What influences whether parents recognise COVID-19 symptoms, request a test and self-isolate: A qualitative study

Lisa Woodland; Fiona Mowbray; Louise E. Smith; Rebecca K. Webster; Richard Amlôt; G James Rubin

doi:10.1371/journal.pone.0263537

Peer Review History

Original SubmissionNovember 8, 2021
29 Nov 2021 Decision Letter - Sanjay Kumar Singh Patel, Editor PONE-D-21-35530What influences whether parents recognise COVID-19 symptoms, request a test and self-isolate: A qualitative study.PLOS ONE Dear Dr. Woodland, 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. Please submit your revised manuscript by Jan 13 2022 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 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: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 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 entitled, " What influences whether parents recognise COVID-19 symptoms, request a test and self-isolate: A qualitative study" by Woodland et al., assessed the factors linked with the use of England’s NHS Test and Trace service among parents of school-aged children by one-to-one telephone interviews with parents (n = 18) of school-aged (4 to 18 years) children living in England between 30 November to 11 December 2020. Authors found three themes and eight sub-themes in their analysis and identified several barriers to parents using NHS Test and Trace as needed. Finally, authors have concluded that Information about the eligibility of testing (main symptoms of COVID-19 and the age of eligibility) needs to be more precise and resources provided to enable families to adhere to self-isolation if the efficiency of test, trace and isolate systems is to be optimized. Altogether this is an important and timely research article, this reviewer has certain suggestions that would help produce a more comprehensive overview of the topic: Comments: 1. Did authors inquire about any depression during their study period in participants? This will be noteworthy to know and authors can include this data to their study. 2. At least one supplementary Figure as illustration may be afforded as to highlight the summary or prospect of this study. 3. Author may explain how to adjust the limitation of selection bias in their study. 4. The abbreviations should be cross validated in the manuscript (First define them fully followed by abbreviation) and one paragraph can be added for abbreviations. 5. This study was done between 30 November to 11 December 2020 (very starting period of Covid19), did authors find any communication gap between NHS and the parents? Reviewer #2: In this paper entitled "What influences whether parents recognize COVID-19 symptoms, request a test and self-isolate: A qualitative study.", the authors investigated the factors associated with the use of England NHS test and trace service among parents of school-aged children.The results identify several barriers to parents and the importance of information to adhere to self-isolation. The manuscript is good and well carried out. The manuscript addresses a research topic of great interest; however, it requires particular suggestions that would improve the manuscript: Minor comments: 1) The study investigated parents (n=18), whereas Hodson, woodland et al. 2021 has interviewed 30 parents in England. Could the authors explain how his results are significant with a small sample size in the manuscript? 2) There are formatting errors in Tables 2 and 3. 3) The importance of the study may be specifically highlighted in the introduction. 4) The author may provide a paragraph regarding challenges or prospects of study in the manuscript. 5) Correct reference error in the manuscript. 6) A figure could be provided to summarise the results for better understanding. 6a) Although the number of parents is small. Still, the author can provide information about the number of patients, subtheme, description, frequency, and ratio in the tabular/graphical form in the result section. [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.0263537.r001
Revision 1
7 Jan 2022 Author Response Reviewer #1: The research article entitled, " What influences whether parents recognise COVID-19 symptoms, request a test and self-isolate: A qualitative study" by Woodland et al., assessed the factors linked with the use of England’s NHS Test and Trace service among parents of school-aged children by one-to-one telephone interviews with parents (n = 18) of school-aged (4 to 18 years) children living in England between 30 November to 11 December 2020. Authors found three themes and eight sub-themes in their analysis and identified several barriers to parents using NHS Test and Trace as needed. Finally, authors have concluded that Information about the eligibility of testing (main symptoms of COVID-19 and the age of eligibility) needs to be more precise and resources provided to enable families to adhere to self-isolation if the efficiency of test, trace and isolate systems is to be optimized. Altogether this is an important and timely research article, this reviewer has certain suggestions that would help produce a more comprehensive overview of the topic: Comments: 1. Did authors inquire about any depression during their study period in participants? This will be noteworthy to know and authors can include this data to their study. Response: We did not directly ask participants about depression or any other illnesses in our interviews. We agree that it may have been useful to investigate this in the study. However, mental illness was not the focus of the study and we only had scope to focus on questions relating to how parents used NHS Test and Trace. We purposively asked open-ended questions and parents were encouraged to talk about their own experiences of using the system, including how their mental or physical health may have impacted how they were using the system and we have reported on these findings. Furthermore, we describe the questions that we ask in the Method section and the interview guide is provided as supporting information. We feel that this is sufficient for the reader to understand what was discussed in the interviews. 2. At least one supplementary Figure as illustration may be afforded as to highlight the summary or prospect of this study. Response: We have added a table summarising the study findings. 