“Addressing the bigger picture”: A qualitative study of internal medicine patients’ perspectives on social needs data collection and use

Victoria H. Davis; Katie N. Dainty; Irfan A. Dhalla; Kathleen A. Sheehan; Brian M. Wong; Andrew D. Pinto

doi:10.1371/journal.pone.0285795

Peer Review History

Original SubmissionFebruary 20, 2023
10 Apr 2023 Decision Letter - André Ramalho, Editor PONE-D-23-05027"Addressing the bigger picture": qualitative study of internal medicine patients' perspectives on social needs data collection and usePLOS ONE Dear Dr. Pinto, 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 May 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. 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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 If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.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: Dear Authors, I was pleasantly surprised by the approach demonstrated in your article. Congratulations on taking the initiative to work on concepts that are often overlooked in the hospital environment. Your conclusion highlights the critical importance of addressing social needs and collecting sociodemographic data to improve patient care and provide resources to address their social needs. As we know, the natural history of disease and health is influenced not only by biological factors but also by social and environmental factors. Your article also brought to light the challenges hospitals face in fulfilling this role, such as infrastructure, time, staffing, and financial barriers. Furthermore, the article emphasizes the need for an integrated approach that incorporates sociodemographic information and patients' social needs to provide adequate care. Therefore, it is vital for hospitals to adopt a broader view of health that recognizes their responsibility is not limited to diagnosing and treating diseases, but also includes understanding the social and environmental conditions that impact patients' health. Incorporating this understanding must be done in conjunction with other levels of care in the network, including primary health care, which plays a crucial role in identifying and addressing the social and environmental needs of patients. I suggest considering these points in your discussion. Hospitals can work outside their walls in various ways to address the social and environmental factors that impact patients' health. Here are a few possibilities: 1. Partnerships with other institutions: By partnering with community organizations, schools, and businesses, hospitals can provide services and resources that meet the social and environmental needs of patients. 2. Awareness programs: Hospitals can offer awareness programs on social and environmental factors that impact patients' health, such as nutrition, physical activity, and disease prevention. 3. Support programs: Hospitals can offer support programs to help patients address social and environmental problems, such as unemployment, inadequate housing, and domestic violence. 4. Integration with other levels of care network: Hospitals can integrate with other levels of care in the network, such as primary health care, to identify and address patients' social and environmental needs more efficiently and effectively. These are just a few of the possibilities for hospitals to act outside their walls and consider the social and environmental factors that impact patients' health. It is crucial for hospitals to consider the specific needs of their community and work collaboratively with other institutions to provide adequate and effective services and resources. Thank you for the opportunity to share my thoughts, and I hope this feedback is helpful. Best Regards, André Ramalho, MD PhD Academic Editor PLOS One [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: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: N/A Reviewer #2: Yes ****** 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 ****** 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 ****** 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: Itz a well investigated and well written exploration. However as a reader, I may suggest some minor additions to add more qualitative flavor. Line 121-Kindly add a sentence about what criteria made a participant being ELIGIBLE. Line 144-In the same way what do you mean by LOCAL COMMUNITY RESOURCES? Line 131 & Line 150 describes interviewer. This description may be unified at the same place. Line 185+ describes percentages where as in qualitative research, facts not figures matter. Table-1 again focusses on figures and is too lengthy. It may be reduced to only important attributes of the participants. IMPORTANT: A table specifying themes, subthemes and codes may kindly be included. Reviewer #2: "Addressing the bigger picture": qualitative study of internal medicine patients' perspectives on social needs data collection and use Title: Qualitative Study? Type: Semi structured interview. Appropriate but long Abstract: Appropriate and informative, but long. Method section did not mention the tools used in the study. No specific points were mentioned/described in the results section. Keywords: Add more words like; University of Toronto. Keywords are not included in the manuscript file after the abstract. Introduction: Appropriate and informative; but long. Objective: Appropriate and informative; SMART. Methods: Appropriate and informative. Results: Text of the Results; Appropriate and Informative. Well-structured. Discussion: Appropriate and Informative. Section “Strengths and limitations” is well-organized and informative. Conclusion: Appropriate and Informative. References: Most of references are recent (Published <6 years ago). Table 1: Appropriate and Informative. ****** 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: Mohamed Farouk Allam ******** [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. https://doi.org/10.1371/journal.pone.0285795.r001
