PONE-D-20-05329

Patients’ experiences of tobacco cessation including a prescription approach in Swedish primary health care with a focus on socioeconomically disadvantaged areas

PLOS ONE

Dear Dr. Leppänen,

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Bronwyn Myers

Academic Editor

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: Yes

Reviewer #2: No

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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: The manuscript, “Patients’ experiences of tobacco cessation including a prescription approach in Swedish primary health care with a focus on socioeconomically disadvantaged areas” uses clear and consistent writing to discuss important topics about how to improve the delivery of tobacco treatment. The discussion focuses on factors related to the implementation of a new instrument to facilitate the delivery of smoking cessation treatment. As smoking cessation treatment is mostly provided by Primary Health Care (PHC) worldwide, perceptions of instrument could enrich the knowledge-base of how to effectively engage the PHC in tobacco treatment in countries beyond Sweden.

Introduction:

The introduction is clear and addresses relevant and updated references. The only suggestion I have is to describe a little bit more about the context in which the Tobacco Cessation on Prescription (TCP) form was implemented. I understood that the form has been tested as part of a clinical trial. However, I’m not sure if the form is also part of the smoking cessation treatment guidelines in Stockholm. If so, did the providers receive training on smoking cessation treatment as well? Is the treatment subsidized?

Methods:

General comments

It would be helpful to understand the results if the authors include more socio-demographic and treatment information from each participant. Consider including this in a table. For instance, how was the engagement of each participant with TCP? Did they just fill out the form or did they receive smoking cessation treatment (medication, counseling, follow up calls, referral to Quitline)? Besides smoking status, consider including other smoking related information, such as type of tobacco used, dependence level and also socioeconomic disadvantage. My understanding was that not all of the 8 participants were in a situation of socioeconomical disadvantage.

Study information and setting

1. It is not clear how participants were selected. Could you explain in a few sentences the characteristics that were assessed to determine participants with best knowledge of the phenomena? Were they purposely from different PHC centers? Could you provide more information on the theory that guides the information power?

Data collection and analysis

1. Describe the authors training and experience with qualitative research instead of mentioning just “some experience”.

2. “Passages in the text related to the aim of the study were extracted from the transcripts”. Was this step also done by 2 researchers and then compared?

3. Describe the number or percentage of coding that were random checked. Also, describe if the authors made changes in the coding after the categories were checked by participants.

Results/discussion:

The way the authors presented the themes and subcategories made the reading smooth and clear. However, I’d suggest presenting the results related to patient’s perceptions of the TCP and in the support received from the PHC center first. The title and introduction get attention for these aspects and I felt like the result section was missing these categories until towards to theme 2. Last, the discussion is supported by the main findings. But, the patients’ perceptions probably differ according to their engagement in the smoking cessation support prescribed in their form. How could this be related to the results found in this study?

Minor comments: In the results, instead of using terms such as “several informants” present the number of participants.

Reviewer #2: This manuscript addresses a topic that is highly relevant to public health interventions- tobacco cessation. A few areas require modification:

1. Please define socio-economic disadvantage clearly

2. A little more information about the trial and the training that the interventionists received will help us interpret the results

3. Methods- these need to follow COREQ guidelines- there are some aspects that are missing. We need to know more about the criteria used to purposefully select participants, more information about the interviewers, and there is no information about reflexivity- among other aspects. Was software used to aid analyses

4. We need more information about the participants and their smoking and quit attempt histories- did any differences emerge based on smoking involvement or other factors?

5.The TCP form was poorly remembered. If the trial is about using this prescription, surely more of the results should focus on what patients remember, what kind of prescription they received and whether they attempted to follow through on it. I am not clear on why they thought it was more useful for providers? Also it raises questions about the implementation of this intervention- this could all be reflected upon more in the discussion.

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Reviewer #1: Yes: Erica Cruvinel

Reviewer #2: No

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Experiences of tobacco cessation including a prescription approach among patients in Swedish primary health care with a focus on socioeconomically disadvantaged areas

PONE-D-20-05329R1

Dear Dr. Leppänen,

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

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Bronwyn Myers

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

Reviewer #2: 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

Reviewer #2: Yes

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

Reviewer #1: Yes

Reviewer #2: N/A

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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: Yes

Reviewer #2: Yes

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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

Reviewer #2: 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: It appears that the authors thoroughly addressed the reviewer's concerns. I have no further revisions.

Reviewer #2: I am happy with the revisions that have been made. All original concerns have been fully addressed.

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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

Reviewer #2: No