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Hi Stefania and All,</div>
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Sorry that it is not a more straightforward publication process Stefania. You've worked so hard on the paper!</div>
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I am happy to help with revisions. Please let me know what you need.</div>
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Best wishes, Janet</div>
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<span style="line-height:17.25px"><font color="#000000"><font face="garamond, serif" size="2"><b>Janet Jull, OT Reg (Ont), PhD</b></font></font></span></div>
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<div id="divRplyFwdMsg" dir="ltr"><font face="Calibri, sans-serif" style="font-size:11pt" color="#000000"><b>From:</b> Futuregen <futuregen-bounces@euro.centre.org> on behalf of Stefan Fors <stefan.fors@ki.se><br>
<b>Sent:</b> April 6, 2021 5:24 AM<br>
<b>To:</b> Afshin Vafaei <vafaei.afshin@gmail.com>; Stefania Ilinca <ilinca@euro.centre.org><br>
<b>Cc:</b> futuregen@euro.centre.org <futuregen@euro.centre.org><br>
<b>Subject:</b> Re: [Futuregen] Widowhood paper: Rejected by Journal of Gerontology</font>
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<p class="x_MsoNormal"><span style="">That’s too bad, but as Afshin points out the reviewers do see merit in the study. Much of their concerns can probably be addressed by strengthening the rationale of the study and clarifying some issues.
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<p class="x_MsoNormal"><span style=""> </span></p>
<p class="x_MsoNormal"><span style="">All the best,</span></p>
<p class="x_MsoNormal"><span style=""> </span></p>
<p class="x_MsoNormal"><span style="">Stefan</span></p>
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<p class="x_MsoNormal"><b><span lang="SV">Från:</span></b><span lang="SV"> Futuregen <futuregen-bounces@euro.centre.org>
<b>För </b>Afshin Vafaei<br>
<b>Skickat:</b> den 6 april 2021 00:01<br>
<b>Till:</b> Stefania Ilinca <ilinca@euro.centre.org><br>
<b>Kopia:</b> futuregen@euro.centre.org<br>
<b>Ämne:</b> Re: [Futuregen] Widowhood paper: Rejected by Journal of Gerontology</span></p>
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<p class="x_MsoNormal">Well Sterfanai not the best news but the reviews are in general positive. I have a feeling if it was a journal rathert than this high demand GSA journal you would get a major revision decision and most of the concerns could have been
addressed with clarifications in the response letter.</p>
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<p class="x_MsoNormal">I see reviewer #3 careful and detailed comments particularly useful for improving the manuscript. </p>
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<p class="x_MsoNormal"> </p>
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<p class="x_MsoNormal">Looking forward to seeing your resubmission plan. </p>
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<p class="x_MsoNormal">Cheers,</p>
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<p class="x_MsoNormal">Afshin </p>
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<p class="x_MsoNormal">On Mon, Apr 5, 2021 at 8:21 AM Stefania Ilinca <<a href="mailto:ilinca@euro.centre.org" target="_blank">ilinca@euro.centre.org</a>> wrote:</p>
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<p class="x_MsoNormal">Dear all,<br>
<br>
I keep bringing bad news after important holidays - sorry about that. <br>
Unfortunately, the widowhood paper was rejected by the Journals of <br>
Gerontology, but this time both the reviewers and the editor have <br>
provided detailed and useful comments - see copied below. None seem <br>
insurmountable at a first read.<br>
<br>
I look forward to discussing this once you would have had a chance to <br>
read through the comments. In the meanwhile, I will prepare a plan for <br>
re-submission (including planned changes to the manuscript and the <br>
analyses, as well as a few target journal proposals).<br>
<br>
My best regards, Stefania<br>
<br>
From:<br>
<br>
<a href="mailto:JGeronSoc@Geron.org">JGeronSoc@Geron.org</a><br>
<br>
To:<br>
<br>
<a href="mailto:ilinca@euro.centre.org" target="_blank">ilinca@euro.centre.org</a><br>
<br>
CC:<br>
<br>
Subject:<br>
<br>
Journal of Gerontology: Social Sciences - Decision on Manuscript ID <br>
JGSS-2021-012<br>
<br>
Body:<br>
<br>
Dear Author,<br>
<br>
On 12-Jan-2021 we received your manuscript entitled Gender Differences <br>
in Access to Community-Based Care: A Longitudinal Analysis of the <br>
Effects of Widowhood and Living Arrangements for possible publication in <br>
the Journal of Gerontology: Social Sciences. The thoughtful comments of <br>
the reviewers are enclosed for your consideration.<br>
<br>
The reviewers are very accomplished in their research and knowledgeable <br>
of the topic of your manuscript. I am quite impressed by the careful <br>
and constructive reviews that they have submitted.<br>
<br>
Although the reviewers value the topic of your study, they raise a <br>
number of fairly serious concerns about your manuscript. The reviewers' <br>
comments are thorough and quite explicit. After carefully considering <br>
the judgment of the reviewers, I am sorry to write that we will not be <br>
able to publish your paper in the Journal of Gerontology: Social Sciences.<br>
<br>
To put this editorial decision into perspective, let me add that the <br>
Journal accepts less than 20% of all manuscripts submitted.<br>
<br>
When I reread the paper with the reviewers' comments in mind, I had many <br>
of the same reactions: the topic is very interesting, and the paper has <br>
great potential. Probably the most significant limitation derives from <br>
the study design.<br>
<br>
This is a study using SHARE to examine the risk of unmet care needs <br>
among widowed men and women. Findings indicate that women who transition <br>
into widowhood are more likely to receive care than men. Living alone <br>
and widowhood have independent influences on likelihood of receiving <br>
care. As population ages in Europe, the degree to which functional <br>
needs are being met in the community is an important line of inquiry.<br>
<br>
The reviewers expressed enthusiasm for the general question, but pointed <br>
out a number of weaknesses with the present manuscript, both <br>
conceptually and methodologically. In my own reading of the manuscript, <br>
I concur. I will not reiterate all of their points here but will note <br>
some of the key ones that drove this decision. Foremost, the study is <br>
grounded in a very delimited question, attempting to parse the influence <br>
of widowhood from living arrangement on receiving care. Conceptually, <br>
bereavement, widowhood, and living arrangement are not clearly <br>
separated. Methodologically, the analyses test simultaneously for <br>
effects of widowhood, health needs, living alone, and household size <br>
with little attention to their measurement overlap. Second, the analyses <br>
did not provide formal contrasts by gender even though the results were <br>
interpreted in this way. Third, the statistical model may be a novel <br>
contribution to the literature but this needs further elaboration for <br>
the reader as to its strengths over traditional fixed and random effects <br>
models. It seems that indicators of model fit are missing, as well, <br>
making it difficult to evaluate impact of the findings. These are not <br>
insurmountable critiques but careful attention to them would likely <br>
yield a completely different manuscript. I hope that the feedback is <br>
helpful as you revise your manuscript for another journal such as <br>
Research on Aging.<br>
<br>
<br>
<br>
I wish that this letter could have brought you better news, and I thank <br>
you for considering the Journal of Gerontology: Social Sciences. I hope <br>
that you will continue to submit your work to us in the future.<br>
<br>
I also encourage you to exploit the thorough and constructive comments <br>
of the reviewers. They felt that the paper has promise, and I am sure <br>
that their comments will help you in revising the paper to fulfill that <br>
promise.<br>
<br>
Best regards,<br>
Jessica Kelley, Editor<br>
<br>
<br>
<br>
Reviewer(s)' Comments to Author:<br>
<br>
Reviewer: 1<br>
<br>
Comments to the Author<br>
This manuscript examines gender differences in getting help among older <br>
adults, and trying to separate out the effects of widowhood and living <br>
arrangements.<br>
<br>
The premise: Although this topic of older adults needing care is an <br>
important one, I'm not sure I understand this way of approaching the <br>
question. Why do we need to separate out the effects of living alone <br>
and widowhood? How does this help us make sure that people who need care <br>
get it?<br>
<br>
There are some vague terms used and I'm not sure that I followed. For <br>
example, "fairness" in European long-term care systems.<br>
<br>
I'm not sure if it might be useful to look at why people are not <br>
receiving care? Is it because they don't want it, or because they can't <br>
get it, or can't afford it? If you're interested in issues of access, <br>
then affordability might be a dimension to examine.<br>
<br>
If you want to stick with this question, try to explain what we gain <br>
from separating out the effects of widowhood vs living arrangements. <br>
I'm not sure that that case was made.<br>
<br>
Reviewer: 2<br>
<br>
Comments to the Author<br>
This study examines the impact of gender, widowhood, and living <br>
arrangements on the use of home and community-based care among older <br>
adults. The study demonstrates the important influence of gender, <br>
particularly in the use of informal and formal health care settings <br>
among the widowed population. The study is well written and uses <br>
rigorous data analysis, but I still have questions about its approach to <br>
separating widowhood from bereavement.<br>
1) On page 4 lines 26 – 40. The study defines widowhood as “a long-term <br>
and ongoing state” while bereavement is a short-term experience of the <br>
death of a spouse. However, the study also states both widowhood and <br>
bereavement have “immediate and long-lasting effects”. These two <br>
statements contradict each other. If bereavement has lasting effects, <br>
then it is widowhood. Could the author clarify the definition of <br>
widowhood and bereavement and how to use them in the study?<br>
2) There are three independent variables in the study: sex, widowhood, <br>
