“Do we even have a voice?” Health providers’ perspective on the patient accommodation strategies in Bangladesh

Md. Ruhul Kabir; Kara Chan

doi:10.1371/journal.pone.0271827

Peer Review History

Original SubmissionDecember 1, 2021
31 Jan 2022 Decision Letter - Paavani Atluri, Editor PONE-D-21-37993“Do We Even Have a Voice?” Health providers’ perspective on the patient accommodation strategies in BangladeshPLOS ONE Dear Dr. Ruhul Kabir, 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 17 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 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. During our internal checks, the in-house editorial staff noted that you conducted research or obtained samples in another country. Wile we appreciate that in the Ethics statement you have indicated that "The study was also approved by the review board of the two health facilities where the study was conducted". Please check the relevant national regulations and laws applying to foreign researchers and state whether you obtained the required permits and approvals. And please revise your statement to include the full name of the ethics committee/institutional review board(s) that approved your specific study and to confirm that your named institutional review board or ethics committee specifically approved this study. 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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 If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references.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 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: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: N/A Reviewer #2: I Don't Know ****** 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: No 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: Overall an excellent manuscript. However, few suggestions or comments: 1. Discussion should be based on CAT, although results section does include integration of CAT. 2. In the methodology section, how and on what grounds the participants were selected? What inclusion and exclusion criteria was followed? 3. If no saturation was achieved, then justify 10 participants for the study? 4. Selection of hospitals was done on what grounds? Are both hospitals similar? From the methodology section it appears that 1 is secondary health institution and 1 is primary health institution. How can you justify using 2 different levels of health institutions? For study to have some uniformity, both institutions have to be of similar nature. 5. How reliability and validity of the data (transcriptions) was ensured. 6. The study has one perspective only that is service provider perspective. In my opinion if patients are also included the study would have had more strength. This is one future direction that needs to be explicitly stated in future directions. Reviewer #2: The manuscript talks about the experience of mistreatment, discrimination, and disrespect in a resource constrained setting in a developing country. This manuscript concentrates on the degree of interaction with pregnant women particularly in the context of accommodating patients and their relatives to improve communication between the parties of health care as well as patients. Manuscript also mentions of systematic limitations of health care facilities and heavy workload reported by staff. Poor attitudes and neglect from some patients and providers perception of interaction with patients therefore their adopted accommodation strategies for providing health care services were studied. This was analyzed using communication accommodation strategy (CAT). Communication accommodation theory which is one of the prominent behavioral theories of communication and the author provides a thematic analysis in table 1. Provider’s perception of patient interaction and their adopted accommodation strategies were studied. Due to systematic limitations of health care facilities and heavy workload especially nurses and midwives reported poor attitudes and neglect from some patients. The health care providers also use different approaches to accommodate patients emotional and psychological needs through verbal and nonverbal clues. The author request for prompt delivery of health care services and awareness programs to urge patients and visitors to cooperate with medical procedures, so they can collaborate with current settings as much as possible. Health care sector can also consider facilitating providers workload and maintaining a power balance and service management. ****** 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.0271827.r001
Revision 1
11 Feb 2022 Author Response The authors would like to thank the Editor and the two reviewers for their valuable comments and insights that helped to improve the manuscript. We have tried to answer all the issues mentioned by the reviewers and update some parts based on the suggestions received. Please find the details below where we have tried to clarify points one by one. Two references added to the (Introduction part, Reference number: 11, 13) reference list due to their relevance to the literature. Comments from reviewers and responses from the author: 1. Discussion should be based on CAT, although results section does include integration of CAT. Response: Thank you for this important comment. We have updated the discussion section, which focused more on CAT, although CAT was discussed in the middle part of the discussion section already. 2. In the methodology section, how and on what grounds the participants were selected? What inclusion and exclusion criteria was followed? Response: The study used a convenience sampling technique and considered healthcare providers who were directly involved with patients and their relatives in the maternity ward in providing delivery care or other care related to maternal and childcare. The study interviewed doctors, midwives, and nurses who had a significant role in maternal health service operations. This study did not consider health providers who were not directly involved with maternity care. 3. If no saturation was achieved, then justify 10 participants for the study? Response: Initially, it was planned to include more participants for this study. But due to covid-19, it was difficult to reach health providers even if they work in maternity care mostly. They were involved in other patients' care as well, which made them a very difficult group of people to reach in this unprecedented period of time. The study did encounter saturation to some extent; however, inflicting saturation might be a little far-fetched since only limited participants were available. The final number of participants was decided based on their availability, timing, and free schedule. No generalization of the findings was targeted. The study tried to deliberately include a diverse group of participants (doctors, nurses, and midwives) to explore and understand the diversity in perceptions of communication with patients and their diverse accommodation strategies. 