Exploring the facilitators, barriers, and strategies for self-management in adults living with severe mental illness, with and without long-term conditions: A qualitative evidence synthesis

Abisola Balogun-Katung; Claire Carswell; Jennifer V. E. Brown; Peter Coventry; Ramzi Ajjan; Sarah Alderson; Sue Bellass; Jan R. Boehnke; Richard Holt; Rowena Jacobs; Ian Kellar; Charlotte Kitchen; Jennie Lister; Emily Peckham; David Shiers; Najma Siddiqi; Judy Wright; Ben Young; Jo Taylor; on behalf of the DIAMONDS research team

doi:10.1371/journal.pone.0258937

Peer Review History

Original SubmissionJune 13, 2021
21 Jul 2021 Decision Letter - Eleanor Ochodo, Editor PONE-D-21-18104 Exploring the facilitators, barriers, and strategies for self-management in adults living with severe mental illness, with and without long-term conditions: a qualitative evidence synthesis PLOS ONE Dear Dr. Claire Carswell, 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. We ask your team to address comments raised by the peer reviewers' about the qualitative review's methods and presentation of findings. Please refer to the detailed comments at the end of this section. Please submit your revised manuscript by 20 August 2021. 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. We look forward to receiving your revised manuscript. Kind regards, Eleanor Ochodo Academic Editor PLOS ONE 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. Thank you for stating the following in the Acknowledgments Section of your manuscript: “This article presents independent research funded by the National Institute for Health Research (NIHR).” 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. Please remove any funding-related text from the manuscript and let us know how you would like to update your Funding Statement. Currently, your Funding Statement reads as follows: “NS received an NIHR Programme Grant for Applied Research (Grant number: RP-PG-1016-20003) by the National Institute for Health Research: https://dev.fundingawards.nihr.ac.uk/award/RP-PG-1016-20003 The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.” Please include your amended statements within your cover letter; we will change the online submission form on your behalf. 3. One of the noted authors is a group or consortium DIAMONDS research team. In addition to naming the author group, please list the individual authors and affiliations within this group in the acknowledgments section of your manuscript. Please also indicate clearly a lead author for this group along with a contact email address. 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: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: 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 Reviewer #2: 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 Reviewer #2: 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: The research article is presented in an intelligible fashion and written in standard English. The data presented in the paper support the conclusions made and address the hypothesis from the originally registered report protocol. All underlying data is fully available in the manuscript. There are deviations from the registered protocol, and these deviations have been clearly described in the manuscript and are appropriate for the study. However, there was an additional exploration of other participants (those who provide care or support to people with SMI) not outlined in the registered report protocol. Inclusion of these participants is reasonable but should be acknowledged as part of the revisions to the registered protocol. The analysis of extracted data is described in sufficient detail and are methodologically sound. Minor revisions • Include other participants explored in the study (those who provide care or support to people with SMI) to the “revisions to systematic reviews” table. • The Author should fill in the missing details in the Methods section, paragraph one, last sentence on Page 5 of the manuscript before publication. “Findings from quantitative studies have been reported xxx [ to add details nearer submission depending on where we are up to with that paper.” Reviewer #2: Thank you for the opportunity to review this manuscript! ABSTRACT: Background: The evidence gap could be rephrased. Only mentioning barriers makes it seem like this QES is solely about barriers. Aim: The aim and title seem mismatched. Is the review including information about long-term management of LTCs only or not? Methods: The word ‘determinants’ is vague and could be replaced with “barriers, facilitators and strategies”. This comment is applicable across the whole manuscript. Why did the authors only define self-management in the abstract and not “severe mental illness” and “long-term conditions”? Additionally, one or two sentences could be added on the actual review processes, e.g. screening, data extraction, analysis, methodological quality assessment, and if these were done in duplicate? INTRODUCTION: The authors should clarify what the purpose of this QES is. For example: “Exploring the facilitators, barriers, and strategies for self-management in adults living with severe mental illness, with and without long-term conditions: a qualitative evidence synthesis” (title) “We therefore systematically reviewed and synthesised qualitative evidence about the experiences of self-management in people with SMI to understand how these may impact on LTC management in this population.” (rationale) METHODS: Deviations from the protocol: It is not unusual for review authors to deviate from the protocol, but it potentially concerning that there were several deviations, as this potentially indicates that the review question and eligibility criteria were not sufficiently clarified before the start of the review. Authors have left a note within the text. “Findings from quantitative studies have been reported xxx to add details nearer submission depending on where we are up to with that