and living arrangements. The study mentions that “A binary variable that <br>
identifies widowhood was generated based on self-reported marital status <br>
in each panel wave – married living with a spouse, married not living <br>
with a spouse or widowed” (page 9 line 36 – 40). It is not clear how the <br>
study measures “bereavement”. Since separating widowhood and bereavement <br>
is a significant contribution of the study to the field, the study needs <br>
to tell readers how to make it.<br>
3) In tables 1 -3, the study also has variables for “transitions into <br>
widowhood” and “transitions out of widowhood”. How to define these two <br>
variables and why they are important in this study?<br>
4) The study mentioned that due to the limited number of <br>
regional-specific analyses by<br>
“the size of the longitudinal sample in SHARE” (p15, line 47-50). <br>
However, according to Table 1, there were 7554 women in the continental <br>
area, 2553 women in the Nordic region, 5874 women in the Southern <br>
region, and 5991 women in the Eastern region. This study seems to have <br>
enough people to analyze the regional impact on people's use of home and <br>
community care. It is well known that local health policies and <br>
culturally based information care systems can significantly influence <br>
people's behaviors of trust and use of informal and formal health care. <br>
As the study mentions, support for widowhood is also gender-based and <br>
influenced by local culture and policies. Since these regional data is <br>
available for this study, could the authors tell us how the region <br>
influences these gender-based behaviors? Maybe a moderation effects <br>
analysis can help.<br>
<br>
<br>
Reviewer: 3<br>
<br>
Comments to the Author<br>
The present manuscript presents a cross-national analysis of thousands <br>
of older adults from across Europe. The manuscript aims to “explore the <br>
complex pattern of associations between widowhood, living arrangements, <br>
and use of home and community-based care”. I think this is a worthy <br>
topic of study and the authors effectively convinced me of the <br>
importance of the research questions. At the same time, I think there <br>
are some fundamental problems with the ways that some of the analyses <br>
were conducted and presented. I provide more detailed comments below in <br>
the hopes of helping to strengthen a future iteration of this important <br>
and interesting manuscript. I also want to couch my comments with the <br>
caveat that while I feel comfortable conducting and interpreting <br>
multilevel models, REWB models are new to me and I apologize for any <br>
misunderstandings that occurred because of my ignorance.<br>
<br>
Major comments:<br>
1) The second objective, it seems to me, is concerned with the <br>
interaction between a) sex and bereavement (within effects) and b) the <br>
interaction between sex and widowhood (between effects), but my <br>
understanding of the analyses is that no interactions were tested. <br>
Instead, statistically significant effects for one sex (usually females) <br>
along with statistically non-significant effects for another sex <br>
(usually males) were treated as if they indicated a sex difference. <br>
Likewise, the third objective states that it wants to, “…reflect on how <br>
disadvantages in [financial and human capital] can intersect with sex to <br>
influence patterns of [HCBS] use”. Here interactions of interest appear <br>
to be those between sex and the stated dimensions of capital.<br>
1a. Here are some other statements that lead me to think the manuscript <br>
was concerned with, and interpreted results as if there were, <br>
interactions, despite not testing interactions: “Our results further <br>
confirm previous findings of a differential effect of socio-economic <br>
status indicators across sexes”; “We next turn our attention to the <br>
possibility that the above results are moderated by country specific <br>
characteristics and institutional factors that are not fully captured by <br>
country specific dummy variables.”; “This suggests older widows are <br>
better able to access care resources following bereavement, whereas <br>
older widowers are less likely to do so”; “We found socio-economic <br>
status indicators were associated with care use only for older women, <br>
suggesting a modifying effect of sex.”; “More specifically, we find <br>
gender differences in the effect of widowhood and living arrangements on <br>
probability to receive long-term care are attenuated in countries that <br>
emphasize defamilialization (of care) through public provision, shifting <br>
responsibility for care from the family towards the state (Saraceno, <br>
2016: 317).”<br>
2) It seems that the analyses for males in Table 3 are almost definitely <br>
underpowered (because the 168 bereavement events are spread across 4 <br>
countries) and that this may also be the case for females (especially if <br>
there is disproportionate sampling or disproportionate observation of <br>
bereavement events across the welfare clusters). I do not believe there <br>
was a discussion of power in the manuscript but given that there were <br>
some large effects in Table 3 that did not achieve statistical <br>
significance, this seems to support the contention of insufficient power.<br>
