‘We do not talk about it’: Engaging youth in Malawi to inform adaptation of a mental health literacy intervention

Sandra Jumbe; Joel Nyali; Maryrose Simbeye; Nelson Zakeyu; Gase Motshewa; Subba Rao Pulapa

doi:10.1371/journal.pone.0265530

Peer Review History

Original SubmissionSeptember 16, 2021
28 Jan 2022 Decision Letter - Sonia Brito-Costa, Editor PONE-D-21-29945‘We do not talk about it’: Engaging youth in Malawi to inform adaptation of a mental health literacy interventionPLOS ONE Dear Dr. Jumbe, 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 Mar 14 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. 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. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Sonia Brito-Costa, Ph.D. 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. 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 more 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 sensitive information, data are owned by a third-party organization, etc.) 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. 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. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions 5. Review Comments to the Author Reviewer #1: Thank you for giving me the opportunity to review this manuscript. It is very interesting, and quite up to the date. I have some comments and doubts for the authors. First of all, the population interviewed are universitary people, why? Refereing to the sample, the authors said that 76 people agreed to participate; 44 of them enroled into the interviews, 25 did not give an answer and 6 had connectivity problems... That sum reaches to 75 people. There ir one missing person. How did the authors coded the topics and the subtopics? Which was the followed procedure? It would have been really interesting to also know the proposals of the youth in regards to mental health improvement, in order to stablish future research lines. What are the main objectives of these results obtained? Which is the next step related to the improvement of youth Malawis mental health? [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.0265530.r001
Revision 1
5 Feb 2022 Author Response To: Dr Emily Chenette Editor-in-chief, PLOS One 3rd February 2022 Dear Dr Chenette and associated PLOS One editors RE: Manuscript submission reference PONE-D-21-29945 Many thanks for the opportunity to revise our manuscript. You will find attached clean and track change revisions of our manuscript, “‘We do not talk about it’: Engaging youth in Malawi to inform adaptation of a mental health literacy intervention”. We indicate below how we have addressed comments from reviewer #1. 1. Thank you for giving me the opportunity to review this manuscript. It is very interesting, and quite up to the date. I have some comments and doubts for the authors. Response: Thank you for your positive feedback, acknowledging interest of this paper, especially how it addresses current issues regarding youth mental health in Malawi. We have addressed your comments below and revised our manuscript accordingly 2. First of all, the population interviewed are universitary people, why? Response: Thank you for your question. The population interviewed was not just university people. As outlined in the abstract and the ‘study setting’ paragraph under the ‘Materials and Methods’ section, the sample included young people from universities and other community settings e.g. youth organisations in Malawi (see page 6 line 3-9). 3. Refereing to the sample, the authors said that 76 people agreed to participate; 44 of them enroled into the interviews, 25 did not give an answer and 6 had connectivity problems... That sum reaches to 75 people. There ir one missing person. Response: Thank you for noting this typing error. It was 75 people who agreed to participate initially. This has been amended on the manuscript under the ‘participant recruitment’ section (page 6 line 25) 4. How did the authors coded the topics and the subtopics? Which was the followed procedure? Response: We used qualitative content analysis as an approach to analysis data from the focus group transcripts. The procedure followed to code the themes and subthemes is detailed in the ‘Data collection, analysis, and management’ section. We have revised this section with more details and an additional Table 3 (see page 9) to clarify this process (see page 8 line 13 to page 9 line 21). We have also included a paragraph on rigor of the data analysis process (page 10 line 5 to page 11 line 13) 5. It would have been really interesting to also know the proposals of the youth in regard to mental health improvement, in order to stablish future research lines. Response: Thank you. This has already been outlined in the results under the section ‘suggested mental health solutions’ (see page 27 line 5 to page 28 line 20), where the youth proposed several ideas regarding mental health improvement. Examples in this section include more awareness raising of mental health, having a mental health