Peer support intervention (ABA-feed) to improve breastfeeding: UK based, multicentre, parallel group, randomised controlled trial.
Jolly K, Clarke J, Crossland N, Dombrowski SU, Gkini E, Hoddinott P, Ingram J, Johnson D, MacArthur C, Mann M, McKell J, Moss N, Roberts T, Sanders J, Savory N, Sitch A, Taylor B, Tearne S, Thomson G, Williams E, Woolley R, ABA-feed study group
- DOI
- 10.1136/bmj-2025-086558
- Record issued
- 2026-08-15
- Engine
- 7.39.0
- Exported
- 2026-09-22
Prepared by Alpha1. This document is confidential: it is intended for the recipient it was shared with and must not be redistributed. The live record at alpha1science.com/verify/fffd2884-306e-4e86-a7bd-58bae37359f0 is authoritative.
How this rating was calculated
- IntegrityIntegrity concern ×2−1★
- ClaimsEfficacy rests on an unvalidated surrogate endpoint−0.5★
- ClaimsTreatment effect not shown to be clinically meaningful−0.5★
- CitationsUnresolved reference−0.25★
- The numeric-impossibility checks (GRIM/GRIMMER/DEBIT/SPRITE) did not run: 20 reported means were read, and their group size is not stated where the values are printed (this source has no machine-readable table structure). These checks need the count the mean was averaged over, so none was performed.
- 01Efficacy rests on an unvalidated surrogate endpoint
The primary outcome is 'any breastfeeding at eight weeks after birth', which is a behavioral/clinical outcome but not a hard clinical endpoint like mortality or a validated clinical scale. It is a surrogate for longer-term health benefits. The paper does not demonstrate target engagement at the tested dose (e.g., PK/PD) nor cite validated evidence linking this surrogate to the clinical outcome of interest. The efficacy claim rests on this surrogate without such support.
“The primary outcome was any breastfeeding at eight weeks after birth collected by self-report questionnaire.”
- 02Treatment effect not shown to be clinically meaningful
The primary outcome showed no significant difference between groups (risk difference 0.01, 95% CI -0.03 to 0.04). The effect size is essentially null and not anchored to any clinically meaningful threshold. The paper itself concludes no benefit, so the effect size is inadequate as evidence of efficacy.
“Rates of any breastfeeding at eight weeks did not differ between the intervention group (1013/1452; 69.8%) and usual care group (698/1015; 68.8%); adjusted risk difference 0.01, 95% confidence interval −0.03 to 0.04.”
This Kaimen Rigor review uses Kaimen Rigor reviewers trained on a curated corpus of high-fidelity and retracted papers, with expert supervision and curation. It can still make mistakes; verify each finding against the source before relying on it.
This is a well-conducted and transparently reported randomised controlled trial of a peer support intervention for breastfeeding. The methods are rigorous, with clear randomization, sample size justification, and prespecified analyses. Minor reporting gaps include lack of explicit CONSORT statement and some threshold p-values, but these do not undermine the overall integrity.
Both reviewers classified the study as interventional, and I adopt that. The evaluation covered all eight dimensions; several sub-criteria were not applicable (e.g., animal-related, cell lines). The statistics verification recomputed only 3 tests, all consistent; other statistics remain unverified. The citation check found 1 reference not found in registry, which is a potential fabrication signal.
Numerical inconsistencies
1 finding · worst lowValues that contradict each other or are impossible for the stated sample: recomputed p-values and test statistics, GRIM/GRIMMER checks on summary numbers, percentages against their own counts, totals against their parts, and estimates against their own confidence intervals.
- Internal contradictions in the reported numbersAssessed
Recomputed 3 tests: 3 consistent, 0 inconsistent; 3 via agent-written checks.
- CONSISTENTreported p = .690 · recomputed p = .575Reviewers 1, 2Primary outcome risk difference p-value
“risk difference 0.01, 95% CI −0.03 to 0.04, P=0.69”
Taken as given: The risk difference is 0.01 with 95% CI -0.03 to 0.04.; The CI is two-sided at 95%.Method: Recomputed p-value from the reported risk difference and 95% CI using the normal approximation.How we recomputed it: pCI(0.01, -0.03, 0.04, 0) - CONSISTENTreported p = .130 · recomputed p = .075Reviewers 1, 2Breastfeeding initiation risk difference p-value
“risk difference 0.02, 95% CI −0.004 to 0.04; P=0.13”
Taken as given: The risk difference is 0.02 with 95% CI -0.004 to 0.04.; The CI is two-sided at 95%.Method: Recomputed p-value from the reported risk difference and 95% CI using the normal approximation.How we recomputed it: pCI(0.02, -0.004, 0.04, 0) - CONSISTENTreported p = .370 · recomputed p = .327Reviewer 2Any breastfeeding at 16 weeks risk difference p-value
“Any breastfeeding at 16 and 24 weeks and exclusive breastfeeding rates at eight, 16, and 24 weeks were similar between the groups ().”
Taken as given: The risk difference is 0.02 with 95% CI -0.02 to 0.06.; The CI is two-sided at 95%.; The p-value is for the risk difference.Method: Recomputed two-tailed p from the estimate and 95% CI using normal approximation.How we recomputed it: pCI(0.02, -0.02, 0.06, 0)
- lowinternal contradictionThe abstract reports the primary outcome p-value as 0.69, while Table 3 reports the risk ratio p-value as 0.77 and the risk difference p-value as 0.69. This is not a contradiction but a difference in the statistic tested.
adjusted risk difference 0.01, 95% confidence interval −0.03 to 0.04. ... P=0.69
Table 3reviewer’s wording - lowinternal contradictionThe paper states that 2475 participants were recruited, but the sample size calculation required 2730. The paper acknowledges this shortfall in the limitations.
“Overall, 2475 participants were recruited from 17 sites across the UK between January 2022 and January 2024 and randomised to usual care plus ABA-feed (n=1458) or to usual care only (n=1017).”
MethodsFind in source
Overstated conclusions
2 findings · worst highConclusions that reach past what the paper's own results support — including a significance claim that no longer holds when the statistic is recomputed, and efficacy resting on an unvalidated surrogate endpoint.
- Efficacy rests on an unvalidated surrogate endpointAssessed
- Treatment effect not shown to be clinically meaningfulAssessed
6 major claims checked against the paper's own evidence: all adequately supported.
- supportedReviewers 1, 2The ABA-feed peer support intervention did not improve breastfeeding rates compared with usual breastfeeding support in a UK context.The primary outcome showed no significant difference, and the conclusion is consistent with the results.Evidence: Primary outcome: any breastfeeding at 8 weeks 69.8% vs 68.8%, risk difference 0.01 (95% CI -0.03 to 0.04).
“The ABA-feed peer support intervention did not improve breastfeeding rates compared with usual breastfeeding support in a UK context.”
ConclusionFind in source - supportedReviewers 1, 2At eight weeks the intervention group reported higher social support, but this was not sustained at 16 weeks.The results show a significant difference at 8 weeks but not at 16 weeks.Evidence: Medical Outcomes Study score at 8 weeks: median difference 6.25 (95% CI 1.99 to 10.51, P=0.004); at 16 weeks: 3.13 (95% CI -1.45 to 7.70, P=0.18).
“At eight weeks the intervention group reported higher social support, but this was not sustained at 16 weeks.”
AbstractFind in source - supportedReviewer 1The ABA-feed intervention did not show any benefits to breastfeeding rates or formula feeding practices in the UK.All feeding outcomes were non-significant, and formula feeding practices showed no consistent benefit.Evidence: No significant differences in any breastfeeding or exclusive breastfeeding at any time point; formula preparation practices were similar.
“The ABA-feed model of enhanced peer support did not show any benefits to breastfeeding rates or formula feeding practices in the UK.”
ConclusionFind in source - supportedReviewer 2The ABA-feed intervention did not improve formula feeding practices.The paper reports no significant differences in formula feeding practices, and the conclusion is consistent with the presented data.Evidence: Supplementary table 5 details formula feeding practices; no significant differences were reported.
“The ABA-feed model of enhanced peer support did not show any benefits to breastfeeding rates or formula feeding practices in the UK.”
ConclusionFind in source - supportedReviewer 2The intervention was delivered with good fidelity.The paper reports high rates of antenatal and postnatal contacts, with 82.2% receiving the main meeting and 90.3% at least one postnatal contact.Evidence: Table 2: Participants with main or initial meeting 1033 (82.2%), at least one postnatal contact 1135 (90.3%).
“The intervention was delivered with good fidelity and without evidence of contamination.”
LimitationsFind in source - supportedReviewer 2The trial did not achieve full recruitment but exceeded the target for 80% power.The paper states recruitment was 90.7% of the 2730 target, and the sample size calculation indicated 2730 was needed for 90% power, but 80% power could be achieved with a smaller sample.Evidence: Results: 'At final recruitment, 90.7% of the 2730 target population was achieved.'
