PONE-D-20-10999

Evaluating the effectiveness of in-service training program of Amhara Public Health Institute Dessie Branch, Northeast Ethiopia: a concurrent nested mixed quantitative/qualitative facility based cross sectional study

PLOS ONE

Dear Dr. Hassen,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please address my comments as well as those made by reviewer 1.

Please submit your revised manuscript by Sep 20 2020 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

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We look forward to receiving your revised manuscript.

Kind regards,

Conor Gilligan

Academic Editor

PLOS ONE

Additional Editor Comments:

Thank you for submitting this paper to PLOS ONE. It is certainly worthwhile to scrutinise and evaluate in-service training programs, particularly in low and middle income countries, so i commend you on this effort.

The paper needs some re-working before it can be accepted for publication. Please see reviewer 1's comments as well as my own suggestions below.

1. The context of the training is not clear - are these standard training programs delivered by a national agency or varied programs delivered by a range of groups? The authors do mention the training institution but this could be described in more detail in the introduction to provide context. Further, the objectives and nature of training could be described - the results detail the topics and skills covered but it is not clear if the training is a single course designed to cover all these topics, a range of courses covering separate topics, or something else? Do participants select courses based on the topics covered/time of offering etc or are they directed to attend? Do participants attend more than one course? do workplaces support their employees to attend...etc etc. Please provide this context in the introduction.

2. The introduction talks about both laboratory inservice and quality of care improvement training but it seems that the study relates to the former only - again, please clarify the context and objectives of this study and the training being evaluated.

3. More detail is needed to describe the survey and qualitative data collection methods. There is a reference to 'visits' - was data collected in person? How many people completed the survey, and how many participated in interviews?

4. The results could be presented more succinctly - the tables are unnecessarily detailed (e.g. you don't need the frequency for both yeas and no responses). Results could be more meaningful if they were linked to the objectives of the training, and you could also link the outcomes with participants' level of experience etc.

4. Please provide more detail about the thematic analysis methods.

5. The discussion and conclusions could be improved by providing a more clear direction in terms of future directions and recommendations for improvement of training programs.

6. Please engage an English language editor or native English speaker to assist with improving the grammar and writing.

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4.Thank you for stating the following in the Acknowledgments Section of your manuscript:

"We acknowledge Amhara Public Health Institute Dessie Branch for covering data enumeration expense."

We note that you have provided funding information that is not currently declared in your Funding Statement. However, funding information should not appear in the Acknowledgments section or other areas of your manuscript. We will only publish funding information present in the Funding Statement section of the online submission form.

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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: Partly

Reviewer #2: Yes

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

Reviewer #1: No

Reviewer #2: Yes

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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: 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: No

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: This is a very important paper and very relevant to improve in-service training in low- and middle-income countries. I agree with the authors that such outcome assessment do identify training gaps to improve. However, the paper is a lot limited which can be resolved. Below are some of the areas that need the authors’ attention.

1. The title of the paper is too long. Can you please consider a shorter but attention grapping title?

2. I do understand that the authors may not be native English speakers, the paper is filled with grammatical errors and inconsistencies.

3. Authors indicated that “…. only 65.6% of participants transferred their knowledge and skills in to practice”. This is a major outcome measure, but the authors failed to indicate how it was measured.

4. The introduction is inconsistent and difficult to follow. It starts with objectives, then to needs, gaps, and then back to objectives. This confuses the readers to know which of the objectives the authors are out address.

5. It is clear that the investigators collected the data themselves. What is not very clear is if they were the trainers? If they were, the results may be skewed because the trainees (in this case the respondents) will want to please the researchers especially in a qualitative design.

6. There are a lot of important points made in the results section, but some were never followed through in the discussion section. If any issue raised in the results section that the authors feel not relevant to discuss, should be deleted.

7. Authors should avoid blank statements that suggest a pre- and post-training assessments. This is evident in third paragraph of the discussion section.

Reviewer #2: Thanks for giving the opportunity to review this manuscript. Congratulations to authors for conducting this manuscript.

This manuscript has been well written. I have no further comments. I would like to request you

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Reviewer #1: No

Reviewer #2: No

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Attachments

Attachment

Submitted filename: Review Comments_Ethopia Training evaluation paper.docx

PONE-D-20-10999R1

In-service training program evaluation of Amhara Public Health Institute Dessie Branch, northeast Ethiopia: a concurrent mixed-method study

PLOS ONE

Dear Dr. Hassen,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Nov 13 2020 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols

We look forward to receiving your revised manuscript.

Kind regards,

Conor Gilligan

Academic Editor

PLOS ONE

Additional Editor Comments (if provided):

The paper is much improved and almost ready to accept but it does require some further minor corrections and careful English editing.

Line 29 – suggest ‘involved interviews with each of these key stakeholders’

Line 34 –The abstract needs some re-working for language. The results are presented as ‘x% agree/strongly agree with…’ doesn’t fit grammatically. I suggesting changing to “…agree/strongly agree that the trainers had adequate knowledge and skills….” Etc etc

Line 50 – replace could with should

Line 109 – here it says 110 respondents – then in line 113 it says 107 - what happened to 3 participants?/which number is correct?

Line 113 – add ‘in-person’ and the location in which the interviews occurred

Line 115 ‘close’ should be ‘closed’

Lines 152 and 153 – I am unclear what you mean by diploma holders vs first degree professionals – can you please explain the qualifications of respondents?

Line 164 – should be algorithm?

Table 2 – please just show the yes results. Being dichotomous, the ‘no’s’ can be assumed from this

Line 205 – ‘as a potential to confident to the trainers’ – this needs to be re-worded

Lines 220 – 227 – this section needs some elaboration to better describe the issues being raised

Line 231 – “Agreeing with the training set-up” doesn’t make sense grammatically – was the question that it was appropriate/adequate/conducive to learning…please clarify

Table 8 talks about the ‘effectiveness’ of different elements – I suggest using ‘effective’ where describing the learning and transfer of knowledge to the workplace, but ‘appropriate’ or ‘adequate’ may be better for other elements such as the training set up

I think the findings need to more clearly inform conclusions/recommendations including the need for more experiential/practical learning. Obviously the adequacy of venues etc should also be considered.

I was also interested in the comment about the judgment regarding access to perdiem – I think this needs some exploration as it is unclear why this would occur and in what context.

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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: Yes

**********

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

**********

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)

**********

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

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

PONE-D-20-10999R2

Evaluation of in-service training program of laboratory professionals in Amhara Public Health Institute Dessie Branch, northeast Ethiopia: a concurrent mixed-method study

PLOS ONE

Dear Dr. Hassen,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please engage copyediting to address the residual grammatical and language concerns with the paper.

Please submit your revised manuscript by Dec 14 2020 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols

We look forward to receiving your revised manuscript.

Kind regards,

Conor Gilligan

Academic Editor

PLOS ONE

Additional Editor Comments (if provided):

The authors have done a comprehensive job of addressing the previous comments but there remain problematic language and grammatical errors in the paper. I request that you pursue professional copyediting to enable further consideration of this manuscript.

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[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Evaluation of in-service training program of laboratory professionals in Amhara Public Health Institute Dessie Branch, northeast Ethiopia: a concurrent mixed-method study

PONE-D-20-10999R3

Dear Dr. Hassen,

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,

Conor Gilligan

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Thank you for your effort to improve the English in your manuscript.

Reviewers' comments: