PONE-D-22-24837Ascertaining the Feasibility of Implementing a Tobacco Cessation Intervention Package at Non-Communicable Disease Clinics: A Qualitative Study among Health Care Providers & Program Managers of a North Indian StatePLOS ONE

Dear Dr. Goel,

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 01 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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Academic Editor

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Additional Editor Comments:

Please use the comments of two independent reviewers below to revise and resubmit your manuscript

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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

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

Reviewer #1: Yes

Reviewer #2: 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: No

Reviewer #2: No

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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

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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 research presented is clearly justified and well described. The conclusions drawn are well-supported by the analysis.

Background:

Inclusion of data on “tobacco use disorders” whilst interesting, is a bit confusing as the term is not explained and it is not clear how these disorders might play a role in cessation, NCDs and whether they were tackled specifically in this feasibility assessment. Suggest rewording for clarity or removing the sentence.

“The World Health Assembly affirmed a 30 percent relative reduction in current tobacco usage (daily and occasional) between 2010 and 2025 among individuals aged 15 years and above” Needs citation.

Methods:

Typo on the 4th line. “13.4t”?

Strengths and Limitations:

“Second, the results may be subject to responder bias; since all participants were from the public sector, there is a tendency to present a less realistic view”. Could you clarify what is meant by “less realistic view”. Do you mean public sector workers are overly idealistic, or that their perspective is simply limited, or…?

Reviewer #2: As an early-career researcher in this area, I would like to express my compliment to the authors who conducted this study as I believe this article might enrich the body of knowledge in tobacco cessation work as valuable evidence. I do agree that integrating tobacco cessation service package into regular healthcare service could be beneficial to encourage people quit smoking. However, there is limited evidence regarding this matter from developing countries.

Regarding the manuscript, I have several points I would like to elaborate below and hopefully could be an advantageous comment toward your work.

1. In general, I found some mistyped words, redundant parts, and uncommon academic English words. I also found many uncommon vocabularies that might be unfamiliar for public, namely ASHA workers, Panchayati Raj Institution, Ayuverdic, OTT, etc. You may consider to give footnote or brief explanation of the words. Moreover, through the manuscript, I found many acronyms and sometimes it became obstacle to follow the content.

2. For the title, I would suggest to consider cut it shorter. How about this title? "The Feasibility of Tobacco Cessation Intervention at Non-communicable Diseases Clinics: A Qualitative Study From North Indian State"

3. In the abstract, I would suggest to paraphrase or state the objective of the study clearly. For the background part in the abstract, I also think this part is not strong enough to catch reader's attention. Moreover, I would consider the first sentence in the conclusion part to be deleted.

4. In the main manuscript, of Background section, I would suggest a more concise background. In general, background section should consist of rationale, what's known, what's unknown, and the significancy and objective of the study. The background could elaborate on the NCD in India, how tobacco cessation is needed but scarce (for example, depends on the situation in the India), what's previous studies say about the integration program of NCD clinics and what's the gap of the study in current situation, the significancy of the study and study's objective. In detail, paragraph 1 explained the high prevalence of NCDs and tobacco consumption in India. I would rather stick to the "one paragraph, one main idea". Moreover, I believe the 2-4 paragraphs could be summarised into shorter one with the idea of tobacco cessation service and its demand and regional data regarding this case. There are many global data stated in the body of paragraph, however I believe regional or national data might be useful to support the notion.

5. In the Method section, I am not sure what is the meaning of this data "13,4t"? Regarding the GATS, is the latest available? I also not quite sure whether the subjects of the study came from same hospitals/working places? if yes, I think it would be great if the authors could mention that and including the matter in the table of analysis.

6. In the Result section, as I read through the manuscript, sometime it is difficult to differentiate the result from each theme. For example, in the second theme of demand, I am not expecting the discussion would address the resistance or hesitation from patient side. Due to this matter, I would suggest to give additional information in the Method section regarding the explanation or meaning of each theme.

7. In the Discussion section, I would suggest the first paragraph is not necessary. Otherwise, you may consider to summarise the objective of the study and highlight of the key findings from the Result section. The following paragraphs may discuss each key findings and comparing the current study's findings to the previous studies. Reasonings or rationalization of the trend, either current study and previous studies are supporting or against each other, may be added, as well. Moreover, in the sub-section of strength and limitation, the authors mentioned "rigorous qualitative analysis (P.39), you may want to add how rigorous or what analysis or measurements had been done to make this study is rigorous. Overall, I would suggest sub-section of the implication and recommendation is not necessary since the content is a summary of discussion and restate again in the conclusion.

