PONE-D-20-30256

“Like a doctor, like a brother”: achieving competence amongst lay health workers delivering community-based rehabilitation for people with schizophrenia in Ethiopia

PLOS ONE

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Academic Editor

PLOS ONE

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Reviewers' comments:

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Comments to the Author

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Reviewer #1: Yes

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

Reviewer #1: N/A

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Reviewer #1: Yes

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Reviewer #1: Yes

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5. Review Comments to the Author

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Reviewer #1: Overall, this is a very interesting paper, documenting how lay people were trained and supervised in order to work with people with schizophrenia. It is documented by scorings of competences and focus group interviews. The paper is highly relevant as it documents how lay people can be trained and learn to help mental health services, which are sparse.

The introduction is interesting, it is clearly written and includes relevant citations and considerations.

The study is highly relevant as it addresses unmet needs in the population in LMIC countries and it demonstrates an elaborated model for training lay people. The authors conducted a mixed method study of lay people trained in mental health treatment. The CBR worker competence was measured using the ENhancing Assessment of Common Therapeutic factors (ENACT) rating scale.

It would be interesting to know which proportion of the patients were on medication?

The legends of table 1 should mention the sample and explain ENACT, in order to make it possible to read the table without consulting the text in details.

I am not an expert in qualitative research, but I do know that nVIVO is often used and is considered a gold standard instrument. If necessary due to space limitations, some of the cited phrases could be left out

The discussion adequately discusses the results and future interventions

The main challenge will be to make sure that lay people do not practice work that is difficult or dangerous for themselves and for the patients. This could involve emotional overinvolvement, taking over too much responsibility, and ending up in a role like a relative. Lay people will be faced with unmet needs of the patients, and how to decide what to do? Procedures must make sure that the lay people can continue their own personal life outside working hours without too much worry and concern regarding their job. Also, idiosyncratic practice where a lay person starts to work mainly guided by own opinion or therapeutic ideas should be addressed. It could also be considered to work in pairs in order to make sure that practice is visible?

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Reviewer #1: Yes: merete nordentoftno COI

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“Like a doctor, like a brother”: achieving competence amongst lay health workers delivering community-based rehabilitation for people with schizophrenia in Ethiopia

PONE-D-20-30256R1

Dear Dr. Asher,

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.

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Kind regards,

Danuta Wasserman

Academic Editor

PLOS ONE

Additional Editor Comments (optional): Important topic. The authors addressed relevantly the methods used and the data analysis. 

Reviewers' comments: