Lay community mental health workers (cadres) in Indonesian health services: A qualitative exploration of the views of people with mental health problems and their families

Heni Dwi Windarwati; Herni Susanti; Helen Brooks; Ice Yulia Wardani; Hasniah; Mardha Raya; Niken Asih Laras Ati; Hasmila Sari

doi:10.1371/journal.pone.0289943

Peer Review History

Original SubmissionDecember 17, 2022
22 Mar 2023 Decision Letter - Lucinda Shen, Editor PONE-D-22-34567Lay community mental health workers (cadres) in Indonesian health services: A qualitative exploration of the views of people with mental health problems and their familiesPLOS ONE Dear Dr. Susanti, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please note that we have only been able to secure a single reviewer to assess your manuscript. We are issuing a decision on your manuscript at this point to prevent further delays in the evaluation of your manuscript. Please be aware that the editor who handles your revised manuscript might find it necessary to invite additional reviewers to assess this work once the revised manuscript is submitted. 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Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent. b) If there are no restrictions, please upload the minimal anonymized data set necessary to replicate your study findings as either Supporting Information files or to a stable, public repository and provide us with the relevant URLs, DOIs, or accession numbers. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories. We will update your Data Availability statement on your behalf to reflect the information you provide. [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: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: No ****** 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 ****** 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 ****** 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 current qualitative study conducted on a small sample aimed to explore the experiences of people with mental disorders and their families about the role of mental health workers in improving users’ mental health and in providing support to their caregivers. Given the relevance of roles assumed by families in the context of community psychiatric care in looking after relatives affected by mental disorders, the paper provides scientific contribution to the panorama of studies investigating on the role of family members in caring for relatives affected by mental disorders. Globally, the clarity of the manuscript is overall good enough in the language style, syntax, and sentences construction. The topic is interesting enough and qualitatively good to be published. However, some changes and explanations to improve quality of manuscript for his acceptance should be done. “Abstract section” In the description of the methods, the authors should also report the site or sites of recruitment and the mental disorders that predominantly characterized the sample. In the results section, the authors could report the most significant data, in quantitative terms (relevant statistical data). The keyword "caregiver or “caregivers " could be entered. Introduction section In the ‘introduction section’ the bibliography is appropriate and updated. However, it would be useful to mention, for example, some studies that have focused on the role of 1) the family as a resource for the rehabilitation process of the family member suffering from mental disorder, and of 2) the scientific evidence based interventions. There are several evidences of the effectiveness of psychoeducational interventions involvement of family members aimed at mitigating the effects of the disease, in particular, schizophrenia (1,2,3,4,5,6 listed below). The authors should integrate the bibliography reported, considering the development of EBM psychoeducational interventions aimed at family members of people with serious and disabling mental illnesses. For example, a very recent study conducted on 136 caregivers showed that caregivers’ personal growth was associated with good family functioning, but also, adequate professional support. suggesting as the many challenges and positive aspects associated with caregiving they should be recognized by mental health services and integrated into routines clinical assessment and intervention framework. Row 74. In the sentence “…….arrangements with families and the wider community in a therapeutic capacity..” it is unclear what the authors mean by ‘arrangements’. “Materials and methods section” Row 135: The authors contextualize this study in a "larger research project"; the authors could clarify better and report more information on the mentioned project. Row 148: The authors specify the countries in which the recruitments were carried out, but neither the structure in which the patients were recruited nor the number of accesses and the percentage of patients recruited on the basis of them is specified. Rows 149-150. The authors report “…… with details for 149 family participants and people with mental disorders presented in table 1.” Socio-demographic and clinical data of the sample is not present in the manuscript. Furthermore, Table 1 reports “Distribution of Focus Group Discussion Family and Client”. Could the authors clarify this inconsistency? It would be appropriate to report the clinical data of the sample (patients and family members), the diagnoses, as well as the role of the caregivers (i.e. mother, father, husband, wife, brother, sister, etc.) either in the table or in the text. Regarding Table 2 , it could be implemented with the percentages of the identified themes. Row 184: The authors reported that they had administered the Self Reporting Questionnaire-29 (SRQ-29) scale to family members without any description; it would be useful to know which constructs/dimensions the questionnaire evaluates, related psychometric information and examples of items. In addition, it could be interesting to carry out regression analyses with the socio-personal data collected and questionnaire dimensions. ‘Discussion and Conclusions section’ In the discussion, as well as in the introduction, the authors should integrate the discussion and comment on the results by citing family psychoeducational approaches ( 1,2,3,4,5,6 listed below). In the ‘Conclusions section’ the Authors should report how their study contributes to achieving the Global Goals of the 2030 Agenda for Sustainable Development. References References are reported inconsistently. For example, some contain the 'DOI' while others do not; some (i.e. citation 39) report volume and page numbers, others do not. Greater homogeneity and coherence between references would be needed 1. https://pubmed.ncbi.nlm.nih.gov/36713911/ 2. https://pubmed.ncbi.nlm.nih.gov/29942416/ 3. https://pubmed.ncbi.nlm.nih.gov/36553947/ 4. https://pubmed.ncbi.nlm.nih.gov/24879572/ 5. https://pubmed.ncbi.nlm.nih.gov/9565182/ 6. https://pubmed.ncbi.nlm.nih.gov/21147896/ ****** 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 ******** [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.0289943.r001
