[Futuregen] Widowhood paper: Rejected by Journal of Gerontology

Tue Apr 6 13:58:27 CEST 2021

Hi Stefania and All,
Sorry that it is not a more straightforward publication process Stefania. You've worked so hard on the paper!
I am happy to help with revisions. Please let me know what you need.
Best wishes, Janet

Janet Jull, OT Reg (Ont), PhD

Assistant Professor, School of Rehabilitation Therapy,
Queen's University, Kingston, Ontario
janet.jull at queensu.ca

Doctor of Science in Rehabilitation and Health Leadership (DSc RHL)
https://rehab.queensu.ca/academic-programs/dsc

Affiliate Investigator, Ottawa Hospital Research Institute
Ottawa, Ontario

Queen's University is situated on traditional Anishinaabe and Haudenosaunee Territory.
________________________________
From: Futuregen <futuregen-bounces at euro.centre.org> on behalf of Stefan Fors <stefan.fors at ki.se>
Sent: April 6, 2021 5:24 AM
To: Afshin Vafaei <vafaei.afshin at gmail.com>; Stefania Ilinca <ilinca at euro.centre.org>
Cc: futuregen at euro.centre.org <futuregen at euro.centre.org>
Subject: Re: [Futuregen] Widowhood paper: Rejected by Journal of Gerontology

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.

All the best,

Stefan

Från: Futuregen <futuregen-bounces at euro.centre.org> För Afshin Vafaei
Skickat: den 6 april 2021 00:01
Till: Stefania Ilinca <ilinca at euro.centre.org>
Kopia: futuregen at euro.centre.org
Ämne: Re: [Futuregen] Widowhood paper: Rejected by Journal of Gerontology

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.

I see reviewer #3 careful and detailed comments particularly useful for improving the manuscript.

Looking forward to seeing your resubmission plan.

Cheers,

Afshin

On Mon, Apr 5, 2021 at 8:21 AM Stefania Ilinca <ilinca at euro.centre.org<mailto:ilinca at euro.centre.org>> wrote:

Dear all,

I keep bringing bad news after important holidays - sorry about that.
Unfortunately, the widowhood paper was rejected by the Journals of
Gerontology, but this time both the reviewers and the editor have
provided detailed and useful comments - see copied below. None seem
insurmountable at a first read.

I look forward to discussing this once you would have had a chance to
read through the comments. In the meanwhile, I will prepare a plan for
re-submission (including planned changes to the manuscript and the
analyses, as well as a few target journal proposals).

My best regards, Stefania

From:

JGeronSoc at Geron.org<mailto:JGeronSoc at Geron.org>

To:

ilinca at euro.centre.org<mailto:ilinca at euro.centre.org>

CC:

Subject:

Journal of Gerontology: Social Sciences - Decision on Manuscript ID
JGSS-2021-012

Body:

Dear Author,

On 12-Jan-2021 we received your  manuscript entitled Gender Differences
in Access to Community-Based Care: A Longitudinal Analysis of the
Effects of Widowhood and Living Arrangements for possible publication in
the Journal of Gerontology: Social Sciences. The thoughtful comments of
the reviewers are enclosed for your consideration.

The reviewers are very accomplished in their research and knowledgeable
of the topic of your manuscript.  I am quite impressed by the careful
and constructive reviews that they have submitted.

Although the reviewers value the topic of your study, they raise a
number of fairly serious concerns about your manuscript. The reviewers'
comments are thorough and quite explicit.  After carefully considering
the judgment of the reviewers, I am sorry to write that we will not be
able to publish your paper in the Journal of Gerontology: Social Sciences.

To put this editorial decision into perspective, let me add that the
Journal accepts less than 20% of all manuscripts submitted.

When I reread the paper with the reviewers' comments in mind, I had many
of the same reactions: the topic is very interesting, and the paper has
great potential. Probably the most significant limitation derives from
the study design.

This is a study using SHARE to examine the risk of unmet care needs
among widowed men and women. Findings indicate that women who transition
into widowhood are more likely to receive care than men.  Living alone
and widowhood have independent influences on likelihood of receiving
care.  As population ages in Europe, the degree to which functional
needs are being met in the community is an important line of inquiry.

The reviewers expressed enthusiasm for the general question, but pointed
out a number of weaknesses with the present manuscript, both
conceptually and methodologically.  In my own reading of the manuscript,
I concur. I will not reiterate all of their points here but will note
some of the key ones that drove this decision. Foremost, the study is
grounded in a very delimited question, attempting to parse the influence
of widowhood from living arrangement on receiving care.  Conceptually,
bereavement, widowhood, and living arrangement are not clearly
separated. Methodologically, the analyses test simultaneously for
effects of widowhood, health needs, living alone, and household size
with little attention to their measurement overlap. Second, the analyses
did not provide formal contrasts by gender even though the results were
interpreted in this way.  Third, the statistical model may be a novel
contribution to the literature but this needs further elaboration for
the reader as to its strengths over traditional fixed and random effects
models.  It seems that indicators of model fit are missing, as well,
making it difficult to evaluate impact of the findings.  These are not
insurmountable critiques but careful attention to them would likely
yield a completely different manuscript.  I hope that the feedback is
helpful as you revise your manuscript for another journal such as
Research on Aging.

I wish that this letter could have brought you better news, and I thank
you for considering the Journal of Gerontology: Social Sciences. I hope
that you will continue to submit your work to us in the future.

I also encourage you to exploit the thorough and constructive comments
of the reviewers. They felt that the paper has promise, and I am sure
that their comments will help you in revising the paper to fulfill that
promise.

Best regards,
Jessica Kelley,  Editor

Reviewer(s)' Comments to Author:

Reviewer: 1

Comments to the Author
This manuscript examines gender differences in getting help among older
adults, and trying to separate out the effects of widowhood and living
arrangements.

The premise: Although this topic of older adults needing care is an
important one, I'm not sure I understand this way of approaching the
question.  Why do we need to separate out the effects of living alone
and widowhood? How does this help us make sure that people who need care
get it?

There are some vague terms used and I'm not sure that I followed. For
example, "fairness" in European long-term care systems.

I'm not sure if it might be useful to look at why people are not
receiving care?  Is it because they don't want it, or because they can't
get it, or can't afford it?  If you're interested in issues of access,
then affordability might be a dimension to examine.

If you want to stick with this question, try to explain what we gain
from separating out the effects of widowhood vs living arrangements.
I'm not sure that that case was made.

Reviewer: 2

Comments to the Author
This study examines the impact of gender, widowhood, and living
arrangements on the use of home and community-based care among older
adults. The study demonstrates the important influence of gender,
particularly in the use of informal and formal health care settings
among the widowed population. The study is well written and uses
rigorous data analysis, but I still have questions about its approach to
separating widowhood from bereavement.
1) On page 4 lines 26 – 40. The study defines widowhood as “a long-term
and ongoing state” while bereavement is a short-term experience of the
death of a spouse. However, the study also states both widowhood and
bereavement have “immediate and long-lasting effects”. These two
statements contradict each other. If bereavement has lasting effects,
then it is widowhood. Could the author clarify the definition of
widowhood and bereavement and how to use them in the study?
2) There are three independent variables in the study: sex, widowhood,
and living arrangements. The study mentions that “A binary variable that
identifies widowhood was generated based on self-reported marital status
in each panel wave – married living with a spouse, married not living
with a spouse or widowed” (page 9 line 36 – 40). It is not clear how the
study measures “bereavement”. Since separating widowhood and bereavement
is a significant contribution of the study to the field, the study needs
to tell readers how to make it.
3) In tables 1 -3, the study also has variables for “transitions into
widowhood” and “transitions out of widowhood”. How to define these two
variables and why they are important in this study?
4) The study mentioned that due to the limited number of
regional-specific analyses by
“the size of the longitudinal sample in SHARE” (p15, line 47-50).
However, according to Table 1, there were 7554 women in the continental
area, 2553 women in the Nordic region, 5874 women in the Southern
region, and 5991 women in the Eastern region. This study seems to have
enough people to analyze the regional impact on people's use of home and
community care. It is well known that local health policies and
culturally based information care systems can significantly influence
people's behaviors of trust and use of informal and formal health care.
As the study mentions, support for widowhood is also gender-based and
influenced by local culture and policies. Since these regional data is
available for this study, could the authors tell us how the region
influences these gender-based behaviors? Maybe a moderation effects
analysis can help.

Reviewer: 3

Comments to the Author
The present manuscript presents a cross-national analysis of thousands
of older adults from across Europe. The manuscript aims to “explore the
complex pattern of associations between widowhood, living arrangements,
and use of home and community-based care”. I think this is a worthy
topic of study and the authors effectively convinced me of the
importance of the research questions. At the same time, I think there
are some fundamental problems with the ways that some of the analyses
were conducted and presented. I provide more detailed comments below in
the hopes of helping to strengthen a future iteration of this important
and interesting manuscript. I also want to couch my comments with the
caveat that while I feel comfortable conducting and interpreting
multilevel models, REWB models are new to me and I apologize for any
misunderstandings that occurred because of my ignorance.

Major comments:
1) The second objective, it seems to me, is concerned with the
interaction between a) sex and bereavement (within effects) and b) the
interaction between sex and widowhood (between effects), but my
understanding of the analyses is that no interactions were tested.
Instead, statistically significant effects for one sex (usually females)
along with statistically non-significant effects for another sex
(usually males) were treated as if they indicated a sex difference.
Likewise, the third objective states that it wants to, “…reflect on how
disadvantages in [financial and human capital] can intersect with sex to
influence patterns of [HCBS] use”. Here interactions of interest appear
to be those between sex and the stated dimensions of capital.
1a. Here are some other statements that lead me to think the manuscript
was concerned with, and interpreted results as if there were,
interactions, despite not testing interactions: “Our results further
confirm previous findings of a differential effect of socio-economic
status indicators across sexes”; “We next turn our attention to the
possibility that the above results are moderated by country specific
characteristics and institutional factors that are not fully captured by
country specific dummy variables.”; “This suggests older widows are
better able to access care resources following bereavement, whereas
older widowers are less likely to do so”; “We found socio-economic
status indicators were associated with care use only for older women,
suggesting a modifying effect of sex.”; “More specifically, we find
gender differences in the effect of widowhood and living arrangements on
probability to receive long-term care are attenuated in countries that
emphasize defamilialization (of care) through public provision, shifting
responsibility for care from the family towards the state (Saraceno,
2016: 317).”
2) It seems that the analyses for males in Table 3 are almost definitely
underpowered (because the 168 bereavement events are spread across 4
countries) and that this may also be the case for females (especially if
there is disproportionate sampling or disproportionate observation of
bereavement events across the welfare clusters). I do not believe there
was a discussion of power in the manuscript but given that there were
some large effects in Table 3 that did not achieve statistical
significance, this seems to support the contention of insufficient power.
3) In this study the primary outcome is a binary indicator comprising
any care participants have received, combining informal and formal care
as well as different quantities of care. I think the authors adequately
address the lack of quantity information in the discussion. I am less
satisfied with the rationale for combining formal and informal care.
This seems like an important question that future readers of the
manuscript will be curious about. Perhaps a future iteration of the
manuscript might disaggregate formal and informal care. I am sensitive
to the need to fit within restrictive word limits, so I would completely
understand if such a sensitivity analysis ends up in supplemental
materials along with a stronger rationale for the aggregation of formal
and informal care in the main text.
4) “both widows and widowers have a higher probability of receiving care
than older individuals with partners” Is it possible that this suggests
that there is a problem in measurement wherein people underreport the
care provided by their spouses? If one has needs, and someone is in the
home with them, are they not likely to receive the necessary support?
According to the manuscript, it seems to be the case that live-in
partners provide support, especially when carers are female (e.g.,
“Finally, the surviving spouses in our study (i.e. the widows and
widowers) were likely previously providing informal care to their
deceased spouse. There is evidence that households where the wife is the
informal carer tend to receive less formal care service due to
persistent gender stereotypes of women's roles as caregivers (Schmidt
2017, Larsson et al. 2014). I would like to acknowledge that I am not
saying there is a measurement problem, but I would be interested to hear
the authors’ thoughts on the matter and why they think there is evidence
for/against such an error.
5) Overall there is extensive focus on statistical significance with
relatively little focus on effect sizes. This seems particularly
problematic because the analyses for males are so underpowered in some
circumstances (e.g., the rather sizeable effect of bereavement for males
in Eastern countries, which is the third largest effect in Table 3 and
is in the opposite direction of most of the findings). I’m not
advocating for interpreting null effects, but I do think statistical
significance and effect size should carefully be considered in concert.
6) The consistency of the findings across the four models in Table 2 and
the four types of countries in Table 3 was neat to see! I was especially
surprised to see that was the case in model 4 since the variables
included in that model were likely highly correlated with
bereavement/widowhood effects. Bravo to the authors for testing and
reporting that model (and also presenting the others, which likely have
fewer issues with collinearity).

Minor Comments:

1) “The care literature has overwhelmingly focused on intergenerational
support patterns and caregiving by children to older parents,” this
seems like a tough statement to backup. There is a vast literature on
caregiving focused on spouses. Indeed, in the bereavement-care
literature, I would argue that spouses are focused on to a larger extent
than adult-children because some studies suggest (and lay-wisdom
overwhelmingly suggests) that the adverse consequences of bereavement
for former caregivers is greater than that for adult-children.
2) The manuscript mentions excluding waves 3 and 7, but it was unclear
why. Did these waves not include necessary data?
3) I believe Table 1 presents (for the most part) observation N’s as
opposed to participant N’s (I believe transitions into and out of
widowhood are likely participant N’s, though I guess they may not
necessarily be). I wonder if there might be an interesting way to
incorporate participant N’s in this table along with observation N’s.
For instance, it seems like an interesting data point to include how
many participants received care at any point in the study versus the
number who never received care. Based on my reading of the results
section, it seems that there is interest in this level of analysis and
that much of the first paragraph of the results section interprets the
findings of Table 1 as if it presented results at the individual level.
It seemed especially surprising to me that variables like “low
education” were presented at the level of observations, given that such
a variable is probably not very likely to change over time for this
older sample (though it would be neat to know if it did change for the
sample).
4) Terms like gender and sex seem to be used interchangeably in this
manuscript, though my impression based on the method section is that
“sex” is what was actually measured. I therefore tried to confine my
terminology to sex and the associated categories of it that I believe
were measured here (except for quotes from the manuscript).

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