8. Lastly. I found some minor errors in Reference section. There is inconsistency in reference style, for example in addressing World Health Organization (WHO), and I am not sure about the reference number 25 and 30. You may consider to revise it if needed.

I hope this feedback is useful and may support your work. Thank you.

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Reviewer #1: No

Reviewer #2: Yes: Gea Melinda, MSc

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PONE-D-22-24837R1Feasibility of Tobacco Cessation Intervention at Non-communicable Diseases Clinics: A Qualitative Study from a North Indian StatePLOS ONE

Dear Dr. Goel,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Mar 25 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,

Sheikh Mohd Saleem, MBBS, MD

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.

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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 #3: (No Response)

Reviewer #4: (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 #3: (No Response)

Reviewer #4: Yes

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

Reviewer #3: (No Response)

Reviewer #4: 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 #3: (No Response)

Reviewer #4: 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 #3: (No Response)

Reviewer #4: Yes

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6. Review Comments to the Author

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

Reviewer #3: Section Manuscript Line item Comment(s)/Suggestion(s)

Overall

Background:

Line 10-14: repetitive words in both sentences merge and make one sentence

Abstract Results: The respondent's Mean ± SD age was 39.2± 9.2

Add “years” after 9.2

Methods: Line 16-18 To be removed or rephrased, as this intervention was not part of this manuscript

Also, this intervention should be cited in the methodology section

Year of study

SOPs Expand at the first mention

Order of Authors Remove MD

Short title Rephrase and make it shorter

INTRODUCTION Line 115-122: repetitive words in both sentences merge and make one sentence

METHODS The intervention should be cited in the methodology section

Reviewer #4: Reviewer’s comments:

Abstract

1. Units of measurement not mentioned “respondent's Mean ± SD age was 39.2± 9.2,” page 1, line no. 24

2. Results seem to be part of methodology, “the data was analysed……. for implementation, modifications required, and integrational perspectives). As these are the predefined things on which you will analyze the data and are part of analysis and not result a nd that too in middle of results.. In result section authors can presents the findings under these themes. page 1-2 line 25-30.

Manuscript:

1. Use updated data for latest NCD mortality, “2016” data seems to be too old. The 2019 data states NCD mortality to be around 66% while 2022. Page 3, line no 55-7

2. Correct the name of programme “such as Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke (NPCDCS) page 4, line no. 91-2

3. Write abbreviation at first place where the full form has been used. “NTCP also emphasizes” Page 5, line no 96

4. Typographical error “Figure-1 health care system in India” need to be corrected as Health. Page 7, line no 148

5. Reframe the sentence,” The district hospital….geographical area and population” page 7-8, line no 162-64

6. Under subheading “Study population & sampling”. How many district hospitals out of total District hospitals were selected in your current study? Brief about the technique was used to select the study hospitals and the criteria used for selecting them. How many district hospitals were enrolled for selected 45participants for interview? Page 7-8, line no 160-169

7. Suggestion for changing “focused life history” to demographic details. Page 8, line no 183

8. Units of measurement not mentioned “respondent's Mean ± SD age was 39.2± 9.2,” page 10, line no. 230

9. Table 1: Since both mean and median are the measure of central tendencies, the author is suggested to select one out these two depending upon the distribution of data until and unless the author wants to conclude some inference using both of them. Page 11, line no 232

10. “The results are categorized into the key focus areas as preset domains for feasibility as suggested by Bowen et al. [31]” is a part of statistical analysis. Page 11, line no 237-38

11. “They also stressed the promotion…” Whom you are referring as “they” in this statement. Page 12, line no 268

12. Another limitation of study can be “surrogacy interviews” by HCP for barriers at patient level.

13. Manuscript editing suggested as at some places two words are joined together and at some places one word is bifurcated.

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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 #3: No

Reviewer #4: Yes: Kirtan Rana

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Feasibility of Tobacco Cessation Intervention at Non-communicable Diseases Clinics: A Qualitative Study from a North Indian State

PONE-D-22-24837R2

Dear Dr. Goel,

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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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,

Sheikh Mohd Saleem, MBBS, MD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Dear Authors,

I am pleased to see the revisions that you have made to your manuscript titled "Feasibility of Tobacco Cessation Intervention at Non-communicable Diseases Clinics: A Qualitative Study from a North Indian State". Your attention to the feedback and suggestions provided by the reviewers is highly appreciated, and I believe that the changes you have made have improved the manuscript significantly.

Wish you best of Luck

Best

Reviewers' comments: