PONE-D-22-18010Needs- and user-oriented development of contactless camera-based telemonitoring in heart disease – Results of an acceptance survey from the Home-based Healthcare Project (Feasibility Project)

PLOS ONE

Dear Dr. Borchers,

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.

It is requested to (see for details reviewers' comments):

- revise the conclusion/results presentation to stress the limitations due to low sample size;

- integrate/update literature review (e.g. including telemedicine in Hearth Failure);- address differentiation between non-invasive and invasive tele-monitoring;- specify selection criteria adopted for recruiting patients;- discuss limitations due to translation and reduction of items in the questionnaire;- present absolute values instead of relative ones in the results section;- discuss the time development of the survey in relation to the time development of the overall study;- list in the test the evaluation measurements taken during the survey;- revise the English language. 

Please submit your revised manuscript by Nov 16 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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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.

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We look forward to receiving your revised manuscript.

Kind regards,

Filomena Papa

Academic Editor

PLOS ONE

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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: Partly

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

Reviewer #1: Yes

Reviewer #2: Yes

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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

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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: No

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The paper explores user acceptance of contactless camera-based telemonitoring in heart disease

patients, as a part of The Home-based Healthcare Project.

I found it interesting to read, well written (although language fluency should be improved) and coherent.

The small sample size is not a problem in my opinion: it is a feasibility study and the "Limitations" section properly addresses the issue.

Inference statistical methods cannot be used due to the small sample size: the authors understand that and give themselves self-limitations in the scope of the paper.

Before publication, I suggest a few minor revisions:

* In the Development of the Questionnaire" section, I would not write that "According to which, the acceptance of a technology is expressed in the use of that technology". The original UTAUT paper by Venkatesh is already centered on the intention to use.

* Reference 18 (Venkatesh et al., 2003) should be complemented by more recent work by Venkatesh, expanding the Unified Theory (see, for example, Venkatesh, V., J. Thong, and X. Xu. 2016. “Unified Theory of Acceptance and Use of Technology: A Synthesis and the Road Ahead.” Journal of the Association for Information Systems 17 (5): 328–376)

* The evaluation measurements taken during the study should be listed in the text. Blood pressure is mentioned somewhere, but I would like to read the full catalogue.

* I suggest a thorough language revision. Sentences like "The measures to boost acceptance paid special attention this" in the abstract need adjustments.

Reviewer #2: Dear authors,

Thank you for reviewing your article. The paper covers an interesting topic but is missing relevant information like new literature and a discussion reflecting the overall limitations due to low sample size.

The low sample size is fine for feasibility study but the conclusion/results are presented in a way that it seems to be absolute. Presenting conclusion resulting of 3 patients (group 2) should be in a more descriptive/qualitative manner.

Further I give my comments for specific sections:

Introduction:

Actual literature is missing (ESC guidelines, TIM-HF2, OSICAT, German decision about reimbursement). Especially telemedicine in Heart Failure is a very fast developing research topic and has provided a lot of new research content within the last year. As the authors are from Germany they should reflect the decision of the GEmeinsamen Bundesausschuss to pay for telemedicine in HF as part of standard care (see decision process starting in December 2020 until Qualitätssicherungsvereinbarung in March 2022). The introduction also not differentiate between non-invasive and invasive telemonitoring; at least in one sentence this differentation should be addressed.

In the further paper Heart failure is not mentioned any more – are the survey respondents HF patients?

Please also provide a definition of “elderly”.

Methods

As this feasibility analysis was part of a overall study – has the overall study a registration number (e.g. DRKS)?

Line 85: Why written informed consent is in Brackets. Written informed consent is crucial for any study (see Good Clinical Practice). Also a statement to be in line with declaration on Helsinki is missing.

Why only 19 patient were recruited, when 20 were planned. The authors names “pragmatic reasons” for case low case number. Did they looking for patients regarding specific inclusion and exclusion criteria? Please specify, as this could be big bias.

The UTAUT is only valid in the English and only for the complete version. Please discuss a possible limitation due to translation and reduction of questions in the limitation sections.

Line 97: Are results of the study available. Which 250 measurements were performed?

Section data collection

The first sentence is not necessary. Why the survey ends (December 2020) before the study (July 2021)? Please specify

Line 158/159: As the case number is very low in the results section it is better to present absolute instead of relative numbers. As group 2 included only 3 persons the results are not comparable. This need to be discussed.

Why 3 groups were grouped when only 2 were presented? What are the (mean) values to be categorized in each group? Is the group “moderate/low” a mix of this 2 groups? According the results in Table 2 nobody was categorized as “low acceptance”. Why was the column then named in this way?

Results

Why only 18 patients participated in the evaluation survey? How long did the patients use the measuring system when they answered the questionnaire. Why the questionnaire was not used after the overall study was finished?

Patients idea: visual and acoustic combined – why is this the same group as acoustic? Were Multiple answers possible?

What means “followed by the study” (line 226)?

In the results section results of both groups are often presented together. I would suggest to do this for all results and not to provide to groups. Difference in the groups could be discussed qualitative; but due to the n=18 vs. n=3 patients in groups these results are not comparable. For this reason figure 2 cannot be so conclusive; please name it in a way like “possible characteristics”. When a sample only consists of 3 person, all results can be random.

Line 236: How sun burn can be happen due to use of the camera?

Line 252: “This involved mostly women…” As 17% of 18 participant are only 3 persons, 2 persons have to be female. A conclusion in this way is not correct. The discussion should present absolute numbers to reflect this bias of a low case number.

TMA structure for HF patients (personal, technical) is actually clearly defined by the G-BA; reimbursement is possible in Germany (decision in March 2021, reimbursement numbers defined in January 2022). The decision was not done as the survey was performed but it should be discussed as e.g. a fear of overwhelming the primary care physician is not longer necessary. Physician can decided whether to perform TMA itself or by a telemedical centre.

Line 281: What means modern technology?

Also, the authors could discuss that acceptance does not mean compliance or adherence. A long term analysis is needed for this.

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Reviewer #1: Yes: Bartolomeo Sapio

Reviewer #2: No

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PONE-D-22-18010R1Needs- and user-oriented development of contactless camera-based telemonitoring in heart disease – Results of an acceptance survey from the Home-based Healthcare Project (Feasibility Project)PLOS ONE

Dear Dr. Borchers,

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.

It is requested to:

- revise the manuscript addressing comments from Reviewer 2;

- include in the manuscript (or in the supporting information) items utilized for measurement of all determinants (in English);

- copy edit the manuscript correcting possible errors, for instance a the end of Table 1 eliminate “Error! Reference source not found”.

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,

Filomena Papa

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):

  Answer to the authors' question about translation: since Reviewer1 approved Revision 1 it is not necessary to improve translation.

However it is requested to:

-include in the manuscript (or in the supporting information) items utilized for measurement of all determinants (in English);

- copy edit the manuscript correcting errors (if any), for instance a the end of Table 1 eliminate “(Error! Reference source not found)”.

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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: All comments have been addressed

Reviewer #2: (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

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

Reviewer #1: Yes

Reviewer #2: 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 #1: Yes

Reviewer #2: 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 #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: I am satisfied with the revision proposed by the authors.

The paper can now be published in the journal.

Reviewer #2: Dear authors,

thank you for taking note of my recommendations. I still do not understand the evaluation concept completly. You are writing that 250 evaluation measurements were taken by the study nurses in the patients house (methods sections).

In your review comments you mentioned that „an average of 5 evaluation measurements were carried out before the interview.“. Are these measurements taken by the patients themself? (otherwise 250 measurement divided by 19 patients does not average 5 measurements). Also you write, that the evaluation was taken by phone. Why was the survey not carried out directly after the measurements by the study nurse? How long was the time interval between measurement and evaluation survey?

Many thanks in advance for answering my questions.

Also a note for a further reference for your introduction section: https://academic.oup.com/eurjcn/advance-article/doi/10.1093/eurjcn/zvac080/6691856

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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.

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Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: Yes: Bartolomeo Sapio

Reviewer #2: No

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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.

Needs- and user-oriented development of contactless camera-based telemonitoring in heart disease – Results of an acceptance survey from the Home-based Healthcare Project (Feasibility Project)

PONE-D-22-18010R2

Dear Dr. Borchers,

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,

Filomena Papa

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

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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

**********

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

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #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: I am satisfied with the revision proposed by the authors.

The paper can now be published in the journal.

Reviewer #2: (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: Yes: Bartolomeo Sapio

Reviewer #2: No

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