PONE-D-21-18728“A friend during troubled times”: Experiences of family caregivers looking after people with dementia when receiving professional support via a mobile appPLOS ONE

Dear Dr. Dorell,

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.

It is requested to (see the enclosed reviewers' comments):

-include more and longer quotations presenting the words of the interviewee;

-provide more information or references about the STAV app;

- carefully discuss the "gaps of knowledge" behind this work in relation to the relevant literature;

-include a table that displays the sub-themes that emerged, in addition to just listing the six themes;

- revise the declaration of intent in the abstract;

- better specify the narrative in the introduction;

- revise the conclusion adding future directions and perhaps the specificities of the Swedish case;

- carefully revise the language;

-add a few lines explaining the differences between the terms "dementia" and "Alzheimer";

-harmonize the presentation of numbers in the manuscript.

Please submit your revised manuscript by Nov 05 2021 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.

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We look forward to receiving your revised manuscript.

Kind regards,

Filomena Papa

Academic Editor

PLOS ONE

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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

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Could you therefore please include the title page into the beginning of your manuscript file itself, listing all authors and affiliations.

3. Please include additional information regarding the interview guide used in the study and ensure that you have provided sufficient details that others could replicate the analyses. Please include a copy, in both the original language and English, as Supporting Information.

4. In your Data Availability statement, you have not specified where the minimal data set underlying the results described in your manuscript can be found. PLOS defines a study's minimal data set as the underlying data used to reach the conclusions drawn in the manuscript and any additional data required to replicate the reported study findings in their entirety. All PLOS journals require that the minimal data set be made fully available. For more information about our data policy, please see http://journals.plos.org/plosone/s/data-availability.

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We will update your Data Availability statement to reflect the information you provide in your cover letter.

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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: Partly

Reviewer #2: Yes

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

Reviewer #1: N/A

Reviewer #2: 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

Reviewer #2: 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

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: I do NOT have any potential or perceived competing interests that may influence my review. For further certainty, I state that I have NO actual or potential pecuniary, professional, reputational or other interests that might influence or might be perceived to influence my review.

In the interest of transparency, the Comments to the Author are identical to those provided to the Editor.

Thank you for the opportunity to review this manuscript, which presents the results of a qualitative study of a mobile application designed to support caregivers of people with dementia. The subject (dementia) is perennially important, it addresses a substantial clinical need (caregiver strain), and it involves a novel intervention (mHealth app). It is clearly written and easy to follow. It appears to conform to reporting guidelines.

I entertain some concern that the size of the study (12 interviewees) may not be large enough to justify publication in a large journal of general interest, but I will leave this matter to the Decision Editor.

I recommend that the manuscript be resubmitted with MAJOR REVISIONS.

In general, the ratio of analysis to evidence is too high. I would like to see more and longer quotations to let the interviewees "speak for themselves" a bit more. I think richer quotations would be helpful in illuminating and in some cases supporting your findings, and in allowing the reader to critically assess your conclusions.

As an example, on page 7, the first 2 paragraph state many different observations about multiple aspects of the theme but then this is only supported by basically 2 sentences of quoted text.

Particularly as your study about the basis for your app is unpublished, I would also like to know a lot more about STAV, how it was developed (and any research that it was informed by), what you think is unique about it, and so on. It's a bit hard to get a sense of how the app works and how exactly it addresses perceived needs.

You also state that "not much attention has focused on the physical and mental health of the family members who have to look after their loved ones who have dementia and who take care of them at home." I think this statement needs to be qualified a bit. There are in fact at least three fairly recent reviews of interventions focused on dementia caregivers; Gitlin and colleagues state that there have been around 200 such interventions to date.

Gitlin et al. Gerontologist 2015;55:210–26

Walter et al. Gerontologist 2019;20:1–11

Hinton et al. BMJ Glob Health. 2019 Nov 12;4(6):e001830

Lastly, one specific point -- I would suggest you include a table that displays the subthemes that emerged, in addition to just listing the six Themes. This would be useful in signposting the discussion for the reader.

