Investigating the barriers and enablers to outbreak reporting in the Asia-Pacific region: A mixed-methods study protocol

Amish Talwar; Rebecca Katz; Martyn D. Kirk; Tambri Housen

doi:10.1371/journal.pone.0300077

Peer Review History

Original SubmissionFebruary 20, 2024
26 Jun 2024 Decision Letter - Olushayo Oluseun Olu, Editor PONE-D-24-06613Investigating the barriers and enablers to outbreak reporting in the Asia-Pacific region: a mixed-methods study protocolPLOS ONE Dear Dr. Talwar, 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 Aug 09 2024 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 are unable to adhere to our open data policy, please kindly revise your statement to explain your reasoning and we will seek the editor's input on an exemption. Please be assured that, once you have provided your new statement, the assessment of your exemption will not hold up the peer review process. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions? The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ******** 2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses? The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ****** 3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable? Descriptions of methods and materials in the protocol should be reported in sufficient detail for another researcher to reproduce all experiments and analyses. The protocol should describe the appropriate controls, sample size calculations, and replication needed to ensure that the data are robust and reproducible. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ****** 4. Have the authors described where all data underlying the findings will be made available when the study is complete? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception, at the time of publication. 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: No 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 and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics. You may also provide optional suggestions and comments to authors that they might find helpful in planning their study. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: While publishing study protocols is part of the commitment to improving research standards by promoting transparency, reducing publication bias, and enhancing the reproducibility of study design and analysis. Study protocols for proposed or ongoing prospective clinical research should be those that provide a detailed account of the hypothesis, rationale and methodology of the study, and the associated ethical requirements. The proposed study and the methodology proposed is not knew and while this study my present good findings for the Asia-Pacific region, it has been done elsewhere as cited by the authors in Bochner AF, Makumbi I, Aderinola O, Abayneh A, Jetoh R, Yemanaberhan RL, et al.467 Implementation of the 7-1-7 target for detection, notification, and response to public health threats in five countries: a retrospective, observational study. Lancet Glob Health. Importantly this is a short duration study, and the authors are encouraged to quickly conduct the study and submit the results as a research article. Finally, I suggest that this article is changed into a short viewpoint with the plans for answering key questions in the Asia Pacific Region Reviewer #2: Dear Authors, Thank you for submitting your manuscript, "Investigating the barriers and enablers to outbreak reporting in the Asia-Pacific region: a mixed-methods study protocol," to PLOS ONE. The topic is timely, and the methodology is well-structured, addressing a critical gap in our understanding of outbreak reporting dynamics in a key geographical area. Below are some comments aimed at further strengthening the manuscript before publication: 1. Clarification of Mixed Methods Design: The manuscript effectively outlines the use of mixed methods but could benefit from more detailed explanations on how integrating these methods will enhance the understanding of the study topic beyond what could be achieved by quantitative or qualitative methods alone. 2. Detailed Justification for Geographical Focus: While the Asia-Pacific region is a critical area for study, a more detailed justification for selecting this region, especially considering its diverse political, economic, and health systems, would be beneficial. This could help clarify the expected generalizability of the study findings. 3. Expansion on FETP's Role: The role of Field Epidemiology Training Program (FETP) trainees and graduates is highlighted; however, expanding on how their unique perspectives specifically contribute to understanding barriers and enablers could further enrich the narrative. 4. Methodological Rigor: More information on the validity and reliability of the survey instruments and interview protocols would be useful. Additionally, discussing any pilot testing of the instruments might help reassure readers of the methodological rigor. 5. Ethical Considerations: The manuscript mentions ethical approvals and consent processes but could further discuss how potential ethical issues in dealing with sensitive outbreak data will be managed, especially in interviews. 