Revision 1
18 Apr 2023 Author Response Dear Dr. André Ramalho and reviewers: We are pleased to submit our revised article, “Addressing the bigger picture”: A qualitative study of internal medicine patients’ perspectives on social needs data collection and use”, for your consideration. We wish to thank you and the reviewers for your insightful comments and for allowing us to submit our revision. We are grateful for your time and constructive feedback. To answer the comments on journal requirements, we have reviewed the PLOS ONE requirements and made changes accordingly. We have added additional references based on the reviewer comments. The research in the manuscript has not been formally published or peer-reviewed elsewhere. It was presented as a poster at a conference (Canadian Association for Health Services and Policy Research, 2022). We disclosed in our original cover letter that a variation of the manuscript was part of the lead author’s master’s thesis. It was a requirement for the completion of their degree that the thesis becomes publicly available and will be available in 2024 once the embargo ends. The manuscript submitted to PLOS ONE is not a dual publication. Lastly, regarding the comment on data availability, we have carefully considered PLOS ONE’s data access requirements and confirm that data is only available upon request given privacy and ethical restrictions on sharing it publicly. According to our institutional privacy policy and research ethics, we are not able to publicly release our qualitative data as it contains potentially identifiable and confidential patient information. Reasonable data access requests can be considered by contacting Unity Health Toronto Research Ethics Board (researchethics@unityhealth.to). We have listed the comments from the editor and reviewers and responded below. Editor comments: Additional Editor Comments: 1. COMMENT: I was pleasantly surprised by the approach demonstrated in your article. Congratulations on taking the initiative to work on concepts that are often overlooked in the hospital environment. Your conclusion highlights the critical importance of addressing social needs and collecting sociodemographic data to improve patient care and provide resources to address their social needs. As we know, the natural history of disease and health is influenced not only by biological factors but also by social and environmental factors. Your article also brought to light the challenges hospitals face in fulfilling this role, such as infrastructure, time, staffing, and financial barriers. Furthermore, the article emphasizes the need for an integrated approach that incorporates sociodemographic information and patients' social needs to provide adequate care. Therefore, it is vital for hospitals to adopt a broader view of health that recognizes their responsibility is not limited to diagnosing and treating diseases, but also includes understanding the social and environmental conditions that impact patients' health. Incorporating this understanding must be done in conjunction with other levels of care in the network, including primary health care, which plays a crucial role in identifying and addressing the social and environmental needs of patients. I suggest considering these points in your discussion. Hospitals can work outside their walls in various ways to address the social and environmental factors that impact patients' health. Here are a few possibilities: 1. Partnerships with other institutions: By partnering with community organizations, schools, and businesses, hospitals can provide services and resources that meet the social and environmental needs of patients. 2. Awareness programs: Hospitals can offer awareness programs on social and environmental factors that impact patients' health, such as nutrition, physical activity, and disease prevention. 3. Support programs: Hospitals can offer support programs to help patients address social and environmental problems, such as unemployment, inadequate housing, and domestic violence. 4. Integration with other levels of care network: Hospitals can integrate with other levels of care in the network, such as primary health care, to identify and address patients' social and environmental needs more efficiently and effectively. These are just a few of the possibilities for hospitals to act outside their walls and consider the social and environmental factors that impact patients' health. It is crucial for hospitals to consider the specific needs of their community and work collaboratively with other institutions to provide adequate and effective services and resources. RESPONSE: Thank you very much for your thoughtful feedback and suggestions for our manuscript. We also appreciate that you share our interest on this important topic, and that you have provided additional points on what hospitals can do to address social needs in innovative ways. We have incorporated your feedback into the discussion section of the manuscript, including: Page 27: “… and strong coordination between hospital and primary care is important to efficiently assist patients with their unmet social needs.” Page 28: “Despite these questions, a strong argument can be made that hospitals can work with partners (e.g., community organizations, schools and businesses) to try to provide services and resources that meet the social needs of patients. For example, hospitals can partner with charitable organizations to ensure that patients receive income supports that they are eligible for [74,76] and work in partnership to increase the availability of affordable housing [75,76,78].” Reviewers' comments: REVIEWER #1: 1. COMMENT: It’s a well investigated and well written exploration. However as a reader, I may suggest some minor additions to add more qualitative flavor. Line 121-Kindly add a sentence about what criteria made a participant being ELIGIBLE. RESPONSE: Thank you for this comment. Original line 121 specifies what criteria makes a participant eligible, i.e., if they were “admitted to inpatient general internal medicine, able to speak and understand English, capable of providing consent, and 18 years of age or older”. 