PONE-D-22-02363

Using Systems-Mapping to Address Adverse Childhood Experiences (ACEs) and Trauma: A Qualitative Study of Stakeholder Experiences

PLOS ONE

Dear Dr. Vu,

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.

The reviewers have highlighted important strengths of this paper, but have also identified main points that require revisions at the conceptual, methodological and overall explanation level. 

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Monica Wendel

Academic Editor

PLOS ONE

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Additional Editor Comments:

The peer review is complete, and they recognize the valuable contribution of your manuscript to the current literature. The reviewers provided several critical suggestions to strengthen the manuscript for publication.

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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: 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 #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: Using Systems Mapping to Address Adverse Childhood Experiences (ACEs) and Trauma

SM is useful in understanding and addressing ACES

Introduction:

-Describe what “1 ACES” vs “3 ACES” means. How are ACEs calculated?

-line 63 pg 3: change “attributable” to “associated with” & move the sentences about healthcare costs to the next paragraph after you talk about the kind of diseases/illnesses that ACEs contribute to

-Elaborate on current individual level interventions and the current gap

-Systems thinking is not a “critical component” of CBPR. CBPR can include systems thinking, but it can also be used to address individual level factors. I would argue that systems thinking, which is transdisciplinary in nature, requires community-based participation (in public health) but CBRP does not necessarily require systems thinking.

-The systems field typically refers to systems mapping in more specific techniques. In practice, it can be called system mapping. I suggest redefining systems mapping as community based systems dynamics or causal loop diagramming because this paper is for a technical audience, not community partners.

-Define systems thinking and cite it and systems mapping.

-I don’t know if I agree with the statement on lines 93-95. Do you have a citation?

-The sentence on line 99-100 needs to be reworded and less specific. Describe the overall type of NP and rename this section “Systems Mapping Process” not “project”

-Add more details to mapping process.

Methods:

-Move section about participants to methods & more detail about the participants. Where did they come from? Incentives, recruitment strategy, response rate etc. Was 16 the total # of people recruited?

-Describe study design (qualitative) first then talk about investigators. How many investigators?

-Were interview guides developed based on past literature? Why did you ask the questions you did? What was the overall research /evaluation question being addressed?

- I suggest using COREQ or SRSR guidelines for qualitative research to describe the methods. Look up the Equator Network to find the reporting guidelines.

-How many coders?

-What was inter-rater reliability? This is a statistic that is calculated.

Discussion:

-Based on your first finding, do you think that the SMP was an intervention within itself? It created a shared understanding and individual awareness based on your results, so it could have psychological benefits among others? I think this would be an interesting thing to add to the discussion.

-Discuss the actions resulting from SM in more detail. I think that this study is unique because it used SM to make changes. A lot of research uses SM to conceptualize issues, but doesn’t take the next steps.

Reviewer #2: Kia ora, thank you for the opportunity to read this interesting manuscript. It is a qualitative study consisting of interviews of participants from a larger study that used systems science to explore ways to address trauma related to ACES. The participants in this study were asked about their experience in the larger study, to help describe and understand the usefulness and application of systems science in the ACES subject matter. The interview analysis process was robust and thorough.

Overall this is a helpful piece of work for people to read, who may decide to use this methodology, in the fields of ACES/ Child protection/Child maltreatment.

There are a number of suggestions I have to improve this manuscript:

1. The description of the relationship of this study to the overarching ROI group and original systems science research.

a) The aim of this study needs to be much clearer at the end of the introduction. The lines 95-97 I think are the aims of this study but it would be helpful if they were framed more from the perspective of "the aim of this study was to...."

b) The aim, questions and description of the overarching systems science work are not clear and the powerpoint referenced - reference 26 cannot be accessed to understand this study better. This description needs to much more clearly state what the overall aim of the systems science research was, as well as any sub-objectives/research questions.

c) The interaction between these two studies (the overall systems science SMP project), and this sub project of analysing the process and understanding the impact, needs to be better described. At the moment it doesn't seem to work well to have the description of the ROI systems mapping project at the end of the introduction (lines 98-124). The introduction should end with the aim of the project being described in this manuscript. The detailed description of the SMP project may be better in the methods section under a section around context.

2. Purpose

Line 129 The wording around purpose should be much more including "The purpose of this study was to....."

3. Themes

It would be helpful to have a summary list of the themes before starting straight into each one. E.g. The analysis resulted in three major themes including.....

4. Background literature

At the moment there is not much in the introduction or discussion about the use of systems thinking in ACES/child protection/Child maltreatment research. It would be helpful in the background to have more about how this (or similar approaches) has been used elsewhere in this subject matter. Then in the discussion how the results, strengths and limitations within this study relate to previous studies using this methodology.

5. Minor comments

a) line 119 needs an 'of' in between 'development' and 'several'

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Reviewer #1: No

Reviewer #2: No

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PONE-D-22-02363R1Using Systems-Mapping to Address Adverse Childhood Experiences (ACEs) and Trauma: A Qualitative Study of Stakeholder ExperiencesPLOS ONE

Dear Dr. Vu,

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.

Thanks for the very nice revision. Please note that one of the reviewers still has some minor comments that need to be addressed before I can make a final decision on publication. 

Please submit your revised manuscript by Sep 01 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,

Sara Rubinelli

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.

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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 #2: 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

**********

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

Reviewer #2: 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 #2: 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 #2: 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: Thank you for the changes made in response to review.

Just a couple of minor edits needed:

Line 157 “LLC” is this an acronym – if so expand.

Lines 182-183 “: 1) What were the 183 perceived individual, interpersonal, and societal level impacts the SMP?”

Should there be an ‘of’ between ‘impacts’ and ‘the’

And a couple of general comments:

Names were in manuscript - was this supposed to be a double blind review. If so in future please anonymise your manuscript.

Not sure why original manuscript was submitted in the resubmission. It was confusing initially.

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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: No

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Using Systems-Mapping to Address Adverse Childhood Experiences (ACEs) and Trauma: A Qualitative Study of Stakeholder Experiences

PONE-D-22-02363R2

Dear Dr. Vu,

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.

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Kind regards,

Sara Rubinelli

Academic Editor

PLOS ONE

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