however, owing to some complicated sentences and overly general language. I thought the ethics approval section for this study was well done, outlining committee approval, compliance with the Declaration of Helsinki, receipt of informed consent, and confidentiality issues. Ethical compliance is very important when conducting studies with humans, whether purely observational or involving clinical treatment. Outlining this information as the authors have done here in a separate section is highly recommended.

The Findings section was also well done. The authors discussed that three main findings emerged from the study: (1) parents felt that they experienced respect and genuine interest from the nursing staff; (2) the intervention caused parents to reflect on their use of alcohol; and (3) these reflections persisted over time and caused behavioural changes in many of the parents. Each of these findings was presented in its own subsection and described. Using subsections is a really useful way to present information and keep separate ideas distinct. The authors also addressed these findings in the Discussion in the same order presented here, which provided consistency throughout the paper.

There was good integration of references, giving context to how motivational interviewing can provide a positive effect on a person, particularly in response to questions about their alcohol abuse. It was interesting to consider the specific techniques used in motivational interviewing that appeared to have been meaningful factors leading to such a positive response. Factors such as the timing of the intervention, directing the motivation towards a specific resolution, and the personality traits of the nurses were touched upon, among others. In terms of expanding the use of motivational interviewing into other clinical areas, an analysis on what factors the authors determined to be most important in causing self-reflection and motivation to change for the parents would be worthwhile. By examining these factors, it might have helped the authors to provide more specific examples of what clinical scenarios this technique might be useful for. As it stands, they have only proposed motivational interviewing for use by medical practitioners in a general way, although it may not apply to all scenarios, as currently suggested.

An area of concern I had was that the subheadings in the Discussion section were not descriptive enough and somewhat repetitious.  The authors start out nicely by discussing the strengths and limitations of this study; however, the ‘Detailed findings’ section implied a further expansion on what was found in terms of response from the parents. Instead, it included a good discussion about the merits of using motivational interviewing. This is interesting and useful information, so it may have been better to provide a more descriptive heading for this subsection to indicate the focus of the discussion. Additionally, the final subheading in this section, ‘Implications for clinical practice and future research’, is almost identical to the heading for the Conclusion. It is an appropriate topic of discussion, but these two sections should be distinct. Finally, one of the stated aims of this study was to determine how to reinforce initiatives regarding behavioural changes related to lifestyle problems. This was not really addressed clearly or by using specific examples, thus a subheading and short discussion related to this might have been beneficial to tie the paper together.

Related to my concern about subheadings, the title of the manuscript itself feels a bit inaccurate and misleading. The current title of this manuscript indicates that this study examined alcohol consumption patterns among parents of hospitalized children. In reality, this paper focused more on the usefulness of motivational interviewing for lifestyle interventions and the perception of parents to this technique. A title that more accurately reflects this would be better to ensure that the focus of the study is clear to potential readers.

Presentation and Language

Words

Writing in a way that the reader can clearly understand is one of the main goals of good writing. This can sometimes be challenging when you are trying to be expressive and also get your point across, and this can lead to sentences becoming more complicated than needed. There are a few places in this article where the language was a bit awkward, making it slightly difficult to read. Overall, the level of English was very high, but this is something that even native English speakers sometimes have difficulty with.

Long sentences can be very troublesome to readers. By the time they get to the end of the sentence, they may have forgotten how this relates to the earlier part of the sentence because they have had so much information to process. The first sentence of the Abstract in this article, the very first sentence anyone is likely to read, is 50 words long. It outlines the two aims of the study but could easily be broken up into two sentences. This would make it much easier to process as a reader and could actually improve the Abstract by showing the logical progression of goals. In this case, first the impact the intervention had on the parents, and second, how this led to parents making long-term behavioural changes.

I found this article also had some trouble with unnecessary repetition in the words used, often having repeating words within a sentence. This was probably done to ensure that it was clear what was being talked about, but if it’s not needed, repeating words can be more distracting than helpful. Word choice was also an issue at points throughout this paper. While overall it read well, sometimes the specific words that the authors chose to use were not the most descriptive or appropriate, making it slightly difficult to understand. The use of compound adjectives, for example ‘alcohol-attributable burden’, also felt awkward, and would have read better if written out in another way.

Finally, some of the description of the participant interviews and the data analysis procedure felt very wordy, vague and complicated. As someone not in this immediate field, I felt there were a lot of general terms used that weren’t specific enough to explain the procedures. Using commas to link many ideas together into long sentences in these sections also just served to confuse.

Figures/Tables

No figures or tables were presented in this article. However, it did make reference to three supplementary tables. Good display items are crucial to helping the reader understand your research, but given that this paper was qualitative and did not include a lot of data, I didn’t feel that the lack of tables or figures in this manuscript was a problem. The three supplementary tables provided interesting additional information for the reader explaining in more detail the interview process as well as comments and statements from parents about the process. These tables are either too big to have been included in the main text or wouldn’t have added any additional value to the paper, so moving them to the supplementary material was appropriate. Additional tables or figures are not needed.

