PONE-D-22-17688Reflections on involvement in health research: a qualitative interview study with research participants and patient advisors.PLOS ONE

Dear Dr. Newington,

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 manuscript has been evaluated by three reviewers and their comments are outlined below. 

Please submit your revised manuscript by Sep 26 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,

Steph Scott

Academic Editor

PLOS ONE

Journal Requirements:

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 

https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and 

https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf

2. You indicated that you had ethical approval for your study. Please clarify whether minors were involved in this study. If so, in your Methods section, please ensure you have also stated whether you obtained consent from parents or guardians of the minors included in the study or whether the research ethics committee or IRB specifically waived the need for their consent.

3. 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.

Once you have amended this/these statement(s) in the Methods section of the manuscript, please add the same text to the “Ethics Statement” field of the submission form (via “Edit Submission”).

For additional information about PLOS ONE ethical requirements for human subjects research, please refer to http://journals.plos.org/plosone/s/submission-guidelines#loc-human-subjects-research.

4. Thank you for stating the following financial disclosure: 

 "LN was funded by an NIHR Imperial Biomedical Research Centre (BRC) and Imperial Health Charity Postdoctoral Research Fellowship (RFPO2122_3). 

RKS was funded by an NIHR Imperial BRC Pan-London Research Fellowship (ICHT-39). 

PK was supported by Imperial Health Charity, MW and CMA were supported by NIHR Imperial BRC. "

Please state what role the funders took in the study.  If the funders had no role, please state: "The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript." 

If this statement is not correct you must amend it as needed. 

Please include this amended Role of Funder statement in your cover letter; we will change the online submission form on your behalf.

5. Please expand the acronym “BRC” (as indicated in your financial disclosure) so that it states the name of your funders in full.

This information should be included in your cover letter; we will change the online submission form on your behalf.

6. 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.

"Upon re-submitting your revised manuscript, please upload your study’s minimal underlying data set as either Supporting Information files or to a stable, public repository and include the relevant URLs, DOIs, or accession numbers within your revised cover letter. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories. Any potentially identifying patient information must be fully anonymized.

Important: If there are ethical or legal restrictions to sharing your data publicly, please explain these restrictions in detail. Please see our guidelines for more information on what we consider unacceptable restrictions to publicly sharing data: http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. Note that it is not acceptable for the authors to be the sole named individuals responsible for ensuring data access.

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

7. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. 

8. 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.

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

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: Partly

Reviewer #3: Yes

**********

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

Reviewer #1: N/A

Reviewer #2: N/A

Reviewer #3: N/A

**********

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: No

Reviewer #2: Yes

Reviewer #3: Yes

**********

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: Yes

**********

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: This is a valuable, interesting and well-written piece of research which will be of interest to a broad range of readers. I enjoyed reviewing this manuscript and believe, with some minor adjustments, it would meet the criteria for publication. As such, I have included a few suggestions below to strengthen this manuscript.

Overall:

Some of the language in the paper should be clarified – ‘involvement in research’ or ‘research involvement’ means something specific in the context of health research (i.e. research being carried out ‘with’ or ‘by’ members of the public). You use this term throughout the paper to refer to both participation and actual involvement. When discussing both concepts together you should use another term. For example ‘contribution to research’ (i.e. ‘..interviewees reflections on their contribution to research’).

Introduction:

Later in the paper you mention that the aim of the research was not to differentiate between the views of PPI members and research participants – while I understand your reasons for including both of these groups and collating their views, I do think it is important to be very clear about how these groups differ in the earlier stages of the manuscript. The NIHR provide concise, helpful definitions of the differences between research participation and research involvement and I suggest these should be explicitly referred to in the introduction section (see https://www.nihr.ac.uk/documents/briefing-notes-for-researchers-public-involvement-in-nhs-health-and-social-care-research/27371).

Methods:

In the abstract, you mention that you used Thematic Analysis (TA) but have not cited Braun and Clarke within the main paper and only given brief details of the steps that were taken. Please add more clarification within the methods section, around the method and process of data analysis. It may also be worth keeping in mind that data saturation is a contested concept within certain types of TA (see Braun & Clarke, 2021).

It would also be of benefit to add some more detail detailing the PPI contribution in relation to this project. For example, within the ‘research team and reflexivity’ section you state a public advisor contributed to the analysis, yet at line 123-126 there is mention only of the four authors. Can you provide further detail regarding how your public advisor was involved in this process?

Results:

Great to see lots of supporting quotations throughout the paper.

The sub-theme title for 2.3: ‘There wasn’t the two-way flow’ could more clearly convey the content of the theme (e.g. ‘Improving communication/information sharing between teams’ or similar).

Discussion:

This study appears to have two linked but distinct aims 1) to identify strategies to optimise research experience for members of the public and 2) to understand what research impacts are important to the public. In places it felt like these two aims were conflated somewhat e.g. line 520-524 – Whilst I agree that providing progress updates and feedback to public advisors/participants is crucial, I don’t think this can be described as a ‘research impact’ in itself – it is a strategy to improve research experience. Please more clearly summarise your findings in relation to these two separate aims.

Research impact (changes that come about from the research study itself e.g. clinical outcomes, changes to practice etc.) and impact of public involvement (changes that come about from the inclusion of the public in research e.g. increased confidence, more relevant and accessible research outcomes) are again slightly different things that often seemed to be slightly confused/conflated when reading the manuscript. It may help to briefly delineate these different ‘types’ of impact perhaps within the intro and/or discussion sections.

Line 545-546 – you frame this as a limitation but I would not particularly consider it as such? I think it is a good point to acknowledge, but readers of this study will come from a range of backgrounds and/or interested in public views of impact more generally. For these reasons I think these findings have implications beyond NMAHPP research settings so can also be considered a strength of the study.

Linked to my point above – I feel it would strengthen the discussion if you were to highlight how these findings could be useful/informative in the wider context (i.e. beyond just contributing to your framework). Public views around 1) improving the research experience and 2) important research impacts are valuable for health research more broadly!

Within the conclusion you state ‘Routine sharing of relevant research data with the participants' clinicians was also recommended’ (line 553-554). I did not see adequate evidence of this within participants quotes and it isn’t clear whether you mean sharing individual level data (which may raise ethical concerns) or broader research findings. I feel it would be more accurate/relevant to either refine your wording or emphasise the value of information sharing in the broader context (i.e. to further facilitate translation of research findings into practice).

Ethical consideration:

It was good to see public involvement was included with the study design, materials development and analysis but I was slightly disappointed that public members were not named as part of the authorship team (although I can see they were mentioned in acknowledgements). If public members were involved in drafting/approving the manuscript, please consider whether they would like to be named as co-authors in line with IMCJE guidelines. If not, this would certainly be valuable to consider as you move forwards with your ongoing programme of work.

Reviewer #2: Thank you for allowing me to review this interesting, insightful and well written manuscript. As a pharmacist researcher I found the narrative valuable for considering patient participant and PPIE needs/wants/requirements. The context for the study is adequately described with reference to appropriate literature from the NIHR. The findings are comprehensively reported, illustrated by a variety of quotes from across the sample. I found it particularly insightful to use short quotes as the 'names' for the sub-themes - this is something I have not seen before however ensures that the analysis is underpinned by the patient experience and true to the data. The discussion covers thoughtful topics of importance to NMAHPP researchers, such as the challenges we face with grants & resources and also provides some recommendations of how we can improve recruitment and retention of participants/ PPIE members, as well as make the experience of taking part in a study a more positive/ beneficial one.

I only have a few minor comments/ questions for the authors as highlighted below:

1. Please check author's affiliations. I could not see who was affiliated with '3. Nursing Directorate'.

2. Introduction, Pg. 3, line 56, 'demonstrate and evaluate the impact of this research involvement' - I was unsure what exactly the author's were referring to. Whose involvement? I am assuming PPIE/ patients but there has been no mention of them by this stage in the manuscript.

3. Introduction - It would be of value to describe why the focus on NMAHPP-led research, as oppose to all research (especially when research conducted by dentists & clinical doctors was excluded). What is it about NMAHPP research that is different, which has led to this piece of work?

4. Introduction, Pg. 3, line 63 should 'researcher' be plural?

5. Introduction, Pg. 4, lines 72-76 - I found this a rather large sentence. Suggest breaking up to improve readability if possible. Maybe at 'however'?

6. Research team and reflexivity - Pg. 5. I found this section to be lacking in any reflexivity. The backgrounds of the team were presented and their experience alluded to, however the section is missing what the impacts of this are on the study's conduct/ how this has influenced you. I also wondered if having completed your other work with clinicians might have given you some a priori insight and whether this influenced your data collection/ analysis? Did any personal/ professional beliefs incidentally affect this research? (S6 of SRQR checklist - need to incorporate some narrative around how these factors may have influenced the research/ researcher)

7. Materials and Methods - was any theoretical lens/ perspective used to inform your study? (S5 of SRQR checklist; cannot identify within narrative)

8. Study design, Pg. 6, line 114 - should 'or their involvement' be 'of their involvement'?

9. Study design, Pg. 6 - I would have valued some content around the methods of data analysis. From the abstract and limited detail it sounds as though code book thematic analysis was used, however a description of how the codes were managed into the final thematic map would be useful. It would also be useful to know if PPI data has handled separately to patient participant data. Within the findings differing perspectives were offered between these groups and I wondered how you managed this in the analysis.