“A limitation was that we did not fully achieve recruitment numbers to reach 90% power but did exceed the target for 80% power.”
LimitationsFind in source
Premise concern: surrogate not validated for clinical benefit; effect size not shown to be clinically meaningful.
- INADEQUATESurrogate endpointThe primary outcome is 'any breastfeeding at eight weeks after birth', which is a behavioral/clinical outcome but not a hard clinical endpoint like mortality or a validated clinical scale. It is a surrogate for longer-term health benefits. The paper does not demonstrate target engagement at the tested dose (e.g., PK/PD) nor cite validated evidence linking this surrogate to the clinical outcome of interest. The efficacy claim rests on this surrogate without such support.
“The primary outcome was any breastfeeding at eight weeks after birth collected by self-report questionnaire.”
- INADEQUATEEffect sizeThe primary outcome showed no significant difference between groups (risk difference 0.01, 95% CI -0.03 to 0.04). The effect size is essentially null and not anchored to any clinically meaningful threshold. The paper itself concludes no benefit, so the effect size is inadequate as evidence of efficacy.
“Rates of any breastfeeding at eight weeks did not differ between the intervention group (1013/1452; 69.8%) and usual care group (698/1015; 68.8%); adjusted risk difference 0.01, 95% confidence interval −0.03 to 0.04.”
Data authenticity concerns
None foundAn adversarial read for patterns associated with data that may not be genuine: results that look too clean, implausibly large effects, duplicated data or images, and methods that do not match the results reported.
Checked — nothing surfaced.
Reporting gaps
None foundRequired detail the manuscript never states — study design, biological variables, ethics approval and consent, key resources, statistical reporting, data and code availability, and overall transparency.
Checked — nothing surfaced.
The introduction cites WHO recommendations, UK breastfeeding statistics, a 2022 Cochrane review, and prior UK trials, acknowledging both strengths and weaknesses of previous work. The rationale for the ABA-feed intervention is clearly linked to addressing limitations of prior interventions (low intensity, lack of timely support, need for proactive contact). The paper explicitly states how the intervention was developed to deal with these issues.
“A 2022 Cochrane review reported moderate certainty evidence that interventions providing breastfeeding support (delivered by professionals or non-professionals) probably reduce the risk of women stopping any and exclusive breastfeeding at 4-6 weeks, 3-4 months, and six months after birth.”
“Possible reasons include low intensity interventions, lack of timely support after the birth, and the need for a new parent to initiate contact.”
“The ABA-feed (Assets based feeding help Before and After birth-feed) intervention of infant feeding peer support was developed to deal with these issues”
“A 2022 Cochrane review reported moderate certainty evidence that interventions providing breastfeeding support (delivered by professionals or non-professionals) probably reduce the risk of women stopping any and exclusive breastfeeding at 4-6 weeks, 3-4 months, and six months after birth.”
“Possible reasons include low intensity interventions, lack of timely support after the birth, and the need for a new parent to initiate contact.”
Randomization used a secure central web-based system with a minimisation algorithm, ensuring allocation concealment. The trial was unblinded, which is stated and appropriate for a behavioral intervention. A detailed sample size calculation with assumptions is provided. Inclusion/exclusion criteria are clearly defined. The analysis population (ITT) and missing data handling are prespecified. The trial is a single pivotal trial, so independent replication is not applicable.
“To ensure concealment of treatment allocation, the Birmingham Clinical Trials Unit used a secure, central, web based randomisation system to allocate women in a 1.43:1 ratio to receive intervention or usual care.”
“Assuming 90% power and a two sided 5% significance level, with a control group rate of 44% for the primary outcome (95% CI 30.0% to 58.7%; from ABA feasibility data), a sample size of 2136 women (1068 in each group) was required to detect a risk ratio of 1.16 (ie, an increase of 7%).”
“Regardless of their feeding intention, women were eligible for recruitment if they were nulliparous, between 20 weeks and 35 weeks and six days gestation with a singleton pregnancy, aged 16 years or older, and lived in the study area.”
“To ensure concealment of treatment allocation, the Birmingham Clinical Trials Unit used a secure, central, web based randomisation system to allocate women in a 1.43:1 ratio to receive intervention or usual care.”
“Assuming 90% power and a two sided 5% significance level, with a control group rate of 44% for the primary outcome (95% CI 30.0% to 58.7%; from ABA feasibility data), a sample size of 2136 women (1068 in each group) was required to detect a risk ratio of 1.16 (ie, an increase of 7%).”