Support quotes and referencing

The use of support quotes in an interview-based study can be tricky. It is important not to be overly reliant on support quotes to describe your findings as this interrupts the flow of text and doesn’t in itself provide meaningful discussion. Bjerregaard et al. did a good job summarizing the results of their interviews and incorporating the main points into the discussion. Comments from parents were provided in the supplementary material; however, it might have been beneficial to include at least one relevant quote for each of the major themes observed. In this way, the reader could formulate an opinion on actual statements made by the participants and not just rely on the summary of the authors or have to refer to the statements in the supplementary material to make an assessment.

As mentioned in Section 1 above, the incorporation of supporting references was well done. Background context on the current worldwide situation of alcohol abuse as well as the techniques used during the intervention was well explained and highly useful towards understanding the broader applicability of this study. The majority of the references were also quite recent, indicating the relevance of the background information provided.

English Tips

Good writing is a difficult skill to master. Even native English-speaking scientists can encounter difficulty expressing their ideas clearly and simply, and often fall into bad habits. When writing a manuscript, it is important to remember to keep the style clear and concise; however, the expression of your ideas should be presented in a slightly more formal manner than when speaking.

Awkward phrasing

Readers have certain expectations when reading a sentence. Without even realizing it, they use word placement to understand what the topic of the sentence is and the message you are trying to convey. Therefore, it is very important to structure your sentences in a way that clearly delivers your message to the reader. Introduce the subject of your sentence at the beginning and emphasize the message you want the reader to consider at the end. Use the active voice and limit the use of large compound adjectives. Although sometimes a sentence may technically make sense with few verbs, it can be very important to the clarity of a sentence to include them. Keeping sentences short is helpful, but it is more important to ensure that they are understood.  

Colloquial language/slang

Informal speech involves considerable use of words known as ‘slang’. This type of casual language is often highly specific, but it has the disadvantage of also being specific to a particular region or group of people. Therefore, some readers may have difficulty easily understanding these words. Additionally, slang has a tendency to sound lazy and sloppy when used in more formal written texts such as scientific manuscripts. When a reader is distracted by the language you use, they can lose confidence in the data you are presenting, even though it may be sound.

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Advice : Display Items & Using Supplementary Material

1. Display Items

Using display items in a manuscript can be a great way to help readers understand your results. They allow you to present a large amount of data quickly and efficiently. If you have complicated data, displaying it in a figure or table is much clearer than trying to explain it all in the text. Readers also tend to look at your figures and tables immediately after reading the Abstract; therefore, your display items should present your most significant results and be easily understandable. Good figures may entice readers to read your manuscript in its entirety. In addition to the tips described below, oftentimes publishers will have specific formatting requirements for figures and tables. Please refer to these requirements and format accordingly.

It is important to avoid duplicating the data presented in your figures and the text. Keep simple descriptive statistics in the text and use figures and tables to complement the information you are presenting.

So what makes a good figure? There are many things to consider and it depends on what data you have to work with, but the key point to remember is to ‘Keep it Simple’. It may be tempting to use a lot of colour and include a lot of data, but this can result in your figure appearing too ‘busy’ and difficult to understand. One way to avoid this is to separate your figure into multiple panels. You can also present several different styles of information within a figure to show corresponding data in different ways. For example, you may wish to show images from your study, but you can complement this with a bar chart or graph showing trends in these observations. No matter what style of figure you decide to use, always make sure to label all parts of your figures, including axes, trend lines, scale bars, or levels of statistical significance.

When it comes to tables, these are often easier than figures. However, it is important to not fill your table with too much information, and to only show the most significant results that will interest the reader. Dividing your data into categories and subcategories can help separate the data into more useful sections and make your table easy to understand. Smaller tables are generally preferred, but don’t be afraid to include a larger table if necessary.

Legends are also an important part of creating a useful figure or table. A good legend should clearly outline to the reader just what is being shown in the figure and should be able to stand alone from the main text. Any abbreviations that you use within your figures should be defined in full in the legend or, in the case of tables, you can include this information in a footnote. Other items that should be explained in the legend include any particular feature you have chosen to highlight using symbols (e.g. white arrows pointing to a notable physical change), and any colour-coding you have used (e.g. red lines, blue dashed circles, etc).

2. Supplementary Material

Sometimes you may find that the journal you are submitting to limits the number of display items that you are allowed. Or perhaps the information you want to present is quite large and might be distracting or take up too much space in the journal. There may also be restrictions on specific items that are never allowed to appear in the main text, for example, microarray data. In these cases, you may want to consider moving some figures or tables to the Supplementary Material section. Increasingly, these sections appear online-only; however, it allows researchers who want more details on your study to access this extra information, and there are often no limits on the number of items you can include.