Revision 1
13 Jun 2023 Author Response Thank you for your email dated March 24, 2023, and reviewer comments for the manuscript titled “Lay community mental health workers (cadres) in Indonesian health services: A qualitative exploration of the views of people with mental health problems and their families” (Manuscript ID: PONE-D-22-34567). As directed by your correspondence, we are submitting a substantially revised manuscript with three columns of tables that respond to each point raised by the academic editor and reviewer. We also submit a marked-up copy of our manuscript highlighting changes made to the original (track changes version) and an unmarked version of our revised paper without tracked changes. So again, we thank you for the opportunity to submit this revised manuscript. We look forward to your feedback. Response to the reviewer comments Abstract 1. We thank the reviewers for taking the time to assess our manuscript. We are grateful for the appreciation given by the reviewers for our manuscript. We have ensured to improve the manuscript based on suggestions and input from reviewers. 2. We have added predominantly characterized mental disorders and sites of recruitment in the abstract. In this study, the mental health problems experienced by participants were schizophrenia (100%/19 participants). Nineteen people with mental health difficulties are people diagnosed with schizophrenia. The recruitment sites in this study are three provinces in Indonesia: West Java, East Java, and Aceh. 3. We have added the most significant theme in the quantitative term. 4. We have inserted the new keyword "caregiver." Introduction section 1. We have added a paragraph explaining the reviewer's suggestions regarding the family as a resource for the rehabilitation process of people with mental disorders, evidence of the effectiveness of psychoeducational interventions aimed at family members, and suggested challenges and positive aspects associated with caregiving by integrated mental health services. 2. What we mean is a collaboration with families and communities. We have rearranged the sentence to "Integrative collaboration with families and the wider community can improve mental health services in a therapeutic capacity." Materials and methods section 1. We have inserted the title of the project in the manuscript. 2. The participant selection process was carried out based on the following process: We asked permission from the local government for each site (West Java, East Java, and Aceh) and coordinated with the Provincial and Regional Health Office. The health office directed us to the community health center for the research location. The Head of the community health center identified participants according to predetermined inclusion and exclusion criteria. Then the Head of the community health center, helped by a mental health cadre, made an appointment for a meeting between the participants and the researcher. 3. We have added data about the characteristics of families and people with mental health problems who participated in this study as well as diagnoses of people with mental disorders (Table 2). 4. We have added the percentages of identified themes in Table 3 5. We identified the SRQ in the participants of this study using the SRQ-20. We apologize for the mistakes in writing our manuscript. We performed an SRQ analysis and showed that all participants (25 families and 19 people with mental disorders) had scores below the cut-off point (<6). We also performed correlation analysis using the Spearman Rank and showed that only the variable estimated time of home visit for cadres in a week had a significant relationship with SRQ (p-value 0.06). In contrast, age (p-value 0.081), gender (0.138), and length of time cadres interact with family and clients (0.278) did not significantly associate with the risk of mental-emotional problems. We conducted regression analysis and obtained the model. After eliminating the length of time families interact with mental health cadres variables, the results revealed that the amount of Adjusted Coefficient of Determination (R2 adjusted) from this model, 13.3% of emotional mental health problems changes were related to the estimated time cadres make home visits in a week (p-value 0.044; B:-0.297) but not statistically significant with variable age (p-value 0.070; B:0.265). Discussion and Conclusions section 1. We have integrated the discussion section by citing literature following recommendations from reviewers. 2. We have inserted how our study contributed to SDGs 3: This study contributes to achieving the Global Goals of the 2030 Agenda for Sustainable Development which was ensuring healthy lives and promoting well-being for all at all ages through the role of mental health cadres in supporting the care of patients with mental disorders and their families, thereby increasing family well-being and bridging mental health services for people with mental disorders. References: We have revised the inconsistently and made sure that references have homogeneity Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0289943.r002
31 Jul 2023 Decision Letter - Kishor Adhikari, Editor Lay community mental health workers (cadres) in Indonesian health services: A qualitative exploration of the views of people with mental health problems and their families PONE-D-22-34567R1 Dear Dr. Heni Dwi Windarwati 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, Kishor Adhikari, Ph.D. Academic Editor PLOS ONE Additional Editor Comments (optional): Thank you for addressing all the concerns and querries. Now, the revised version seems okay for me. Reviewers' comments: https://doi.org/10.1371/journal.pone.0289943.r003

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