3. Author may explain how to adjust the limitation of selection bias in their study. Selection bias is an inherent part of any qualitative study – we can only interview people who are willing to be interviewed. We have now expanded the limitations section of the study to ensure that readers are aware of this. 4. The abbreviations should be cross validated in the manuscript (First define them fully followed by abbreviation) and one paragraph can be added for abbreviations. Response: We have checked that all the abbreviations we use have been used as you have suggested and added a paragraph listing all the abbreviations we have used. 5. This study was done between 30 November to 11 December 2020 (very starting period of Covid19), did authors find any communication gap between NHS and the parents? Response: We did not find a clear gap in communication between the NHS and parents. However, we did identify areas where parents had struggled to implement the NHS guidance in practice. For example, where we describe in the discussion (line 432 to 438) how parents needed prompting before they were able to recall the NHS main symptoms of COVID-19 and surrounding the eligibility of testing (line 465 to 470). We have added “parents appeared to be well informed about using NHSTT and we did not identify any clear gaps in communications between parents and the NHS” in the conclusion to distinguish between gaps in communications and misunderstandings. Reviewer #2: In this paper entitled "What influences whether parents recognize COVID-19 symptoms, request a test and self-isolate: A qualitative study.", the authors investigated the factors associated with the use of England NHS test and trace service among parents of school-aged children. The results identify several barriers to parents and the importance of information to adhere to self-isolation. The manuscript is good and well carried out. The manuscript addresses a research topic of great interest; however, it requires particular suggestions that would improve the manuscript: Comments: 1) The study investigated parents (n=18), whereas Hodson, Woodland et al. 2021 has interviewed 30 parents in England. Could the authors explain how his results are significant with a small sample size in the manuscript? Response: We agree that when using qualitative methodology there is no clear sample size that confirms the findings are significant and ensuring data saturation has been reached. We tried to mitigate this issue as much as possible by using Fugard and Potts (2015) ‘supporting thinking on sample sizes for thematic analyses: a quantitative tool’ to provide a high likelihood of reaching data saturation. We met the suggested number of participants; therefore, we can assume that the same themes would be identified if we had interviewed more participants. Hodson, Woodland et al. 2021 had different aims, objectives, and methodological parameters resulting in a larger sample size being used and therefore we cannot use this as a guide for the sample size we used in this study. 2) There are formatting errors in Tables 2 and 3. Response: Thank you for identifying the error we have reformatted our tables to ensure they are displayed accurately. 3) The importance of the study may be specifically highlighted in the introduction. Response: To make the importance of our study clearer, we have added the sentence “these difficulties highlight the importance of identifying areas within the NHSTT process to increase parents’ engagement,” following the paragraph in the introduction about how COVID-19 has negatively impacted children’s health and education (line 90 to 92). 4) The author may provide a paragraph regarding challenges or prospects of study in the manuscript. Response: Within our paragraph on study implications in the discussion we have added the below section describing future areas of study (line 491+): “Fifth, investigating a process with a high public profile, which underwent a series of rapid changes (e.g., increasing the capacity to carry out tests from 2,000 per day to 790,000 nine months later [22]) was challenging during the interviews. We needed to incorporate how a participant’s experience of using NHSTT might have differed depending on when they engaged with the testing process. The functions of NHSTT will continue until at least March 2022 (when it will be reviewed) and it would be beneficial for a further investigation into NHSTT now that the process has been in place for a longer period of time [23].” 5) Correct reference error in the manuscript. Response: Thank you for identifying the error in our references. We have resolved this error and re-checked our in-text citations and references to ensure they are accurate. 6) A figure could be provided to summarise the results for better understanding. Response: We have included a table that summarises the results. 6a) Although the number of parents is small. Still, the author can provide information about the number of patients, subtheme, description, frequency, and ratio in the tabular/graphical form in the result section. Response: Given that the data are inherently qualitative in nature, overemphasising quantitative aspects would be misleading. As noted, the sample is not a large representative sample and our aim is to articulate the breadth of issues that are relevant, and not to quantify number of parents who experience each issue. We have, however, now provided a table of the key themes which we hope goes some way towards clarifying the results. Attachments Attachment Submitted filename: Response to reviewers 01.12.21.docx https://doi.org/10.1371/journal.pone.0263537.r002
21 Jan 2022 Decision Letter - Sanjay Kumar Singh Patel, Editor What influences whether parents recognise COVID-19 symptoms, request a test and self-isolate: A qualitative study. PONE-D-21-35530R1 Dear Dr. Woodland, 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, Sanjay Kumar Singh Patel, Ph.D. Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0263537.r003
Formally Accepted
28 Jan 2022 Acceptance Letter - Sanjay Kumar Singh Patel, Editor PONE-D-21-35530R1 What influences whether parents recognise COVID-19 symptoms, request a test and self-isolate: A qualitative study. Dear Dr. Woodland: 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. Sanjay Kumar Singh Patel Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0263537.r004

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