Reviewer #2: The paper introduces a qualitative study with caregivers of persons with dementia living at home using a mobile app.

I appreciated the article, but also found the necessity for the following revisions.

1. More information or references should be provided about the STAV app.

ABSTRACT

2. The abstract mentions "to evaluate the app's usability". I found this one a rather emphatic declaration, whereas the paper only discusses a few considerations about usablity. I suggest softening the declaration of intent.

INTRODUCTION

3. Some references report studies in specific populations (e.g. ref.2 in Sweden, ref.3 in Europe,...), yet the first paragraph of the introduction is very generic and does not account for geographic differences. I suggest a better level of specification in the narrative.

METHOD

4. At the beginning of the "Intervention" section, the sentence "an overview of available

information channels (collection of web links)" needs a verb.

5. At the beginning of the "Data collection" section, the sentence "it had to be put on hold" should be rephrased as "they had to be put on hold".

6. At the beginning of the "Ethical considerations" section, the sentence "Written informed consent were obtained" should be rephrased as "Written informed consent was obtained".

7. Similar mistakes appear here and there in the text: I suggest a careful langiage revision.

8. I am curious about the chats between nurses and caregivers via the app. Could you provide examples of topics and themes, and the level of detail they were dealt with?

CONCLUSION

9. I felt the "Conclusion" section was rather meager and generic. I suggest to improve it by also adding future directions, and perhaps the specificities of the Swedish case (if any).

10. I am not an expert of neurobiology, therefore I found it difficult to navigate through the terms "dementia" and "Alzheimer", both used in the paper. I guess it could be useful for readers like me to add a few lines explaining the differences.

11. Throughout the paper numers are sometimes written as digits and sometimes as words: please harmonise.

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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: Yes: Thom Ringer

Reviewer #2: Yes: Bartolomeo Sapio

[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.

PONE-D-21-18728R1“A friend during troubled times”: Experiences of family caregivers to persons with dementia when receiving professional support via a mobile appPLOS ONE

Dear Dr. Dorell,

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.

It is requested to revise the manuscript according to comments of Reviewer 2.

Please submit your revised manuscript by Jun 16 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,

Filomena Papa

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.

Additional Editor Comments (if provided):

The use of pictures (e.g. screen shots, drawings) could be useful to describe the STAV app.

[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 #2: (No Response)

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 #2: Yes

Reviewer #3: Yes

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

Reviewer #2: N/A

Reviewer #3: N/A

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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 #2: Yes

Reviewer #3: Yes

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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 #2: Yes

Reviewer #3: Yes

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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 #2: Although the authors improved the paper by addressing the reviewers' comments, I must confess I am not satisfied with the ways they chose to address some of those comments.

The reviewers asked for more information about the STAV app, how it was developed (and

any research that it was informed by), what you think is unique about it, and so on. The authors added a generic sentence bearing little or no extra information.

The reviewers asked to improve conclusions by adding future directions and the specificities of the Swedish case. The authors slightly modified one sentence without really tackling the issue.

The reviewers asked to include a table that displays the subthemes that emerged. The authors added a table with a few examples of the data analysis, which I do not find helpful at all.

I suggest the authors consider the reviewers' comments in a more serious way, if they want to get their paper published in the journal. These are not major revisions and can be done with a little effort.

Reviewer #3: (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 #2: Yes: Bartolomeo Sapio

Reviewer #3: Yes: Merle Varik

[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.

“A friend during troubled times”: Experiences of family caregivers to persons with dementia when receiving professional support via a mobile app

PONE-D-21-18728R2

Dear Dr. Dorell,

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,

Filomena Papa

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

All comments have been addressed. Thank you.

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 #2: 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 #2: Yes

Reviewer #3: Yes

**********

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

Reviewer #2: N/A

Reviewer #3: 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 #2: Yes

Reviewer #3: Yes

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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 #2: 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 #2: Thanks for addressing my comments: tha paper is now ready for publication.

Reviewer #3: This qualitative descriptive study's aim is achieved, and the manuscript was well and appropriately revised.

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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 #2: Yes: Bartolomeo Sapio

Reviewer #3: No

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