3) In this study the primary outcome is a binary indicator comprising <br>
any care participants have received, combining informal and formal care <br>
as well as different quantities of care. I think the authors adequately <br>
address the lack of quantity information in the discussion. I am less <br>
satisfied with the rationale for combining formal and informal care. <br>
This seems like an important question that future readers of the <br>
manuscript will be curious about. Perhaps a future iteration of the <br>
manuscript might disaggregate formal and informal care. I am sensitive <br>
to the need to fit within restrictive word limits, so I would completely <br>
understand if such a sensitivity analysis ends up in supplemental <br>
materials along with a stronger rationale for the aggregation of formal <br>
and informal care in the main text.<br>
4) “both widows and widowers have a higher probability of receiving care <br>
than older individuals with partners” Is it possible that this suggests <br>
that there is a problem in measurement wherein people underreport the <br>
care provided by their spouses? If one has needs, and someone is in the <br>
home with them, are they not likely to receive the necessary support? <br>
According to the manuscript, it seems to be the case that live-in <br>
partners provide support, especially when carers are female (e.g., <br>
“Finally, the surviving spouses in our study (i.e. the widows and <br>
widowers) were likely previously providing informal care to their <br>
deceased spouse. There is evidence that households where the wife is the <br>
informal carer tend to receive less formal care service due to <br>
persistent gender stereotypes of women's roles as caregivers (Schmidt <br>
2017, Larsson et al. 2014). I would like to acknowledge that I am not <br>
saying there is a measurement problem, but I would be interested to hear <br>
the authors’ thoughts on the matter and why they think there is evidence <br>
for/against such an error.<br>
5) Overall there is extensive focus on statistical significance with <br>
relatively little focus on effect sizes. This seems particularly <br>
problematic because the analyses for males are so underpowered in some <br>
circumstances (e.g., the rather sizeable effect of bereavement for males <br>
in Eastern countries, which is the third largest effect in Table 3 and <br>
is in the opposite direction of most of the findings). I’m not <br>
advocating for interpreting null effects, but I do think statistical <br>
significance and effect size should carefully be considered in concert.<br>
6) The consistency of the findings across the four models in Table 2 and <br>
the four types of countries in Table 3 was neat to see! I was especially <br>
surprised to see that was the case in model 4 since the variables <br>
included in that model were likely highly correlated with <br>
bereavement/widowhood effects. Bravo to the authors for testing and <br>
reporting that model (and also presenting the others, which likely have <br>
fewer issues with collinearity).<br>
<br>
<br>
Minor Comments:<br>
<br>
1) “The care literature has overwhelmingly focused on intergenerational <br>
support patterns and caregiving by children to older parents,” this <br>
seems like a tough statement to backup. There is a vast literature on <br>
caregiving focused on spouses. Indeed, in the bereavement-care <br>
literature, I would argue that spouses are focused on to a larger extent <br>
than adult-children because some studies suggest (and lay-wisdom <br>
overwhelmingly suggests) that the adverse consequences of bereavement <br>
for former caregivers is greater than that for adult-children.<br>
2) The manuscript mentions excluding waves 3 and 7, but it was unclear <br>
why. Did these waves not include necessary data?<br>
3) I believe Table 1 presents (for the most part) observation N’s as <br>
opposed to participant N’s (I believe transitions into and out of <br>
widowhood are likely participant N’s, though I guess they may not <br>
necessarily be). I wonder if there might be an interesting way to <br>
incorporate participant N’s in this table along with observation N’s. <br>
For instance, it seems like an interesting data point to include how <br>
many participants received care at any point in the study versus the <br>
number who never received care. Based on my reading of the results <br>
section, it seems that there is interest in this level of analysis and <br>
that much of the first paragraph of the results section interprets the <br>
findings of Table 1 as if it presented results at the individual level. <br>
It seemed especially surprising to me that variables like “low <br>
education” were presented at the level of observations, given that such <br>
a variable is probably not very likely to change over time for this <br>
older sample (though it would be neat to know if it did change for the <br>
sample).<br>
4) Terms like gender and sex seem to be used interchangeably in this <br>
manuscript, though my impression based on the method section is that <br>
“sex” is what was actually measured. I therefore tried to confine my <br>
terminology to sex and the associated categories of it that I believe <br>
were measured here (except for quotes from the manuscript).<br>
<br>
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