Indifferent, ambiguous, or proactive? Young men’s discourses on health service utilization for Chlamydia trachomatis detection in Stockholm, Sweden: A qualitative study

Frida M. Larsson; Anna Nielsen; Erica Briones-Vozmediano; Johanna Stjärnfeldt; Mariano Salazar

doi:10.1371/journal.pone.0257402

Peer Review History

Original SubmissionFebruary 25, 2021
13 Jul 2021 Decision Letter - Georg Häcker, Editor PONE-D-21-05813 Indifferent, ambiguous, or proactive? Young men’s discourses on health service utilization for Chlamydia detection in Stockholm Sweden; a qualitative study. PLOS ONE Dear Dr. Larsson, 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. I apologize for the very substantial delay in handling your submission. I became involved as an editor only moe recently. I have read your manuscript myself, and it has been seen and assessed by an outside specialist reviewer. The reviewer makes only few, more editorial, comments, which are easily satisfied (the spelling should indeed by Chlamydia trachomatis, but CT is fine as an abbreviation). This is not really my field of scientific activity and I realize that you write according to the standard in the field but would it not be possible to give some sort of semi-quantitative assessment of what share of the participants fall in which group (ambiguous etc.)? It may not be representative of the population ut would still give information. Finally, I am not sure that, as you say in the abstract, you can conclude from the study that testing cannot replace safe sex practices. There is no doubt that the statement is correct, but from which of your findings would you conclude that? Please submit your revised manuscript by Aug 27 2021 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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The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. We note that you have indicated that data from this study are available upon request. PLOS only allows data to be available upon request if there are legal or ethical restrictions on sharing data publicly. For information on unacceptable data access restrictions, please see http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. In your revised cover letter, please address the following prompts: a) If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially identifying or sensitive patient information) and who has imposed them (e.g., an ethics committee). 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The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: N/A ****** 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 ****** 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 ****** 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: I have read with interest this paper. I believe that the paper is interesting. However, I have some concerns that are reported herein. The title can be improved for better understanding. Please change Chlamydia Trachomatis to Chlamydia trachomatis in italic form; it is a bacterium anyway. Please avoid using CT to represent C. trachomatis, use this form instead. Please check the following errors or mistakes: “Most reported gymnasium as the highest level of education (14/18)” This is so confusing. “Thus, CT was constructed as a mild curable disease when compared other STI: s such as HIV” Is other STI: s acceptable? Similar words are used in the text. Please correct them. Change candida infection to Candida infection. “why it is natural that clinics are female friendly and that women are offered to test more frequently” is “why” correctly used here? ****** 6. 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. https://doi.org/10.1371/journal.pone.0257402.r001
Revision 1
20 Aug 2021 Author Response Dear editor, We thank you and the reviewers for your very useful comments and notification regarding our Data Availability statement. In the following, we will give a detailed answer to the queries made regarding our Data Availability statement. 1. PLOS journals require that all data presented in the study be made publicly available at or before the time of publication. If there are legal or ethical restrictions on the data being made publicly available, such as IRB restriction or patient confidentiality, authors must provide a way for fellow researchers to access the data. Please note that PLOS does not allow authors to be the sole contact for data inquiries. If the data is only available upon request, please provide contact information, such as an email address, for a non-author, institutional point of contact (such as an IRB or ethics committee contact) who can field data inquiries from fellow researchers. If the data contact is an individual, please provide their title and relationship to the data as well. A. We have changed the Data Availability statement to: “Our paper contains qualitative data. Following Plos One guidelines, excerpts of the data transcripts that are relevant for the study are available within the paper in the result section. Requests for access to more data should be made to the Research Data Office at Karolinska Institutet via rdo@ki.se and if permitted by law and ethical approval, decided on a case by case basis, the data can shared.” For your information, the previous comments from the editor and reviewers are also described below. All the best, Frida Larsson Journal Requirements In your revised cover letter, please address the following prompts :a) If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially identifying or sensitive patient information) and who has imposed them (e.g., an ethics committee). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent. A: Thank you for this question. Our paper contains qualitative data. We follow the EU General Data Protection Regulation (2016/679) regarding restricted access to the data. The study protocol was approved by Stockholm Ethic Review Board (https://www.registerforskning.se/en/the-ethics-review-boards-become-the-swedish-ethical-review-authority/). The sensitive nature of our qualitative data means that even if the names and other identifying information (address, telephone number, etc.) of the young men part of this research have been removed from the transcripts, there is a possibility that they could be identified thorough their narratives (as they share personal experiences). Thus, any request for access must be approved by the project Principal investigator Mariano Salazar: mariano.salazar@ki.se and Karolinska Institutet legal team. Editor´s comment 1. This is not really my field of scientific activity and I realize that you write according to the standard in the field but would it not be possible to give some sort of semi-quantitative assessment of what share of the participants fall in which group (ambiguous etc.)? It may not be representative of the population ut would still give information. A: Thank you for this question. In qualitative research, the focus is to understand, describe or explain a phenomenon not to quantify it [1]. We agree that it will great to quantify the frequency of the discourses identified in our study in the study population but a better method to do this is a study using a quantitative approach. 2. Finally, I am not sure that, as you say in the abstract, you can conclude from the study that testing cannot replace safe sex practices. There is no doubt that the statement is correct, but from which of your findings would you conclude that? A: Thank you for you comment. We have revised the abstract according to your suggestion and made other small changes. The abstract reads as follows: “Introduction. Chlamydia trachomatis (C. trachomatis) infection is the most commonly reported sexually transmitted infection in Sweden and globally. C. trachomatis is often asymptomatic and if left untreated, could cause severe reproductive health issues. In Sweden, men test for C. trachomatis to a lesser extent than women. Aim. To explore factors facilitating and constraining Swedish young men’s health care utilization for C. trachomatis detection and treatment. Method. A qualitative situational analysis study including data from 18 semi-structured interviews with men (21-30 years). Data collection took place in Stockholm County during 2018. A situational map was constructed to articulate the positions taken in the data within two continuums of variation representing men’s risk perception and strategies to test for C. trachomatis. Results. Based on the informants’ risk perception, strategies adopted to test and the role of social support, three different discourses and behaviours towards C. trachomatis testing were identified ranging from a) being indifferent about C. trachomatis -not testing, b) being ambivalent towards testing, to c) being proactive and testing regularly to assure disease free status. Several factors influenced young men’s health care utilization for C. trachomatis detection, where the role of health services and the social support emerged as important factors to facilitate C. trachomatis testing for young men. In addition, endorsing traditional masculinity domains such as leaning on self-reliance, beliefs on invulnerability and framing men as more carefree with their sexual health than women delayed or hindered testing. Conclusion. Testing must be promoted among those young men with indifferent or ambivalent discourses. Health systems aiming to increase testing among those at risk should take into consideration the positive role that young men’s social support have, especially the level of social support coming from their peers. Additionally, endorsement of traditional masculinity values may delay or hinder testing.” Reviewer #1: I have read with interest this paper. I believe that the paper is interesting. However, I have some concerns that are reported herein. 1. The title can be improved for better understanding. Please change Chlamydia Trachomatis to Chlamydia trachomatis in italic form; it is a bacterium anyway. A: Thank you for this comment. The title has changed according to your suggestion. It reads as follows: “Indifferent, ambiguous, or proactive? Young men’s discourses on health service utilization for Chlamydia trachomatis detection in Stockholm, Sweden; a qualitative study.” 2. Please avoid using CT to represent C. trachomatis, use this form instead. A: Thank you for this comment. We have changed the wording throughout the manuscript. 3. Please check the following errors or mistakes: “Most reported gymnasium as the highest level of education (14/18)” This is so confusing. A: Thank you for this. In Sweden gymnasium refers to upper secondary school. We have changed the sentence to reflect this. The text reads as follows (page 7, 3rd paragraph): “Most reported upper secondary school as their highest level of education (14 of 18 young men)” 4. “Thus, CT was constructed as a mild curable disease when compared other STI: s such as HIV” Is other STI: s acceptable? Similar words are used in the text. Please correct them. A: Thank you for this comment. We have revised the text. It reads as follows (page 10, 1st paragraph): “Thus, C. trachomatis was constructed as a mild curable disease when compared other STIs such as HIV.” 5. Change candida infection to Candida infection. A: Thank you. The change has been made. The text reads as follows (page 20, 1st paragraph): “genital pain caused by Candida infection”. 6“why it is natural that clinics are female friendly and that women are offered to test more frequently” is “why” correctly used here? A: Thank you. We have changed the sentence to (page 20, 1st paragraph): “genital pain caused by Candida infection; thus, it is natural that clinics are female friendly and that women are offered to test more frequently.” References: 1. Austin Z, Sutton J: Qualitative research: getting started. Can J Hosp Pharm 2014, 67(6):436-440. Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1-Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. We note that you have indicated that data from this study are available upon request. PLOS only allows data to be available upon request if there are legal or ethical restrictions on sharing data publicly. For information on unacceptable data access restrictions, please see http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. In your revised cover letter, please address the following prompts: a) If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially identifying or sensitive patient information) and who has imposed them (e.g., an ethics committee). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent. b) If there are no restrictions, please upload the minimal anonymized data set necessary to replicate your study findings as either Supporting Information files or to a stable, public repository and provide us with the relevant URLs, DOIs, or accession numbers. Please see http://www.bmj.com/content/340/bmj.c181.long for guidelines on how to de-identify and prepare clinical data for publication. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories. We will update your Data Availability statement on your behalf to reflect the information you provide. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0257402.r002
1 Sep 2021 Decision Letter - Georg Häcker, Editor Indifferent, ambiguous, or proactive? Young men’s discourses on health service utilization for Chlamydia trachomatis detection in Stockholm, Sweden; a qualitative study. PONE-D-21-05813R1 Dear Dr. Larsson, 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. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Georg Häcker Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0257402.r003
Formally Accepted
23 Sep 2021 Acceptance Letter - Georg Häcker, Editor PONE-D-21-05813R1 Indifferent, ambiguous, or proactive? Young men’s discourses on health service utilization for Chlamydia trachomatis detection in Stockholm, Sweden; a qualitative study. Dear Dr. Larsson: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Georg Häcker Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0257402.r004

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