“Missing data were imputed as formula feeding for the primary outcome, excluding pregnancy losses, still births, infant deaths, or maternal deaths.”
The paper reports age, ethnicity, education, family status, employment, and feeding intentions in Table 1. Both sexes are not applicable as participants are women. Age and health status are reported. Demographics are comprehensive. Species/strain and housing are not applicable for a human trial.
“Mean age of the participants was 30 years, and most described their ethnicity as white (2132; 86.5%), family status as married or cohabiting (2309; 94.7%), employment status as in work (2317; 93.9%), and education to degree level (1726; 70.2%).”
“Mean age of the participants was 30 years, and most described their ethnicity as white (2132; 86.5%), family status as married or cohabiting (2309; 94.7%), employment status as in work (2317; 93.9%), and education to degree level (1726; 70.2%).”
The trial was approved by the East of Scotland Research Ethics Committee (21/ES/0045). Informed consent was obtained from each participant, with details on remote consent procedures. Regulatory compliance is implied through adherence to ethical standards, though not explicitly named.
“This trial was approved by the East of Scotland Research Ethics Committee (21/ES/0045).”
“Informed consent was obtained from each participant in person or by telephone or video call.”
“This trial was approved by the East of Scotland Research Ethics Committee (21/ES/0045).”
“Informed consent was obtained from each participant in person or by telephone or video call.”
The intervention is a behavioral peer support program, not a drug or device. The paper describes the intervention components, training, and delivery. Statistical software (SAS 9.4, Stata 18) is identified. No antibodies, cell lines, or reagents are used. The intervention itself is the key resource and is adequately described.
“Statistical analysis was undertaken using the statistical software packages SAS version 9.4 and Stata version 18.”
“Statistical analysis was undertaken using the statistical software packages SAS version 9.4 and Stata version 18.”
The primary analysis used mixed effects log binomial regression, with sensitivity analyses and prespecified subgroups. Effect sizes (risk differences) with 95% CIs are reported for primary and secondary outcomes. Exact p-values are provided for many outcomes. Software is identified. Data presentation includes participant flow and baseline tables. Mathematical plausibility checks were not performed due to lack of raw data.
“The primary outcome (any breastfeeding at eight weeks after birth) was binary, and the planned analysis was to use a mixed effects log binomial regression model, adjusting for intervention group and minimisation variables (age group and site) and the interaction of intervention by infant feeding helper.”
“Any breastfeeding at 8 weeks after birth | 1013 (69.8) | 698 (68.8) | 1.01 (0.96 to 1.06; 0.77) | 0.01 (−0.03 to 0.04; 0.69)”
“The primary outcome (any breastfeeding at eight weeks after birth) was binary, and the planned analysis was to use a mixed effects log binomial regression model, adjusting for intervention group and minimisation variables (age group and site) and the interaction of intervention by infant feeding helper.”
“Rates of any breastfeeding at eight weeks did not differ between the intervention group (1013/1452; 69.8%) and usual care group (698/1015; 68.8%); adjusted risk difference 0.01, 95% confidence interval −0.03 to 0.04.”
The data availability statement names a repository (UBIRA eData) with a URL and conditions for access (registration for ethically approved research). Statistical analysis code is included in the supplementary file. Individual participant data are deidentified and accessible via managed access, which is appropriate.
“Deidentified individual participant data stored at https://edata.bham.ac.uk/1555/ and are fully accessible for ethically approved research after registration with UBIRA eData.”
“The SAS version 9.4 and Stata version 18 statistical analysis code is included in the supplementary file.”
“Deidentified individual participant data stored at https://edata.bham.ac.uk/1555/ and are fully accessible for ethically approved research after registration with UBIRA eData.”
“The SAS version 9.4 and Stata version 18 statistical analysis code is included in the supplementary file.”
The trial is registered (ISRCTN17395671). Methods are comprehensive. Limitations are explicitly discussed, including recruitment bias and generalizability. Conclusions are appropriately cautious, noting no benefit and recommending against universal commissioning. Funding and competing interests are declared.
“Trial registration ISRCTN Registry ISRCTN17395671.”
“A limitation was that we did not fully achieve recruitment numbers to reach 90% power but did exceed the target for 80% power.”
“Trial registration ISRCTN Registry ISRCTN17395671.”
“A limitation was that we did not fully achieve recruitment numbers to reach 90% power but did exceed the target for 80% power.”
Registered (1 ID: ISRCTN). No reporting guideline cited.
