PONE-D-22-23983Lived experiences of caregivers of persons with epilepsy attending an epilepsy clinic at a tertiary hospital, eastern Uganda: A phenomenological approachPLOS ONE

Dear Dr. OLOWO,

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.

Specifically, the reviewers raised substantial concerns. Please see the comments in details below and provide your point-by-point responses.

Please submit your revised manuscript by Jan 16 2023 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,

Jianhong Zhou

Staff 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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2. Please provide additional details regarding participant consent. In the ethics statement in the Methods and online submission information, please ensure that you have specified what type you obtained (for instance, written or verbal, and if verbal, how it was documented and witnessed). If your study included minors, state whether you obtained consent from parents or guardians. If the need for consent was waived by the ethics committee, please include this information.

3. Thank you for stating the following in the Acknowledgments Section of your manuscript: 

No funding was received towards this study however the researchers do acknowledge support Busitema University Directorate of Graduate Studies, Research and Innovation (DGSRI) for small grants programs that facilitated the writing of this manuscript.  

We note that you have provided funding information that is not currently declared in your Funding Statement. However, funding information should not appear in the Acknowledgments section or other areas of your manuscript. We will only publish funding information present in the Funding Statement section of the online submission form. 

Please remove any funding-related text from the manuscript and let us know how you would like to update your Funding Statement. Currently, your Funding Statement reads as follows: 

The author(s) received no specific funding for this work.

Please include your amended statements within your cover letter; we will change the online submission form on your behalf.

4. 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. 

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5. Your ethics statement should only appear in the Methods section of your manuscript. If your ethics statement is written in any section besides the Methods, please delete it from any other section. 

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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

Reviewer #3: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: N/A

Reviewer #3: Yes

**********

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: No

Reviewer #3: No

**********

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

Reviewer #3: No

**********

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: The authors set out to study the lived experiences of caregivers for PWE and address an important topic. However, some areas need improvement to improve understanding.

1. Abstract: needs to be focused and highlight some of the key results got from the study instead of just summarizing in one sentence the findings.

2. Introduction needs refocusing and emphasize the caregiver burden. Some of the text is not required or needs to be summarized.

4. Add a reference for lines 77-78.

4. Eligibility criteria indicates accessible health workers yet the study objective doesn’t include this. Please clarify.

5. Results. Remove the zeros write 9 instead of 09 etc throughout the text.

6. Some of the quotes are too long, they need to be shortened like lines 213-217.

7. The results indicate results from key informants, who are they and how were they selected.

Discussions are too long, please refocus them on caregivers burden.

Reviewer #2: Thank you for the opportunity to review this manuscript focused on understudied lived experiences of caregivers of patients with epilepsy in Uganda. Findings will improve care of both the patients and supports for family caregivers.

Here are suggestions for strengthening the manuscript:

Lines 67-68. review and revise sentence structure. missing a word or comma?

Line 74. stay consistent with either caregivers or care giver.

Line 83-84. the numbers are a bit confusing! where did the remaining (831-295) patients go? were they admitted to inpatient?

Line 87-88. need reference to support this! or is your conclusion about insufficient knowledge of caregiver experiences solely in this one clinic?

Lines 111-112: Introduction of health workers was a surprise. Consider introducing this earlier say in purpose statement. You could say that the caregivers lived experiences will be elicited directly from them and their health workers who work with them in care of the patients. Alternatively give an explanation or the why for their inclusion somewhere in lines 109-120.

Line 123. no reference was provided in support of sample size and saturation info.

Line 132-133. this is a surprise! give more context and detail, such as rationale etc.

Line 151. review and revise this sentence. maybe missing some words.

Line 166-167. review and correct sentence.

Line 244-247. the quote does not seem to fit the sub-theme description preceding it.

Line 325-330. this section was a bit hard to follow.

Line 362. incorrect use of ; need to review entire document for greater grammar.

Line 540. use person-centered or strength-based language, like the patient or person with epilepsy instead of epileptic.

Line 551. Correct heads to headache.

Reviewer #3: Review Comments

This paper highlights the lived experiences of care givers of persons with epilepsy attending the epilepsy clinic at Mbale regional referral hospital of eastern Uganda. I am glad to have reviewed it.