practitioner within schools for consistent access to psychological support for students, creating local youth-friendly mental health services and top-down mental health advocacy strategy from government to facilitate mental health literacy in communities countrywide 6. What are the main objectives of these results obtained? Which is the next step related to the improvement of youth Malawi's mental health? Response: Thank you for your comment. We have added details on work we have done and related next steps to the discussion section (see page 31 line 7-24) We have also addressed additional comments from the editor as outlined below: 1. We have revised headings, tables and figures labels in the manuscript in line with the PLOS ONE style templates 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. In line with PLOS ONE data availability guidance, we have uploaded the study’s focus group discussion guide as the minimal anonymized data set to facilitate replication of our study findings as a supporting Information file (S1 Fig on page 33 line 18). Please update our Data Availability statement on our behalf to reflect the information we have provided. 3. We have uploaded our 2 figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool and inspected them for image clarity and content. Addressing the above comments has improved our manuscript and we are confident that the paper now meets PLOS ONE’s publication criteria. We look forward to your favourable opinion on our revised manuscript. Yours sincerely Dr Sandra Jumbe Attachments Attachment Submitted filename: PONE-D-21-29945 response to reviewers 3.2.22.docx https://doi.org/10.1371/journal.pone.0265530.r002
22 Feb 2022 Decision Letter - Sonia Brito-Costa, Editor PONE-D-21-29945R1‘We do not talk about it’: Engaging youth in Malawi to inform adaptation of a mental health literacy interventionPLOS ONE Dear Dr. Jumbe, 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 Apr 08 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. 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. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Sonia Brito-Costa, Ph.D. Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author Reviewer #1: Thank you for consider my previous comments. The only issue still concerns me is related to qualitative statistical analysis. Now is more complete and clear, but, did the authors use any statistical program to conduct these analyses, such as Atlas.ti or similar? If not, why? Thank you for your effort and your job. [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.0265530.r003
Revision 2
2 Mar 2022 Author Response To: Dr Emily Chenette Editor-in-chief, PLOS One 2nd March 2022 Dear Dr Chenette and associated PLOS One editors RE: Manuscript submission reference PONE-D-21-29945R1 Many thanks for the opportunity to revise our manuscript. You will find attached clean and track change revisions of our manuscript, “‘We do not talk about it’: Engaging youth in Malawi to inform adaptation of a mental health literacy intervention.” We indicate below how we have addressed the comment from reviewer #1. Reviewer 1: Thank you for consider my previous comments. The only issue still concerns me is related to qualitative statistical analysis. Now is more complete and clear, but, did the authors use any statistical program to conduct these analyses, such as Atlas.ti or similar? If not, why? Thank you for your effort and your job. Thank you for acknowledging our efforts in addressing the original comments from reviewers to our manuscript. We are glad that you feel the manuscript is now complete and clear. Regarding your question, we already stated in the manuscript on page 8 lines 12-15 that we used NVivo to conduct our qualitative analysis. We have added a description of what NVivo is on page 8 lines 15-17 to make this aspect clearer. Addressing the above comment has further clarified the data analysis section of our manuscript and we are confident that the paper now meets PLOS ONE’s publication criteria. We look forward to your favourable opinion on our revised manuscript. Yours sincerely Dr Sandra Jumbe Attachments Attachment Submitted filename: PONE-D-21-29945R1 response to reviewer 2.3.22.docx https://doi.org/10.1371/journal.pone.0265530.r004
4 Mar 2022 Decision Letter - Sonia Brito-Costa, Editor ‘We do not talk about it’: Engaging youth in Malawi to inform adaptation of a mental health literacy intervention PONE-D-21-29945R2 Dear Dr. Jumbe, 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, Sonia Brito-Costa, Ph.D. Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0265530.r005
Formally Accepted
21 Mar 2022 Acceptance Letter - Sonia Brito-Costa, Editor PONE-D-21-29945R2 ‘We do not talk about it’: Engaging youth in Malawi to inform adaptation of a mental health literacy intervention Dear Dr. Jumbe: 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. Sonia Brito-Costa Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0265530.r006

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