Broken references and links
1 finding · worst lowReferences checked against Crossref, OpenAlex and Retraction Watch for retractions and resolvability, plus declared data and code links probed for whether they resolve to content matching the paper.
- References not resolvable to a published paperRecomputed
Checked 66 references by DOI: 48 verified — 1 DOI unresolved, 17 no DOI (shown, not verified).
- UNRESOLVED10.1016/s0140-6736(15Preventing disease and saving resources: the potential contribution of increasing breastfeeding rates in the UKCited DOI does not resolve to any Crossref record.
- NO DOIBreastfeedingNo DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
- NO DOIInfant and young child feedingNo DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
- NO DOIAustralia’s childrenNo DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
- NO DOIRates of Any and Exclusive Breastfeeding by Sociodemographic Characteristic Among Children Born in 2019No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
- NO DOIBreastfeeding at 6 to 8 weeks: a comparison of methodsNo DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
- NO DOIBreastfeeding data 2021No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
- NO DOIInfant feeding statistics: Financial year 2020 to 2021No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
- NO DOIBreastfeeding in Northern IrelandNo DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
- NO DOIFingertips: Public Health ProfilesNo DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
- NO DOIGuideline: Counselling of women to improve breastfeeding practicesNo DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
- NO DOIGuide to the UNICEF Baby Friendly Initiative StandardsNo DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
- NO DOIPostnatal careNo DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
- NO DOIMaternal and child nutrition: nutrition and weight management in pregnancy, and nutrition in children up to 5 yearsNo DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
- NO DOIInfant feeding survey 2010No DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
- NO DOIThe effect of peer support on breast-feeding duration among primiparous women: a randomized controlled trialNo DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
- NO DOIA randomized controlled trial indicates benefits of cell phone based peer counseling to support exclusive breastfeeding in KenyaNo DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
- NO DOIThe effect of a programme of organised and supervised peer support on the initiation and duration of breastfeeding: a randomised trialNo DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
1 data/code link checked; 1 live.
- datahttps://edata.bham.ac.uk/1555/LIVEHTTP 200Resolves, but the content could not be matched to the paper.
Copyediting
7 minorWording, consistency and formatting errors that need correcting before submission.
No major wording or formatting errors. 7 minor suggestions below.
7 copyedit issues flagged: mostly consistency, typo, clarity.
- MINORtypoTable 3 footnote“† Value >0 favour favours planned ABA-feed intervention.”→ Remove duplicate 'favour'.Typographical error in footnote.
- MINORconsistencyAbstract vs Results“adjusted risk difference 0.01, 95% confidence interval −0.03 to 0.04”→ Ensure consistent reporting of risk difference across abstract and results.Abstract reports risk difference 0.01, while Table 3 reports 0.01 (−0.03 to 0.04); consistent.
- MINORclarityMethods, Statistical analysis“Infant feeding helper was removed as a partial random effect because of problems with convergence or the estimate was close to zero.”→ Clarify whether removal was due to convergence or estimate close to zero.Ambiguity in reason for removal.
- MINORconsistencyTable 3 footnote“† Value >0 favour favours planned ABA-feed intervention.”→ Change to 'Value >0 favours planned ABA-feed intervention.'Typographical error: 'favour favours'.
- MINORtypoTable 3, row '24'“0.96 (0.89 to 1.03 0.29)”→ Add comma: '0.96 (0.89 to 1.03, 0.29)'Missing comma between CI and p-value.
- MINORconsistencyAbstract“adjusted risk difference 0.01, 95% confidence interval −0.03 to 0.04”→ Consider reporting as 'adjusted risk difference 0.01 (95% CI −0.03 to 0.04)' for consistency with other results.Minor formatting inconsistency.
- MINORclarityMethods, Statistical analysis“Infant feeding helper was removed as a partial random effect because of problems with convergence or the estimate was close to zero.”→ Clarify whether removal was due to convergence or estimate close to zero, as it is ambiguous.Ambiguity in the reason for removal.
The published work is robust and well-reported. An informed reader should weigh the minor reporting gaps (no explicit CONSORT statement, some threshold p-values) and the one unresolved reference. No erratum is warranted for the main findings, but the authors should verify the flagged reference and consider a correction if it is found to be fabricated.
- 1.HIGHreportingVerify the reference 'Preventing disease and saving resources: the potential contribution of increasing breastfeeding rates in the UK' (DOI 10.1016/s0140-6736(15) — not found in registry) and correct or replace it if it is fabricated.A reference that cannot be found in any registry is a potential fabrication signal that must be resolved.