Overall: This is an engaging paper with a well written abstract, a clear aim, well described methodology and well-presented findings that suggest that caregivers of persons with epilepsy various burdens, including psychological, social, economic, and physical burdens.

Abstract and Introduction: The authors have provided a well written abstract, summarising the research question and the key findings. The authors took time to identify existing literature on the topic and justified how their study relates to the available literature. However, these sections could benefit from proofing of the original word document to address any grammatical and typographical errors.

Methodology: The methods are described in sufficient details, making the study technically sound although I am not an expert on the method of data analysis used for this particular study. This section could benefit from proofing of the original word document for rephrasing of some of the sentences (for example, sentence 166-168) to address grammatical and typographical errors.

Results, Discussions and Conclusion: The results are well presented in the various thematic areas that address the aim of the study and support the conclusion of the study. However, the study fails to discuss the limitations of the approach used to address the aim of the study and the implications of the findings of the study in the discussion. Thus, the authors should revisit the discussion to acknowledge the possible strengths and limitations of the study (Researcher or Interviewer induced bias, Validity Vs Reliability, Language Barrier, highly qualitative nature of findings), highlight how the limitations may have been addressed and include the implications for practice of the findings of the present study to Uganda and Global Community. In addition, the authors should consider proofing all the sections of the paper to address grammatical and typographical errors to improve the flow and readability of the text. For instance, sentence 569-579 appears to be incomplete and this means the conclusion may require rephrasing.

Recommendations: While the recommendation for continuity of current activities being done by the mental health practitioners for patients with epilepsy and their care givers is a good idea, it would be good to make recommendations of solutions that address policy initiatives around the different themes of burdens experienced by the care givers and make recommendations for future research that may provide additional data on the burden being experienced by caregivers for patients with epilepsy. For instance, the authors could consider making suggestions of Longitudinal studies that can study the burden experienced by caregivers of patients with epilepsy, associated factors and offers solutions or consider the determinants of caregiver burden and its impact on quality of life (QOL) for caregivers.

Thank you for providing this piece of research. I am certain that with the above suggested revisions, it will be a great paper and worth the read.

**********

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

Reviewer #3: No

**********

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Attachments

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Submitted filename: Reviewer notes.docx

Attachment

Submitted filename: Review Comments.pdf

PONE-D-22-23983R1Lived experiences of caregivers of persons with epilepsy attending an epilepsy clinic at a tertiary hospital, eastern Uganda: A phenomenological approachPLOS ONE

Dear Dr. OLOWO Samuel,

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 10 2023 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,

Mark Kaddumukasa

Guest 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:

The authors have responded to the comments raised by the reviewers however, some changes are needed and clarity to reduce some of the sections that are too wordy.

1. The ethical considerations section is too wordy with lots of repetitions, lines 192-194 similar with 199-201; 199-203 with 204-206. Please avoid repetitions.

2. Some of the quotes remain too long and may reduce readership, it would be better to summarize them in a table under the various themes so as to enhance easy reading.

3. Th discussion and limitations needs to be shortened and some sections deleted like lines 529-531, it would be nice to focus on the major study findings. Focus the limitations and make them concise and clear.

[Note: HTML markup is below. Please do not edit.]

[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-22-23983R2Lived experiences of caregivers of persons with epilepsy attending an epilepsy clinic at a tertiary hospital, eastern Uganda: A phenomenological approachPLOS ONE

Dear Dr. OLOWO,

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 Jun 03 2023 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,

Mark Kaddumukasa

Guest Editor

PLOS ONE

Additional Editor Comments:

Reviewer 1

The authors need to back up their statements in the introduction, for example “the outpatient clinic recruits 295 patients in July” please reference

Eligibility criteria needs to be written well for both care takers and health care providers, how were health workers selected? Was stratification done for the participants

The authors need to discuss their results succinctly, the major findings first and then a fitting explanation, the conclusion and recommendations have to be re written, conclusions drawn from the findings and the implications too

Reviewer 2

This is an important paper that merits publication—the data/content gathered is important and valuable. However, the paper needs notable reworking, and would strongly benefit from all of the authors reviewing it with an eye towards grammar and typical publication standards (some examples below). I would suggest that a senior member of the team review and guide the rework, and that additional support be added to the team if needed.

Open ended questions with follow-up probes are typically considered a structured interveiw guide-- depends on order and flexibility with the questions.

Examples related to grammar and problems with referencing:

-in the abstract "Feelings" is midsentence and capitalized.

-The introduction states that the ILAE recognizes epilepsy as an NCD, which is true. Epilepsy is recognized as a chronic major NCD by ILAE, the World Health Organization, etc. But the reference attached to this (3) is not an ILAE publication. It would be best to reference a publication of th ILAE (or better, the WHO), and then reference the Singh paper for the worldwide statistic (best done by having these 2-3 references together at the end of the sentence).

-The incidence of epilepsy has been reported to be high in Uganda with over 156 new cases of epilepsy per 100,000 people each year and an increasing prevalence of 13.3% [7]-- this paper reports the crude prevalence ast 13.3, what paper holds the 156/100,000 rate? Please reference that primary source.

-Line 80 has 13 referenced twice

-While epilepsy is a common phenomenal in Uganda: phenomenon

-Lines 88-94 are given as justification for the study. The number of people attending the clinic, their gender, etc., should not drive a research question. Instead, lack of knowledge of caregiver's lived experience (regardless of number) drives the question.

-bed occupancy averagely 359

-147: the interviews guide was

-150: like leading question

183: "till" is not standard English

186: Conformability of the study is demonstrated by how the empiricalthe empirical data is in line with the study findings.

The Ethical considerations section is far too long. Please review recent publications for examples of typical reporting.

VERY IMPORTANT: Tables 1, 2, and 3, 4 have theme/subthemes listed and selected illumative quotes. Then the text has more quotes. This presents the data in a split fashion, when it is necessary to pick one. The tables are efficient, and thus the text should be limited to introducing the content of the table, not providing more content.

The Discussion needs to not only relate the current findings to existing papers, as it it does, but also needs to professionally and succinctly offer what NEW information was learned from this study.

Can the sample be described by patient’s age, type/duration/severity of epilepsy? These factors could influence caregiver burden and should be reported.

Recommendations should go in the Discussion unless this journal routinely breaks it into a separate section.

“The collection and analysis of the data were done simultaneously”. I do not think this is accurate. Thematic analysis requires transcription and careful study of results, which would occur well after the discussion that collected the data.

“_an inductive thematic analysis....thorough reading and understanding of the transcrips ensured to obtain an overall sense...Line coding...A thorough review of the transcripts were ensured and later a list of codes....” This could be made more succinct and stated once. If in the methods the authors describe the thematic analysis approach well, it does not need to be stated that the content was read and understood, etc. This is where a review of the paper by the senior member of the team may be helpful to make reporting concise and clear.

[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 #4: All comments have been addressed

Reviewer #5: (No Response)

**********

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 #4: Yes

Reviewer #5: Yes

**********

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

Reviewer #4: Yes

Reviewer #5: 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 #4: Yes

Reviewer #5: 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 #4: Yes

Reviewer #5: No

**********

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 #4: The authors need to back up their statements in the introduction, for example “the outpatient clinic recruits 295 patients in July” please reference

Eligibility criteria needs to be written well for both care takers and health care providers, how were health workers selected? Was stratification done for the participants

The authors need to discuss their results succinctly, the major findings first and then a fitting explanation, the conclusion and recommendations have to be re written, conclusions drawn from the findings and the implications too

Reviewer #5: This is an important paper that merits publication—the data/content gathered is important and valuable. However, the paper needs notable reworking, and would strongly benefit from all of the authors reviewing it with an eye towards grammar and typical publication standards (some examples below). I would suggest that a senior member of the team review and guide the rework, and that additional support be added to the team if needed.

Open ended questions with follow-up probes are typically considered a structured interveiw guide-- depends on order and flexibility with the questions.

Examples related to grammar and problems with referencing:

-in the abstract "Feelings" is midsentence and capitalized.

-The introduction states that the ILAE recognizes epilepsy as an NCD, which is true. Epilepsy is recognized as a chronic major NCD by ILAE, the World Health Organization, etc. But the reference attached to this (3) is not an ILAE publication. It would be best to reference a publication of th ILAE (or better, the WHO), and then reference the Singh paper for the worldwide statistic (best done by having these 2-3 references together at the end of the sentence).

-The incidence of epilepsy has been reported to be high in Uganda with over 156 new cases of epilepsy per 100,000 people each year and an increasing prevalence of 13.3% [7]-- this paper reports the crude prevalence ast 13.3, what paper holds the 156/100,000 rate? Please reference that primary source.

-Line 80 has 13 referenced twice

-While epilepsy is a common phenomenal in Uganda: phenomenon

-Lines 88-94 are given as justification for the study. The number of people attending the clinic, their gender, etc., should not drive a research question. Instead, lack of knowledge of caregiver's lived experience (regardless of number) drives the question.

-bed occupancy averagely 359

-147: the interviews guide was

-150: like leading question

183: "till" is not standard English

186: Conformability of the study is demonstrated by how the empiricalthe empirical data is in line with the study findings.

The Ethical considerations section is far too long. Please review recent publications for examples of typical reporting.

VERY IMPORTANT: Tables 1, 2, and 3, 4 have theme/subthemes listed and selected illumative quotes. Then the text has more quotes. This presents the data in a split fashion, when it is necessary to pick one. The tables are efficient, and thus the text should be limited to introducing the content of the table, not providing more content.

The Discussion needs to not only relate the current findings to existing papers, as it it does, but also needs to professionally and succinctly offer what NEW information was learned from this study.

Can the sample be described by patient’s age, type/duration/severity of epilepsy? These factors could influence caregiver burden and should be reported.

Recommendations should go in the Discussion unless this journal routinely breaks it into a separate section.

“The collection and analysis of the data were done simultaneously”. I do not think this is accurate. Thematic analysis requires transcription and careful study of results, which would occur well after the discussion that collected the data.

“_an inductive thematic analysis....thorough reading and understanding of the transcrips ensured to obtain an overall sense...Line coding...A thorough review of the transcripts were ensured and later a list of codes....” This could be made more succinct and stated once. If in the methods the authors describe the thematic analysis approach well, it does not need to be stated that the content was read and understood, etc. This is where a review of the paper by the senior member of the team may be helpful to make reporting concise and clear.

**********

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 #4: No

Reviewer #5: 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.

Lived experiences of caregivers of persons with epilepsy attending an epilepsy clinic at a tertiary hospital, eastern Uganda: A phenomenological approach

PONE-D-22-23983R3

Dear Dr. OLOWO,

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.

Please also rewrite the statement for eligibility age of consent, clarify on the selection of caregivers and repetitions in this section. 

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,

Mark Kaddumukasa

Guest Editor

PLOS ONE

Additional Editor Comments (optional):

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 #4: (No Response)

Reviewer #5: 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 #4: Yes

Reviewer #5: Yes

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

Reviewer #4: N/A

Reviewer #5: Yes

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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 #4: Yes

Reviewer #5: 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 #4: Yes

Reviewer #5: 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 #4: see the comments attached in the documents

1.Rephrase/ rewrite the statement for eligibility age of consent.

2.How where caregivers selected, given the low educational status?

3.There is a lot of repetition in this section, that needs to be shortened to remove the repetition.

4. How was stratification done to ensure full coerciveness of the group and participation?

Reviewer #5: This manuscript is remarkably improved, and should be published. It is better organized and clear, and contributes to the literature. There are a few remaining items to clean up:

Rigor and Trustworthiness of the study: this section is not typically included, these practices are expected. You can eliminate or reduce to a sentence.

Confirmability: 'Audio recordings not destroyed which can enable others to track the progress.' This is not standard practice. Instead, recordings should be transcribed and destroyed, in order to reduce the likelihood of loss of confidentiality. Deidentified transcripts would then be shared!

349. 407 quotes remain in the text, rather than in textboxes. Would be better to move those into the boxes and allow the text to remain as descriptions.

Ref 42 is now missing. You could add 42 to the previous group (instead of ending -41 it would be -42) and add in references: 42: Sanchez et al, Epilepsy and Behavior, 2021).

WELL DONE REVISION

With these revisions the paper should be accepted

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Reviewer #4: No

Reviewer #5: No

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Attachments

Attachment

Submitted filename: reviewer comments.docx