PONE-D-21-19556Experiences of Black and Latinx health care workers in support roles during the COVID-19 pandemic: A qualitative studyPLOS ONE

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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: Yes

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

Reviewer #1: N/A

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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

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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: 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: It has been well documented that individuals from minority populations have been disproportionately impacted by the COVID-19 pandemic. One such example is provided within the context of poor health outcomes in minority populations. Among Black and Latinx individuals the risk of hospitalization and death from COVID-19 are 2-3 times higher when compared to their white counterparts. The intersectionality of factors such as structural and institutional racism, their higher risk factors and the reduced ability to avoid infection as essential workers make Black and Latinx health care workers (HCWs) a population that is both vulnerable and high-risk.

This manuscript presents a qualitative study that examined the experiences of Black and Latinx HCWs to understand how the pandemic impacted their lives in the following areas: profession, job responsibilities and relationship with their communities. These findings are particularly relevant given that as of September 2021, there exist very few (if any) peer-reviewed published literature that focuses on the unique dual perspective of participants that are both members of a high-risk essential workforce and are also members of marginalized communities that suffered disproportionately during the pandemic.

Participants of this qualitative study were employed as ancillary and support staff at four health care facilities (various inpatient and outpatient health care settings) in New Jersey. It is notable that each of the health care facilities was geographically located in four counties, each with large Black/Latinx populations and high levels of COVID-19. Semi-structured group and individual interviews were conducted virtually using a Zoom secure platform. Proof of the iterative process in developing the semi-structured interview guide was demonstrated through the study’s incorporation of literature review, prior experience and debriefing meetings that were conducted after initial interviews. The interview data was analyzed using an editing approach as it was collected. Three key themes were identified: (1) Profound impact of the pandemic on job responsibilities, work settings and personal connections, (2) Fear and uncertainties caused by the pandemic; and, (3) Shifts in testing frequency and vaccine attitudes as the pandemic evolved. These findings revealed that perspectives expressed by Black and Latinx HCWs were remarkably consistent and informed the authors’ conclusion of reaching thematic saturation.

I found the study to be a well-written and much needed investigation to provide specific insight into the perspectives and experiences of this unique population who are both members of a high-risk essential workforce and are also members of marginalized communities that have been most heavily impacted by COVID-19. I found no major issues with this manuscript. Additionally, it is important to note the context/timing of when this study was conducted is significant (Nov 2020-Feb 2021.) It was conducted during a pivotal moment in the pandemic, which coincided with the first rollout of COVID-19 vaccines. The study’s findings successfully captured temporal changes in HCW experiences at the workplace, including testing and evolving perspectives regarding vaccine hesitation. The participants’ responses provided unique insight into many of the barriers that Black and Latinx HCWs, patients and community members alike, encounter with regard to: essential worker workplace challenges, the availability and accessibility of COVID-19 testing and vaccines. The authors’ address various limitations of the study, specifically the limitations of the sample population in that they “purposively sampled only Black and Latinx HCWs…” from largely urbanized counties in one state. Another minor, yet potential limitation is the relatively small (n=17) and homogeneous sample population. However, as stated, this was done intentionally by the authors’ and does indeed capture highly specific data on a very distinct population of “dual perspective” all-female Black and Latinx HCW participants. Another minor issue is in Lines 139-140, referencing Table 1. Line 140 states that 91% percent of the sample population was female. However, Table 1 reflects that of n=17, 100% is female. Line 140 also states that 82% of HCWs were Black and 18% were Latinx. Yet, Table 1 reflects that 47.1% were Black and 52.9% were Latinx. Again, these are very minor issues and can be easily revised by the authors. I very much enjoyed reading this manuscript and wish to congratulate the authors on this well-written and thought provoking work.

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Reviewer #1: Yes: Sara Mizany, MS

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Experiences of Black and Latinx health care workers in support roles during the COVID-19 pandemic: A qualitative study

PONE-D-21-19556R1

Dear Dr. Rivera-Nunez,

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,

Marlene Camacho-Rivera, ScD, MPH

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

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: 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

**********

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)

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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: Yes: Sara Mizany