paper].” Eligibility criteria: The authors should have used a question framework like SPICE or SPIDER to organise the eligibility criteria, given that the purpose of the review is still unclear. The authors mention that they will include qualitative studies of any design. Does this include mixed method studies with qualitative data? It is unconventional to summarise the eligibility criteria in a table. The eligibility criteria are an important part of the review and should be described in detail in the text. Data extraction: Are the authors able to share the data extraction form they used or mention the aspects the extracted? Quality appraisal: Did the authors use a methodological quality appraisal tool (e.g. CASP or QARI)? What is currently described in this section has to do with data richness. A ‘rich’ study is not by default of ‘good’ quality. RESULTS: It is great that the authors have included quotes from the primary studies, but it sometimes reads as though the quotes are from the authors own primary research. This is a higher-level analysis of primary research and should be presented as such. DISCUSSION: Strengths and limitations: “The review provides novel insights and understanding about factors influencing self-management in people with SMI, which can inform critical thinking about how best to design tailored self-management interventions for this population.” This needs to be explained in the context of existing literature. ****** 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 Reviewer #2: 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.0258937.r001
Revision 1
5 Aug 2021 Author Response Dear Editor and Reviewers Thank you so much for taking the time to review our submitted manuscript and providing informative and constructive comments that we believe have improved the over all quality of the manuscript. In relation to the comments from the editor, we have changed the formatting of the paper to match the template provided by PLOS One. We have also removed any reference of funding from the submitted manuscript, and we would appreciate if the funding statement could be changed to read the following: This paper reports work undertaken as part of the DIAMONDS programme, which is funded by the National Institute for Health Research under its Programme Grants for Applied Research (project number RP-PG-1016-20003). Peter Coventry is part funded by the UK Research and Innovation Closing the Gap Network+ [ES/S004459/1]. We have also provided a list of names from the larger DIAMONDS Research Group in the acknowledgements section according to your guidance. I have provided a list of the reviewers comments and our responses in the below table. Response to reviewers comments We want to thank both of the reviewers for providing such constructive comments, and for taking the time to read and feed back on our manuscript. Reviewer 1 Include other participants explored in the study (those who provide care or support to people with SMI) to the “revisions to systematic reviews” table. This has been added to the table. The Author should fill in the missing details in the Methods section, paragraph one, last sentence on Page 5 of the manuscript before publication. “Findings from quantitative studies have been reported xxx [ to add details nearer submission depending on where we are up to with that paper.” This has been updated. Reviewer 2 The evidence gap could be rephrased. Only mentioning barriers makes it seem like this QES is solely about barriers. We have now stated throughout the manuscript that this review focuses on barriers, facilitators and strategies for self-management of long-term conditions and SMI (rather than just barriers alone) The aim and title seem mismatched. Is the review including information about long-term management of LTCs only or not? We have now rephrased the title and the aim to highlight the review focuses on studies that evaluated self-management strategies in people with SMI either with or without a long-term condition. The word ‘determinants’ is vague and could be replaced with “barriers, facilitators and strategies”. This comment is applicable across the whole manuscript. Why did the authors only define self-management in the abstract and not “severe mental illness” and “long-term conditions”? Additionally, one or two sentences could be added on the actual review processes, e.g. screening, data extraction, analysis, methodological quality assessment, and if these were done in duplicate? We agree that the term ‘determinants’ doesn’t capture the full range of factors that might underpin self-management behaviours and we have where appropriate used the phrase ‘barriers, facilitators and strategies’ to better define the focus of the analysis. We also agree that defining only one core concept in the abstract is inconsistent, and the definition for SMI and LTC were not provided as there is a limit of 300 words for the abstract. Due to the word limit and the request for more information on other aspects of the methods in the abstract, the definition for self-management has been removed to make the abstract more consistent. We have now included an additional sentence about screening, and the abstract mentions the purposive sampling according to data richness and the synthesis. The authors should clarify what the purpose of this QES is. For example: “Exploring the facilitators, barriers, and strategies for self-management in adults living with severe mental illness, with and without long-term conditions: a qualitative evidence synthesis” (title) “We therefore systematically reviewed and synthesised qualitative evidence about the experiences of self-management in people with SMI to understand how these may impact on LTC management in this population.” (rationale) This has been clarified in the rationale so it is more consistent with the title and the purpose is defined as per the reviewer’s useful suggestion. The authors should have used a question framework like