10. Discussion, Pg. 24, lines 463, 464. This sentence around funding doesn't quite make sense/ is hard to read. I understand what you are trying to say, but think the structure of the sentence isn't quite right. I also suggest that you make it more explicit how the challenges of funding/ backfill mean that it is difficult to feedback about changes in practice.

11. Discussion, Pg. 25, line 486, should be 'within the context of...' not 'with'

12. Figure 1. I can see that the blue colour of theme 4 represents (I think) the convergence of the 3 themes, however I am unsure exactly what the arrows represent. Are they crucial to the interaction of the themes in the analysis? If so, I would suggest this is made clearer.

Overall, I believe that this is a valuable piece of work for the NMAHPP community and has useful recommendations for all researchers working with patients/ PPIE. It is very well written and I would recommend it for publication with minor corrections. Thank you once again for the opportunity to review such important work.

Reviewer #3: This paper describes the findings of a qualitative research project investigating the experiences of patients and citizens who contributed to health research done by non-medical/dental health professionals (NMAHPPs). Its findings will inform a framework for evaluating the impact of NMAHPP research. The paper gives a comprehensive account of the study's design and results, supplying additional data to supplement the extracts that illustrate the findings. It is methodologically sound and will be an important addition to the literature on the value of involving people in health research. What is particularly noteworthy about this publication is its focus on NMAHPP health research specifically, an area that the authors acknowledge has yet to be as fully embraced by the relevant professionals as that in medicine or dentistry. Hopefully this project and its outputs will give future NMAHPP researchers confidence and a sound footing from which to plan their research with impact in mind. I look forward to seeing the forthcoming Framework.

**********

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: Yes: Dr Justine Emily Tomlinson

Reviewer #3: Yes: Teresa M. D. Finlay

**********

[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-22-17688R1Reflections on contributing to health research: a qualitative interview study with research participants and patient advisorsPLOS ONE

Dear Dr. Newington,

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 see comments and feedback from all three reviewers below - please note, one reviewer still has a few small outstanding points of clarification for you to address.

Please submit your revised manuscript by Nov 27 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,

Steph Scott

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.

[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 #1: All comments have been addressed

Reviewer #2: (No Response)

Reviewer #3: All comments have been addressed

**********

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: Yes

**********

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

Reviewer #1: N/A

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 #1: Yes

Reviewer #2: Yes

Reviewer #3: 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 #1: Yes

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 #1: The authors have thoroughly addressed all comments and I am more than happy to recommend this article be accepted for publication.

Reviewer #2: Thank you for the opportunity to review this manuscript again. The authors have mostly answered my questions and addressed my feedback. I have 3 further and final comments.

1. You now describe your theoretical underpinning as 'realist'. Please could you briefly describe how this perspective has shaped your work?

2. What particular factors guided your sample size? The manuscript mentions that sample size was determined by what was feasible. Was there anything else? Does your sample size limit or affect the quality or authenticity (https://doi.org/10.1016/j.sapharm.2020.02.005) of your work in any way? A comment in the strengths/ limitations section would be advisable.

3. You have mentioned that the analysis method was Thematic Analysis. Please be aware that current thinking is that there are 3 principle approaches to TA - Code reliability, code book and reflexive (see https://doi.org/10.1007/s11135-021-01182-y and https://doi.org/10.1080/2159676X.2019.1628806). The way it is currently described it sounds like code reliability - please could you accurately describe the approach to TA. This approach may then have implications for sample size (see point 2) and theoretical perspective (see point 1).

I hope this review is helpful.

Reviewer #3: (No Response)

**********

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: Dr Angela Wearn

Reviewer #2: Yes: Dr Justine Tomlinson

Reviewer #3: Yes: Teresa M. D Finlay

**********

[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.

Reflections on contributing to health research: a qualitative interview study with research participants and patient advisors

PONE-D-22-17688R2

Dear Dr. Newington,

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,

Steph Scott

Academic 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

**********

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

**********

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

Reviewer #1: N/A

Reviewer #2: 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: Yes

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 #1: Yes

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 #1: The authors have addressed all comments well, I look forward to seeing the article in publication.

Reviewer #2: Dear authors,

Thank you for addressing all of my comments and questions. The amendments you have made will help the reader to better understand your methods and rationale for certain decisions, which in turn will help others in their research. This is a really important manuscript and I wish you luck in whatever direction your project now takes you!

Best wishes,

Justine Tomlinson

**********

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: Dr Angela Wearn

Reviewer #2: Yes: Dr Justine Tomlinson

**********