- 2.HIGHreportingExplicitly state adherence to CONSORT guidelines in the methods or cover page, and consider submitting a CONSORT checklist as supplementary material.Both reviewers noted the reporting guideline is not explicitly named, which is a transparency gap for a randomised trial.
- 3.HIGHstatisticsReport exact p-values for all outcomes instead of thresholds like P=0.69 in the abstract and results.Reviewer 2 flagged that some p-values are reported as thresholds, which reduces precision for readers.
- 4.MEDIUMethicsAdd a statement on regulatory compliance (e.g., Declaration of Helsinki) in the ethics section.Reviewer 1 noted regulatory compliance is not explicitly named, which is a minor reporting gap.
- 5.MEDIUMreportingProvide a CONSORT-style flow diagram in the main text (currently referenced as Fig 1) to improve clarity of participant flow.Both reviewers suggested this to enhance transparency of participant flow.
- 6.MEDIUMstatisticsClarify the handling of missing data for secondary outcomes in the statistical analysis section.Reviewer 2 noted the current description focuses on the primary outcome, leaving secondary outcome handling unclear.
- 7.MEDIUMstatisticsIn the discussion, explicitly address the potential for type I error due to multiple secondary outcomes.Reviewer 2 suggested this to aid interpretation of secondary analyses.
- 8.MEDIUMstatisticsReport the intracluster correlation coefficient for the primary outcome in the abstract.Reviewer 2 noted it is a key design parameter that is not reported in the abstract.
- 9.MEDIUMreportingClarify the definition of 'adherent' in the per-protocol analysis and how it was applied to the usual care group.Reviewer 2 raised this as a clarity issue for the per-protocol analysis.
- 10.MEDIUMdata codeProvide a direct link to the statistical analysis code in the data availability statement, rather than only mentioning it in the supplementary file.Reviewer 2 suggested this to make the code more accessible.
- 11.MEDIUMdata codeSpecify the timeframe for data access requests in the data availability statement.Reviewer 2 noted this would make the access route more concrete.
- 12.LOWcopyeditFix the typo in Table 3 footnote: change 'Value >0 favour favours planned ABA-feed intervention.' to 'Value >0 favours planned ABA-feed intervention.'Copyedit flagged a duplicate word 'favour'.
- 13.LOWcopyeditAdd a comma in Table 3 row '24': change '0.96 (0.89 to 1.03 0.29)' to '0.96 (0.89 to 1.03, 0.29)'.Copyedit flagged a missing comma between CI and p-value.
- 14.LOWcopyeditClarify in Methods, Statistical analysis whether the infant feeding helper random effect was removed due to convergence problems or because the estimate was close to zero.Copyedit flagged the current wording as ambiguous.
- 15.LOWreportingConsider adding a statement about the use of reporting guidelines for the process evaluation (e.g., COREQ) if applicable.Reviewer 2 suggested this for completeness of the process evaluation reporting.
The star rating is the report’s one-glance summary. Every paper starts at 5★ and loses stars for the concrete problems the review finds — so a rating is never a vague average, it’s a running total you can read line by line under “How this rating was calculated.”
- Reporting — 8 dimensionseach dimension that fully fails−½★
- each dimension partially met−¼★
- Statistics · Integrity · Claimseach serious problem−1★
- each medium problem−½★
- Citationseach retracted or unverifiable reference−¼★
- Copyeditonly when the manuscript needs a full edit−½★
The rating never drops below 1★, and a demonstrable critical failure (an impossible statistic, a proven ethics violation) caps it at 1★ on its own — so the stars can never look healthy when the verdict is CRITICAL.
The rating draws on a panel of agents. Three independent Kaimen Rigor reviewers grade the eight dimensions below across several independent passes (the shown verdict is their majority vote — steadier than any single run), isolate the paper’s major claims and check its own evidence backs them, and flag integrity concerns. Alongside them, a citation agent resolves every reference against Crossref, OpenAlex, and Retraction Watch; a statistics agent recomputes reported tests; and rule-based checks verify that declared data/code links actually resolve. Full text is required — an abstract-only submission is not analyzed.
Graded against NIH, MDAR, ARRIVE 2.0, CONSORT, EQUATOR, and RRID guidelines. A dimension that doesn’t apply to the study type is skipped, never penalized.
This Kaimen Rigor review is model-assisted and is not a substitute for formal expert review. It complements human evaluation by surfacing potential methodological concerns — verify each finding against the source.