PONE-D-19-31528

Qualitative Insights into Reasons for Missed Opportunities for Vaccination in Kenyan Health Facilities

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: N/A

Reviewer #2: N/A

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: No

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Background

1. Line 45: Include more information about immunization coverage in Kenya and the factors that have been identified to predict low immunization coverage in the country.

2. Line 47 – 50: To improve flow, you may consider moving this part to the last paragraph of the background section.

Methodology

1. The term “cross-sectional” is commonly associated with quantitative studies. Given that the philosophical assumptions of this class of studies is markedly different from qualitative, I’d suggest that it should be avoided here.

2. The rationale for using grounded theory in this manuscript is debatable. MOV is already a pre-existing concept. For this reason, the goal of the study was not to develop new theories (and a theoretical framework) about MOV. In my opinion, this study leans more towards a critical realism because of the causal-explanatory approach that was adopted to describe factors that are responsible for MOV. Moreover, the study builds on already existing knowledge by exploring Kenya’s context and identified factors that are relatively similar to those identified in existing literature. Overall, there is a need to extensively and convincingly justify the methodological paradigm that is being adopted in the study design sub-section.

3. Line 80: Include a sub-section on reflexivity.

4. Line 100: Please remove “sample size”

5. Line 101: What were the criteria for this purposive selection? How do the counties differ from each other? Why 10?

6. What were the criteria used to stop data collection?

Reviewer #2: This paper presents a qualitative study which examined the reasons for missed opportunities for vaccinations in Kenyan Health facilities. I do believe this paper would be of interest to readers of PLOS ONE however, the following issues outlined below need to be addressed.

Introduction:

- Lines 47-50: can this be moved to the final paragraph of the introduction?

- I think more references to other studies conducted in Kenya on vaccine uptake needs to be added in the introduction. That way it paints a clearer picture of the the research gap as well as how this study fits into the literature. I don't quite follow at the moment and it is not quite clear.

Methods:

- Can you clarify what type of thematic analysis was used ? It seems like an inductive approach was used but this needs to be mentioned in the methods so that it is clear to the reader.

Discussion:

- this is currently very long and needs to be streamlined. A lot of time is spent regurgitating the results and little time is spent engaging with the literature.

- Did you look for any differences and similarities within your sample? Perhaps also look at other studies that have examined vaccine uptake in Kenyan populations globally? And see if some of the issues identified are the same or different? Obviously there would be a huge distinction between those in low income vs. high income countries but this might add some interesting nuances.

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Reviewer #1: Yes: Charles Shey Wiysonge

Reviewer #2: No

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Qualitative Insights into Reasons for Missed Opportunities for Vaccination in Kenyan Health Facilities

PONE-D-19-31528R1

Dear Dr. Li,

We are pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it complies with all outstanding technical requirements.

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With kind regards,

Holly Seale

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: N/A

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: No

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: (No Response)

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No