2. COMMENT: Line 144-In the same way what do you mean by LOCAL COMMUNITY RESOURCES? RESPONSE: We have added clarification on page 29: “(e.g., shelter and food bank locations, government assistance programs, financial assistance, legal aid, mental health supports).” 3. COMMENT: Line 131 & Line 150 describes interviewer. This description may be unified at the same place. RESPONSE: I have unified the descriptions of the interviewer to one place (under “participants and recruitment”). 4. COMMENT: Line 185+ describes percentages where as in qualitative research, facts not figures matter. Table-1 again focusses on figures and is too lengthy. It may be reduced to only important attributes of the participants. RESPONSE: We appreciate your focus on the qualitative components of the paper. We have removed the following sentence: “The most commonly reported unmet social needs were social, subsidized, or rent-geared-to-income housing or living in shelters (n=7) and difficulty making ends meet (n=6).” In response to your comment about Table 1, we have removed information reporting participant’s physical, emotional, or mental difficulties, and the type of difficulties. 5. COMMENT: IMPORTANT: A table specifying themes, subthemes and codes may kindly be included. RESPONSE: We have included Table 2, which has a list of themes and subthemes. Our style of qualitative research involves providing more detailed themes and subthemes as opposed to providing a more “general” topic/category for our themes. For example, theme five is: “Trust before disclosure: Verbal data collection facilitates relationship-building and alleviates concerns”. As a consequence, some of our codes are repetitive with our subthemes, and would not necessarily offer meaningful insight into the research. For example, the sub-theme “increase access to and knowledge of community resources” under theme 6 is a longer version of a couple of codes: community resources – knowledge, community resources – access, etc. Please let us know if this is something that you would still like us to add. REVIEWER #2: 6. COMMENT: Title: Qualitative Study? Type: Semi structured interview. Appropriate but long RESPONSE: We recognize the title is a bit long, but have made it that way to describe the content of the paper in sufficient detail while also reflecting participant voices – i.e., “Addressing the bigger picture”. (Please note that we have reread the title and have decided to add “A” in front of “qualitative study” for grammar.) 7. COMMENT: Abstract: Appropriate and informative, but long. Method section did not mention the tools used in the study. No specific points were mentioned/described in the results section. RESPONSE: We have shortened the abstract by removing: “recorded with field notes and audiotapes, transcribed verbatim, and..” We did not add a description of the Health Equity Questionnaire because of word constraints. It was solely for the purpose of helping us understand the purposive recruitment sampling and to help patients understand what we meant by sociodemographic and social needs data collection. With regards to our results section in the abstract, we briefly described all of our six themes. 8. COMMENT: Keywords: Add more words like; University of Toronto. Keywords are not included in the manuscript file after the abstract. RESPONSE: Thank you - we have added more keywords and included it in the manuscript file after the abstract. 9. COMMENT: Introduction: Appropriate and informative; but long. RESPONSE: Thank you for the feedback. We have carefully considered the introduction and opportunities to shorten it without removing necessary background from this field and addressing the significance and gaps of this research question. Please let us know if there is a particular part of the introduction that you feel should be shortened. 10. COMMENT: Objective: Appropriate and informative; SMART. Methods: Appropriate and informative. Results: Text of the Results; Appropriate and Informative. Well-structured. Discussion: Appropriate and Informative. Section “Strengths and limitations” is well-organized and informative. Conclusion: Appropriate and Informative. References: Most of references are recent (Published <6 years ago). Table 1: Appropriate and Informative. RESPONSE: Thank you very much for reviewing our paper and for providing feedback on each of our sections – we greatly appreciate your time. Attachments Attachment Submitted filename: Reviewer Responses.docx https://doi.org/10.1371/journal.pone.0285795.r002
2 May 2023 Decision Letter - André Ramalho, Editor "Addressing the bigger picture": A qualitative study of internal medicine patients' perspectives on social needs data collection and use PONE-D-23-05027R1 Dear Dr. Pinto, I hope this message finds you well. I am delighted to let you know that your responses to the editor and reviewers' inquiries have been received and considered carefully. So, 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, André Ramalho, PhD Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0285795.r003
Formally Accepted
11 May 2023 Acceptance Letter - André Ramalho, Editor PONE-D-23-05027R1 “Addressing the bigger picture”: a qualitative study of internal medicine patients’ perspectives on social needs data collection and use Dear Dr. Pinto: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. 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. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Prof. Dr. André Ramalho Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0285795.r004

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