4. Selection of hospitals was done on what grounds? Are both hospitals similar? From the methodology section it appears that 1 is secondary health institution and 1 is primary health institution. How can you justify using 2 different levels of health institutions? For study to have some uniformity, both institutions have to be of similar nature. Response: The study targeted public health facilities in Bangladesh, so in that aspect, both the facilities were publicly funded and selected based on convenience of access. The study was not intended to compare the primary and secondary level of care; it was intended to assess health providers' perceptions about their interaction with patients in different levels of healthcare and how they accommodate their patients based on their level of facilities. Of course, similarities-dissimilarities were discussed, but the basis was to have a deeper understanding of common grounds. 5. How reliability and validity of the data (transcriptions) was ensured. Response: Probing questions were asked to participants to prevent ambiguity or double meaning. Data curation and analysis were assisted by one research associate who also independently read and coded the data set to validate the process through multiple angles. We focused only on interview responses to limit researcher’s subjectivity. The principal researcher and associate went through all the data sets to find out any incongruity in their coding based on the initial codebook developed by the principal researcher. The process was rechecked multiple times (from field notes to transcriptions to theme development) till the generation of themes, so that discrepancies could be reconciled and resolved. The process is thoroughly discussed in the data analysis section. 6. The study has one perspective only that is service provider perspective. In my opinion if patients are also included the study would have had more strength. This is one future direction that needs to be explicitly stated in future directions. Response: I agree with you completely and therefore, I already included it in the limitation section (last part of the discussion). Conclusion and policy implication is based on the current study findings. A future research is under consideration which will also include patients’ perspectives. Thank you for this great suggestion. 7. The manuscript talks about the experience of mistreatment, discrimination, and disrespect in a resource constrained setting in a developing country. This manuscript concentrates on the degree of interaction with pregnant women particularly in the context of accommodating patients and their relatives to improve communication between the parties of health care as well as patients. Manuscript also mentions of systematic limitations of health care facilities and heavy workload reported by staff. Poor attitudes and neglect from some patients and providers perception of interaction with patients therefore their adopted accommodation strategies for providing health care services were studied. This was analyzed using communication accommodation strategy (CAT). Communication accommodation theory which is one of the prominent behavioral theories of communication and the author provides a thematic analysis in table 1. Provider’s perception of patient interaction and their adopted accommodation strategies were studied. Due to systematic limitations of health care facilities and heavy workload especially nurses and midwives reported poor attitudes and neglect from some patients. The health care providers also use different approaches to accommodate patients emotional and psychological needs through verbal and nonverbal clues. The author request for prompt delivery of health care services and awareness programs to urge patients and visitors to cooperate with medical procedures, so they can collaborate with current settings as much as possible. Health care sector can also consider facilitating providers workload and maintaining a power balance and service management. Response: Thank you for your comment. Attachments Attachment Submitted filename: Rebuttal letter_Plos_10.02.2022.docx https://doi.org/10.1371/journal.pone.0271827.r002
15 Jun 2022 Decision Letter - Paavani Atluri, Editor PONE-D-21-37993R1“Do We Even Have a Voice?” Health providers’ perspective on the patient accommodation strategies in BangladeshPLOS ONE Dear Dr. Kabir, 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 Jul 30 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, Paavani Atluri 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 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 #3: (No Response) Reviewer #4: 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 #3: Yes Reviewer #4: Partly ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #3: Yes Reviewer #4: 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 #3: Yes Reviewer #4: 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 #3: Yes Reviewer #4: 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 #3: The manuscript can be improved further if the comments inserted in the document are addressed/considered. Reviewer #4: The authors addressed the points raised by the reviewers. However the limitations imposed by the small and not so diverse group of interviewees in the study persist in some extent. I also suggest a final review of the text. There are some minor mistakes which should be corrected. ****** 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 #3: Yes: Manoja Kumar Das Reviewer #4: 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. Attachments Attachment Submitted filename: PONE-D-21-37993_R1_reviewer.pdf https://doi.org/10.1371/journal.pone.0271827.r003
Revision 2
16 Jun 2022 Author Response Reviewer's comments: Reviewer #3: The manuscript can be improved further if the comments inserted in the document are addressed/considered. Reviewer #4: The authors addressed the points raised by the reviewers. However the limitations imposed by the small and not so diverse group of interviewees in the study persist in some extent. I also suggest a final review of the text. There are some minor mistakes which should be corrected. Author’s response: Thank you for your comments and suggestions which we belief have made us more focused to improve our work further. We addressed all the comments/suggestions made by the reviewers and tried to improve the manuscript. We went through the manuscript again, according to your suggestion, to find out and correct minor mistakes, where applicable. We agree with you regarding the relatively small sample size, to some extent. We tried to make the sample as heterogenous as possible involving doctors, nurses, and midwives as participants within our limits. Attachments Attachment Submitted filename: Response to reviewers_2_16.06.2022.docx https://doi.org/10.1371/journal.pone.0271827.r004
8 Jul 2022 Decision Letter - Paavani Atluri, Editor “Do We Even Have a Voice?” Health providers’ perspective on the patient accommodation strategies in Bangladesh PONE-D-21-37993R2 Dear Dr. Kabir, 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, Paavani Atluri Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0271827.r005
Formally Accepted
22 Jul 2022 Acceptance Letter - Paavani Atluri, Editor PONE-D-21-37993R2 “Do We Even Have A Voice?” Health Providers’ Perspective On The Patient Accommodation Strategies In Bangladesh Dear Dr. Kabir: 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. Paavani Atluri Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0271827.r006

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