PONE-D-22-09660An exploratory study on excess weight gain: Experiences of Postmenopausal Women in GhanaPLOS ONE

Dear Dr. Mensah Bonsu,

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 note that we have only been able to secure a single reviewer to assess your manuscript. We are issuing a decision on your manuscript at this point to prevent further delays in the evaluation of your manuscript. Please be aware that the editor who handles your revised manuscript might find it necessary to invite additional reviewers to assess this work once the revised manuscript is submitted. However, we will aim to proceed on the basis of this single review if possible. They request some clarifications on the manuscript, could you please revise your article to address their concerns?

Please submit your revised manuscript by Sep 15 2022 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

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We look forward to receiving your revised manuscript.

Kind regards,

Thomas Tischer

Staff Editor

PLOS ONE

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Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

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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

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

Reviewer #1: 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

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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

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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: Many thanks for inviting me to review the manuscript titled “An exploratory study on excess weight gain: Experiences of postmenopausal women in Ghana”. Overall, the findings could shade lights on the potential influential components on developing appropriate interventions for managing excess weight gain in the postmenopausal women.

Nonetheless, some parts of the manuscript warrants clarification. I have the following comments for the authors to consider while revising their manuscript:

Abstracts:

• Please clarify if “the society” stated in introduction and result refers to the Ghanaian society rather than society as a whole.

• Suggest to bring forward the three main themes earlier in the result section.

Methods:

• Please clarify what inclusion criteria was used to define postmenopausal women in the study.

• Page 7, moderator’s guide is commonly used for FGD rather than semi-structured interview guide.

• Please clarify whether thematic analysis or content analysis was used. It was stated in page 7 that thematic analysis was performed whilst in abstract and page 8 (data analysis) that thematic content analysis was used. Note that there is subtle difference between thematic analysis and content analysis approaches (see: Vaismoradi et al, 2013, DOI:10.1111/nhs.12048).

• Stated on page 8 that de-briefing and member checking were performed to ensure trustworthiness and credibility of the study. Please provide details on how these processes were conducted.

• Page 8, I don’t understand the statement “The first author also surmised the responses of each focus group interview to facilitate an exact representation of participants’ views and experiences”. Please clarify how this was performed.

• Please provide the moderator’s guide as a supplementary document.

Results:

• Page 9, total participants of the study was 24, if n=24, should it be 100%? Please rectify the frequency and percentage for “Christians” and “high school certificate”.

• Suggest to add participants’ anthropometric data in Table S1.

• Page 11, sub-theme – diet-related changes. Consider to add information on participants’ previous diet in the description, e.g. they reduced the intake of starch and meat, and have now switches their diet to mainly fruits and vegetable.

• Page 12, suggest to provide explanation on “fufu” in bracket, this will help international readers' better understand the context.

Discussions:

• Page 18, stated that “Most of the times, the efforts and efficacy of these therapies do not produce successful outcomes”. Please provide evidence or references to support your claim.

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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: Yuet Yen Wong

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[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-22-09660R1An exploratory study on excess weight gain: Experiences of Postmenopausal Women in GhanaPLOS ONE

Dear Dr. Mensah Bonsu,

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 Dec 10 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,

Sandra Boatemaa Kushitor, Ph.D.

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):

Dear Authors,

Please revise your manuscript. I have made detailed comments on the pdf attached. The manuscript should be reviewed by an English editing institution that to reduce the grammatical errors in the document. The authors should also use the COREQ checklist for reporting qualitative studies.

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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 #1: (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

**********

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

Reviewer #1: 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 #1: (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

**********

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: Many thanks for inviting me to review the revised manuscript. Of note, some of the previously raised comments were addressed in the author’s responses; however, changes were not made in the revised manuscript. Please make corrections accordingly for the previously raised items as below:

Abstracts:

• Please clarify if “the society” stated in introduction and result refers to the Ghanaian society rather than society as a whole.

Methods:

• Please clarify what inclusion criteria was used to define postmenopausal women in the study.

• Page 8, I don’t understand the statement “The first author also surmised the responses of each focus group interview to facilitate an exact representation of participants’ views and experiences”. Please clarify how this was performed.

In this round of review, I have several additional minor comments/suggestions for the authors to consider in improving the manuscript.

Introduction:

• Please provide a reference citation for the statement on page 5, paragraph 3, i.e. “The public health interventions to address excess weight gain in Ghana have focused on diet related changes and the adoption of physical activity.”

Methods:

• Please add some detail information on how data analysis was performed. Please include who performed the codings? Any software was used?

Results:

• Please integrate participants’ demographic characteristics and anthropometric data into one single table.

• Please add a brief sentence in the paragraph, e.g. the Participants demographic characteristics and anthropometric data are summarised in Table 1.

• Page 12, line 2…enjoy seasonal fruits are grown locally, please remove “are”.

Discussions:

• Page 17, paragraph 2, “…..a finding supported in previous studies [24]”. The reference citation suggests that there was only one previous study. Please cross-check.

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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: Yes: Yuet Yen Wong

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[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.

An exploratory study on excess weight gain: Experiences of Postmenopausal Women in Ghana

PONE-D-22-09660R2

Dear Mr. Bonsu,

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. Complete all the comments found in the attached file. 

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,

Sandra Boatemaa Kushitor, Ph.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Dear Author,

Please make the changes I have suggested in the attached file.

Reviewers' comments:

Attachments

Attachment

Submitted filename: MODERATORS QUIDE.docx