PONE-D-21-19730The influence of patriarchy on Nepali-speaking Bhutanese women’s diabetes self-managementPLOS ONE

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Reviewers' comments:

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Reviewer #1: Yes

Reviewer #2: Yes

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

Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #2: 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: Title: The influence of patriarchy on Nepali-speaking Bhutanese women’s diabetes self management

General comments

This manuscript is based on primary qualitative data collected through virtual interviews. The goal of this analysis is to understand the manifestations of patriarchy and its impact on NSB women’s diabetes self-management employing a conceptual framework based on Walby’s structures of patriarchy. This manuscript covers the unique characteristics of population. It will contribute to scientific literature on the patriarchy and its influence on self-management of diabetes among women. However, it does require substantial revisions.

Abstract

No comments

Introduction

It would be beneficial to consider the diabetes self-management status of migrant women in USA and other developed countries. Also, mention other scientific studies from similar cultures or where patriarchal society is prevalent to understand how patriarchal society impacts women in diabetes self-management.

Method

Recruitment: Please mention the rationale of contacting 29 people. Is it due to only 29 people are registered in the Hershey Medical Center and meet eligibility criteria or it is due to for convenience?

Line 179-180: Do clinical physicians contacted 29 people to recruit initially? It needs to be clear.

Procedure: Please mention that the Deximity app allows video call to clarify that observation was possible in virtual interview. Please use the one term for indepth virtual interviews. It appears in different names- interviews, semi-structured interviews.

Interview guidelines: Mention the process of translation of interview guidelines. Based on interview guide it appears 35 questions and mostly open-ended questions. However, in Line 200-208, all questions are not addressed as mentioned in the interview guide. If authors only highlighted main questions in the text, please mention it for clarity.

Ethical consideration: Please mention the ethical consideration related to data management and analysis. Also, please consider how issues with privacy related to virtual interview were addressed.

Result

The result is comprehensive however all the statements made should be substantiated by data. Some of the sub-themes do not have any data. Please include this. Also, since the age group of participants is diverse, is there any difference cited by younger and older participants in any themes and sub-themes?

Discussion

Overall, it has dense information. However, it is hard to follow since it has several paragraphs without headings. It would be better to mention themes as headings and discuss under them.

The authors have discussed well on the marriage and impact on education in a patriarchal society. However, this is missing information on how child marriage and education has influenced migrant women to self-management of diabetes. Please include this information to add richness to the finding of this study.

Paragraph 6: Please link how economic, systemic, informational, cultural, and linguistic barriers impact migrant women to manage diabetes.

Paragraph 8: Please mention scientific evidence to support ‘As part of Nepali culture, people do not purposely engage in exercise activities to remain physically active; it is simply achieved through routine activities during daily life’.

Paragraph 12: Please mention what are these several studies, “Several studies conducted in Nepal associating depression with diabetes reported that low educational status and poor understanding of the disease was associated with poor mental health outcomes among diabetics”.

Thank you for the opportunity to review your work.

Reviewer #2: This is a well written manuscript that provides a qualitative analysis of a small sample of Bhutanese women. I would have expected the manuscript to improve on two fronts before publication. First, refers the link with studies on patriarchy and overweight, as this is the main connection of the story. Second, provide slightly more practical implication in the discussion part, what are the policy implications of the results?

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Reviewer #1: Yes: Mandira Adhikari

Reviewer #2: No

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The influence of patriarchy on Nepali-speaking Bhutanese women’s diabetes self-management

PONE-D-21-19730R1

Dear Dr. Aditi Sharma,

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.

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Sharon Mary Brownie

Academic Editor

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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 #3: 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

Reviewer #3: Yes

**********

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

Reviewer #1: Yes

Reviewer #3: Yes

**********

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 #3: (No Response)

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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 #3: 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: Dear Authors,

Thank you for revising manuscript based on input provided in earlier review. You may need to consider the journal requirements related to formatting. Your study will be valuable for future studies in migrant population.

Reviewer #3: Dear Authors,

I am glad you addressed all the reviewers' comments, adding details to make the study clearer. This study shows the influence of the patriarchy on the inadequacy of diabetes management in a rapidly growing Nepali-speaking Bhutanese community, which is subject very relevant. Understood the age was not the focus of this study, but agree with the comment 9 of the first reviewer, that it would be interesting to observe the differences among ages, as in some data you transcribed the patients referred that they rely on members of the family to help them with the translation in the consultations, that sometimes were females. Also because 5 of them had some access to education and I wondered whether they were among the 6 patients under 49 years old. At younger ages, the influence of the occidental culture and education could have some influence on the development of different policies among different groups. Maybe you could evaluate it better in a future study with a bigger sample.

Yours Sincerely

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Reviewer #1: Yes: Mandira Adhikari

Reviewer #3: No