PONE-D-22-03840Neurotrauma clinicians’ perspectives on the contextual challenges associated with traumatic brain injury follow up in low-income and middle-income countries: a reflexive thematic analysisPLOS ONE

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Academic Editor

PLOS ONE

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4. Thank you for stating the following in the Competing Interests section: 

"AGK and PJAH are supported by the National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre, Royal College of Surgeons of England, and the NIHR Global Health Research Group on Neurotrauma. PJH is also supported by an NIHR Research Professorship. The NIHR Global Health Research Group on Neurotrauma was commissioned by the UK NIHR using Official Development Assistance funding (project no. 16/137/105). INE, CK, MMK, DJFS and AGK are members of the Young Neurosurgeons Committee of the World Federation of Neurosurgical Societies. The committee is supporting this project."

We note that you received funding from a commercial source: National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre

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Additional Editor Comments (if provided):

My apologies again for the delays inherent to the review process. The three reviewers were in agreement that your manuscript shows promise for publication. I would ask that you please carefully onsider their requests for minor revision and provide point-by-point responses to their critiques. We look forward to reviewing a revision of your work.

Thank you!

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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

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

Reviewer #1: N/A

Reviewer #2: N/A

Reviewer #3: 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

Reviewer #3: 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

Reviewer #3: No

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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: Qualitative research is not commonly undertaken in the field of neurosurgery and yet an increasing number of papers have been published over the last several years which use this labor-intensive methodology to advance our understanding key issues in a field from a person-centered approach. This paper applies such methodology to developing an understanding of long-term follow-up of traumatic brain injury patients in low resource settings. After interviewing 18 neurosurgeons from 13 different countries the authors identified 5 main themes and discuss their findings in the context of managing these patients and providing future direction for both research and care.

Overall, this is a well written paper that is grounded in solid methodology. Its findings are interesting and relevant to the emerging conversation in global neurosurgery which is struggling to define the scope and depth of challenges in neurosurgical care in LMICs due largely to the limitations of collecting data in the traditional sense. The methodology section is somewhat lengthy as the authors spend a great number of words explaining many details to presumably enlighten a readership that is naïve to such approaches. They might do well to shorten the “Data Analysis” and “Rigour” sections and let those readers who take an interest in “Reflexive Thematic Analysis”, for example”, to pursue it elsewhere. Beyond that I think their paper needs little modification. And, for what it is worth, I believe that the authors conclusion that further studies of this topic from the patients’ perspective are needed cannot be overstated enough; it is in these data that we be needed to truly advance the treatment of neurotrauma patients in LMICs.

Reviewer #2: Congratulations for the study and manuscript, all PLOS ONE guidelines have been met.

My only recommendation is about exclusion criteria, those were rightly opposite to the inclusion criteria, thus, they are unnecessary.

Reviewer #3: This is an interesting point addressed by the authors due to the lack of discussion regarding the challenges faced by LMIC researchers, when it comes to data collection and follow up of TBI patients. The authors performed a qualitative analysis of the perceptions of researchers from LMIC and found 5 themes. However, there are some aspects that need to be better clarified in the methods section (particularly regarding the excess of explanation and lack of how each phase were done). Moreover, as this is a very “dense” paper, the writing must be improved for clarity and conciseness (i.e, in lines 99 and 120, it is missing a comma; there are several wordy sentences like “the aim of inquiry “ , “through interpretation of”, “additionally at this time”, etc; there are lots of passive voice along the text – lines 111, 112, 119, 157, 189 etc).

Find bellow specific comments:

Abstract

In the conclusion: change “results in improved” to “improves”

Conclusion is confused (rewrite sentence for clarity)

Introduction

First two sentences: be more specific, showing quantitative data.

Consider rewrite this sentence for clarity: “Accurate data also facilitates the evaluation of systems and services, enabling: identification targets of wider systems improvement in injury prevention,(15) assessment of the efficacy of management decisions and patient treatment,(10,14) facilitation of quality improvement initiatives and clinical trials, and lastly, the establishment and continuation of registries; of which themselves facilitate the development of care pathways, health policy, and injury prevention strategies” - (maybe, taking of “…of which themselves… strategies”and/or splitting in two sentences)

Consider taking off “that does exist” of the sentence in lines 81 and 82

Methods

In line 111 and 113: change “may” to “might”

Typo in line 115“renumerate”, and missing comma after “participants”:

In lines 148-153: Hard to read. Consider splitting the sentence…

In line 174: please specify the demographic data collected

In lines 181-184: Hard to read sentence

Was the semi- structured interview guide pilot tested?

I think it’s better to put the initials of the authors along with the text in the following format: “B.G.S.” instead of “BGS”

Sometimes along with the methods, the authors explain and discuss about the methodology. I suggest that the authors stick to describing the methods and not justifying it. The authors published the protocol (BMJ, 2021), therefore, you might use it to save words.

It was hard to understand what the authors wanted to say with this sentence: “Through the use of NVivo and reflexive journal writing, a clear audit trail was created from data to findings, which also adds to the dependability and confirmability of the study”. It would be interesting if the authors could explain how they used the NVivo and the reflexive journal writing to guarantee rigour.

Moreover, consider providing the codebook and a sample analysis of interview transcripts as supplemental material.

Results

In line 239, take the word “Unfortunatelly” off.

Please specify all the reasons for participants withdrawing from the study (and quantify objectively)

In table 2: Years of experience – 1 to 5 or 2 to 5? I thought one year of experience was an exclusion criteria.

It is interesting to be persuasive when writing the paper, however, I think it is too much. Consider taking off some words such as “important” or “illuminate”.

The themes are well presented and highlight several issues related to the low-resource environment challenges.

Discussion is well written

Conclusion

Focus on the leading suggestions derived from the study.

It is the same as the abstract. Consider being more concise in the abstract.

Finally, I’d like to congratulate the authors for their hard work and shed light on this issue.

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Reviewer #1: No

Reviewer #2: Yes: Sérgio Brasil

Reviewer #3: Yes: ROBSON LUIS OLIVEIRA DE AMORIM

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Submitted filename: PlosOne 1.docx

Neurotrauma clinicians’ perspectives on the contextual challenges associated with traumatic brain injury follow up in low-income and middle-income countries: a reflexive thematic analysis

PONE-D-22-03840R1

Dear Dr. Smith,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Hanna Landenmark

Staff 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 #1: All comments have been addressed

Reviewer #2: All comments have been addressed

Reviewer #3: (No Response)

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: (No Response)

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

Reviewer #1: N/A

Reviewer #2: N/A

Reviewer #3: (No Response)

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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 #1: Yes

Reviewer #2: Yes

Reviewer #3: (No Response)

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: (No Response)

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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 #1: (No Response)

Reviewer #2: Congratulations, I believe mine and the others reviewers' comments have been addressed correctly. Thank you all for your efforts and hope this information will help improve neurotrauma follow-up around the world.

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 #1: No

Reviewer #2: Yes: Sérgio Brasil

Reviewer #3: Yes: Robson Luis Oliveira de Amorim

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