PONE-D-20-26810

Normalisation process theory and the implementation of a new glaucoma clinical pathway in hospital eye services: Perspectives of doctors, nurses and optometrists

PLOS ONE

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Khatijah Lim Abdullah, DClinP, MSc., BSc

Academic Editor

PLOS ONE

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Reviewers' comments:

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Comments to the Author

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

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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: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

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Reviewer #1: A well written paper applying NPT to understanding implementation feasibility for a 4hour-4week glaucoma treatment program. Some minor comments as follows:

Line 179- please clarify what does "independent of the health board" mean.

Line 191- Under clinical observations. Because it is not clear how many researchers were collecting the data it would be helpful to explain what is meant by "52 week-by-week.." means. Is it 52 consecutive weeks? Or 52 field notes? Please state if these field notes are referencing the "wider observational data" in Line 187, are they the same thing?

Line 209 "favourable ethical opinion" sounds odd, is this equivalent to ethical approval?

Line 233 "where data should sit" It is not clear what this phrase means.

Line 259 Staffing - what is the value of about mapping not having a staff to NPT constructs (in this case cognitive participation>initiation, enrolment), rather than just using a more straightforward implementation framework that would mention manpower/ staffing/ champions? This for me seems counter intuitive especially for someone more familiar with other implementation frameworks. Suggest to consider this as the NPT fit is discussed under Discussion>limitations.

Line 315- It is hard to tell who these staff are in terms of having more formal knowledge of glaucoma, perhaps some indicator of why they are considered so should be included after their quotes e.g. OH 301 (<state etc job level of position training>)

Line 397 - This theme is quite relevant as the 4 hour + 4 week schedule clearly illustrates how elasticity and plasticity can be applied to analysing feasibility. However, I wonder if the CMGC is really just about these larger parameters which were of course quite easy to predict in terms of how they would affect feasibility. It would be interesting if authors could also illustrate more macro level examples of these concepts to show how smaller instructions in the CMGC were either elastic/ plastic or not.

Line 420- " that the retention rate of patients for all procedures ran at 94.3%" Should clarify if this refers to CMGC and if so across the same period of observation as this study (ie was it a sister/ substudy)?</state>

Reviewer #2: The manuscript met all the guidelines from the introduction, methods, results, discussion and conclusion.

The study used was a non-randomised observational type with an ethnographic approch to the qualitative elements which gave a good picture of the data. The limitations were well dcumented as to the small pool of particiapnts.

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Reviewer #1: Yes: Lee Yew Kong

Reviewer #2: Yes: Laly Joseph

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Normalisation process theory and the implementation of a new glaucoma clinical pathway in hospital eye services: Perspectives of doctors, nurses and optometrists

PONE-D-20-26810R1

Dear Dr. Read,

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,

Khatijah Lim Abdullah, DClinP, MSc., BSc

Academic Editor

PLOS ONE

Reviewers' comments:

Comments to the Author

 All comments have been addressed

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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.

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