SPICE or SPIDER to organise the eligibility criteria, given that the purpose of the review is still unclear. The authors mention that they will include qualitative studies of any design. Does this include mixed method studies with qualitative data? We are not convinced that using SPICE or SPIDER post-hoc would add value at this stage. We had previously outlined the eligibility criteria for the review in Table 1. We appreciate that not all items were clearly defined and we have included additional explanations about the eligibility criteria. We have also made clear in the eligibility criteria that qualitative data from mixed-methods research were eligible for inclusion in the review. It is unconventional to summarise the eligibility criteria in a table. The eligibility criteria are an important part of the review and should be described in detail in the text. We have summarised the key aspects of the eligibility criteria in the text and this is supplemented by additional detail in Table 1 which will be adjacent to the text. We have included additional detail in text to provide justification for some items within the table. We are happy to be guided by the editor about whether there is scope to increase the length of the Methods section by importing the more detailed content of this table into the main body of the text. Are the authors able to share the data extraction form they used or mention the aspects the extracted? The data extraction form is presented in Table 2. This is now clarified within the text of the manuscript. Did the authors use a methodological quality appraisal tool (e.g. CASP or QARI)? What is currently described in this section has to do with data richness. A ‘rich’ study is not by default of ‘good’ quality. We did not assess quality using conventional tools such as CASP as our approach was driven by sampling studies likely to be of most utility based on the data richness scale. Quality assessments in qualitative reviews is controversial and their value is debateable (Dixon-Woods, 2006) [1]. While we acknowledge that rich data is not necessarily synonymous with good quality data we have found in previous qualitative reviews that judgments about the ability of each study to contribute to the synthesis based on data thickness and richness have greater interpretative utility than judgments based on formulaic notions of study quality alone (Coventry, 2015)[2]. We have included additional explanation in the limitations section to support this approach. Authors have left a note within the text. “Findings from quantitative studies have been reported xxx to add details nearer submission depending on where we are up to with that paper].” This has now been updated. It is great that the authors have included quotes from the primary studies, but it sometimes reads as though the quotes are from the authors own primary research. This is a higher-level analysis of primary research and should be presented as such. This is an important distinction to make and we thank the reviewer for giving us a chance to rephrase reporting to ensure readers recognise that the findings are about the synthesis rather than just about the primary studies. “The review provides novel insights and understanding about factors influencing self-management in people with SMI, which can inform critical thinking about how best to design tailored self-management interventions for this population.” This needs to be explained in the context of existing literature. We accept that this statement might be a little premature and vague. We have instead highlighted that a strength of our review is that it fits with the early and exploratory phases of programmatic work to design complex interventions (e.g. MRC Framework; Science of Behaviour Change). Supporting references 1. Dixon-Woods M, Cavers D, Agarwal S, Annandale E, Arthur A, Harvey J, et al. Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups. BMC medical research methodology. 2006;6(1):35. doi: 10.1186/1471-2288-6-35. PubMed PMID: 16872487; PubMed Central PMCID: PMCPMC1559637. 2. Coventry PA, Small N, Panagioti M, Adeyemi I, Bee P. Living with complexity; marshalling resources: a systematic review and qualitative meta-synthesis of lived experience of mental and physical multimorbidity. BMC family practice. 2015;16(1):171. doi: 10.1186/s12875-015-0345-3. PubMed PMID: 26597934; PubMed Central PMCID: PMCPMC4657350. We appreciate the time and effort that was involved in providing such a detailed response, and we look forward to hearing back from you. Best wishes, Dr Claire Carswell Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0258937.r002
11 Oct 2021 Decision Letter - Eleanor Ochodo, Editor Exploring the facilitators, barriers, and strategies for self-management in adults living with severe mental illness, with and without long-term conditions: a qualitative evidence synthesis PONE-D-21-18104R1 Dear Claire Carswell, 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, Eleanor Ochodo Academic Editor PLOS ONE 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 ******** 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: Partly ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: N/A Reviewer #2: N/A ****** 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 ****** 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: (No Response) Reviewer #2: (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 Reviewer #2: No https://doi.org/10.1371/journal.pone.0258937.r003
Formally Accepted
15 Oct 2021 Acceptance Letter - Eleanor Ochodo, Editor PONE-D-21-18104R1 Exploring the facilitators, barriers, and strategies for self-management in adults living with severe mental illness, with and without long-term conditions: a qualitative evidence synthesis Dear Dr. Carswell: 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 Prof Eleanor Ochodo Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0258937.r004

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