6. Limitations: I appreciate the discussion of limitations; however, it might be beneficial to elaborate on how these limitations could affect the study's outcomes and the steps taken to mitigate them. 7. Implications for Policy and Practice: While the manuscript discusses the study's potential impacts, specific recommendations for policy-makers and public health officials based on anticipated findings could make the conclusions more actionable. Reviewer #3: Title – Appropriate Abstract – Well presented. However, replace Discussion with Conclusion Introduction – Statement of problem, magnitude of problem, rationale for the study and study objectives well presented. Line 128 - Does this mean health care providers in public and private health facilities? Methods and analysis – Clearly presented. Specific study design not mentioned - Is it a descriptive cross-sectional study? Study setting, target population, sampling techniques and data management are well described Line 155 - It is desirable to state where the piloting will be done. Line 250 - Please indicate the number of respondents targeted for the pilot survey. Also indicate geographical locations of the pilot survey. Line 323 - It is not clear if this will be Key Informant Interview or In-Depth Interview. It needs to be clearly stated. Discussion – Inappropriate for proposal as a sub-section. Most of the content is Limitation of the study. This can be made the sub-section title. References - Adequate ****** 7. 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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. Attachments Attachment Submitted filename: PONE-D-24-06613_reviewer1.pdf https://doi.org/10.1371/journal.pone.0300077.r001
Revision 1
29 Jul 2024 Author Response Dear Editor: We thank you and the reviewers for your thorough review of our manuscript. Regarding your concerns, we edited the document to conform with PLOS ONE editorial standards. Furthermore, we would like to clarify that as this is a protocol paper, there will be no data generated in association with it. All data will be generated through the study proposed in the protocol paper, which has not been completed yet. We clarify this point in the “Questionnaire” section as per the below: “No datasets were generated or analysed for the creation of the protocol. Once the study proposed in this protocol paper is completed, all relevant data generated through that study will be made available upon study completion through the Australian Data Archive.” Please find below our responses to the reviewer feedback. Note that page numbers refer to the corrections made in the manuscript with track changes. Reviewer #1: "While publishing study protocols is part of the commitment to improving research standards by promoting transparency, reducing publication bias, and enhancing the reproducibility of study design and analysis. Study protocols for proposed or ongoing prospective clinical research should be those that provide a detailed account of the hypothesis, rationale and methodology of the study, and the associated ethical requirements. The proposed study and the methodology proposed is not knew and while this study my present good findings for the Asia-Pacific region, it has been done elsewhere as cited by the authors in Bochner AF, Makumbi I, Aderinola O, Abayneh A, Jetoh R, Yemanaberhan RL, et al.467 Implementation of the 7-1-7 target for detection, notification, and response to public health threats in five countries: a retrospective, observational study. Lancet Glob Health." We respectfully disagree that this is not a novel study or methodology. The cited study by Bochner, et al. (2023) entailed a synthesis of outbreak response performance metrics (i.e., time to detection, reporting, and response) for specific outbreak events and official insights into the bottlenecks and enablers for achieving those metrics through desk reviews and workshops. Our study entails a survey of putative outbreak reporters, particularly trained field epidemiologists, to delineate the relative importance of event-agnostic barriers and enablers for outbreak reporting, followed by interviews with a subset of those respondents to obtain detailed qualitative data to further elaborate on those findings. Furthermore, our study seeks to engage a more comprehensive body of reporting barriers and enablers, including infrastructural, bureaucratic, political, economic, and personal/behavioural barriers and enablers, which is particularly needed given the paucity of literature with respect to non-technical barriers and enablers. Therefore, this represents a completely different methodology with a more focused topic of interest (outbreak reporting) while exploring a broader array of putative barriers and enablers. We clarify our study’s unique insights in lines 141-143. "Importantly this is a short duration study, and the authors are encouraged to quickly conduct the study and submit the results as a research article. Finally, I suggest that this article is changed into a short viewpoint with the plans for answering key questions in the Asia Pacific Region" We also respectfully disagree that our study findings can be communicated in a short viewpoint, which is more appropriate for articulating brief opinions on current global public health issues. This is particularly true for mixed methods studies, which provide extensive quantitative and qualitative information subject to significant explication and interpretation that can only be achieved in a full scientific manuscript. Reviewer #2: "Dear Authors, Thank you for submitting your manuscript, "Investigating the barriers and enablers to outbreak reporting in the Asia-Pacific region: a mixed-methods study protocol," to PLOS ONE. The topic is timely, and the methodology is well-structured, addressing a critical gap in our understanding of outbreak reporting dynamics in a key geographical area. Below are some comments aimed at further strengthening the manuscript before publication: 1. Clarification of Mixed Methods Design: The manuscript effectively outlines the use of mixed methods but could benefit from more detailed explanations on how integrating these methods will enhance the understanding of the study topic beyond what could be achieved by quantitative or qualitative methods alone." We further elaborate on how integrating these methods will enhance understanding of the study topic in lines 161-162 and lines 165-167. Further information is communicated in the Study design section. "2. Detailed Justification for Geographical Focus: While the Asia-Pacific region is a critical area for study, a more detailed justification for selecting this region, especially considering its diverse political, economic, and health systems, would be beneficial. This could help clarify the expected generalizability of the study findings." We further elaborate on the justification for evaluating the Asia-Pacific region in lines 141-143, in addition to the information previously provided in the Evidence gap section. "3. Expansion on FETP's Role: The role of Field Epidemiology Training Program (FETP) trainees and graduates is highlighted; however, expanding on how their unique perspectives specifically contribute to understanding barriers and enablers could further enrich the narrative." We further expand on the unique perspectives provided by FETP personnel in lines 84-87, in addition to the information previously provided in the Introduction section. We further clarified the rationale for reaching out to FETP personnel in lines 184-192. "4. Methodological Rigor: More information on the validity and reliability of the survey instruments and interview protocols would be useful. Additionally, discussing any pilot testing of the instruments might help reassure readers of the methodological rigor." We discuss and expand on pilot testing of the survey and interviews in lines 268-271 and lines 294-297, respectively. We note that although we can assess for content validity, as an exploratory, anonymous survey other measures of validity and reliability are not applicable. We cannot establish internal validity because unlike a psychometric assessment, in which questions are related and responses are expected to vary in the same direction, there is no empirical basis to expect the barriers and enablers examined in this study to vary together, making measures of internal validity like Cronbach’s alpha inapplicable here. As a unique survey that has no known antecedent in terms of both methodology and subject matter, there is no gold standard or otherwise that this survey can be assessed against to evaluate for external validity. Finally, as an anonymous survey, it is not conducive to having participants repeat the survey to assess for reliability. We hope that future surveys in the field will allow for a more standardized assessment of validity and reliability, especially as they are repeated across different environments. "5. Ethical Considerations: The manuscript mentions ethical approvals and consent processes but could further discuss how potential ethical issues in dealing with sensitive outbreak data will be managed, especially in interviews." This is an important point, and we thank you for pointing it out. We further elaborate on how we will redact any location or event information that could potentially be linked to interviewees or their countries of work in lines 400-403. "6. Limitations: I appreciate the discussion of limitations; however, it might be beneficial to elaborate on how these limitations could affect the study's outcomes and the steps taken to mitigate them." We further clarify the limitations' impact on study outcomes and how we intend to mitigate these limitations in lines 445-448 and lines 451-454, respectively. "7. Implications for Policy and Practice: While the manuscript discusses the study's potential impacts, specific recommendations for policy-makers and public health officials based on anticipated findings could make the conclusions more actionable." We elaborate on specific recommendations in lines 469-474. Reviewer #3: "Title – Appropriate Abstract – Well presented. However, replace Discussion with Conclusion" We replaced Discussion with Conclusion in the Abstract. "Introduction – Statement of problem, magnitude of problem, rationale for the study and study objectives well presented. Line 128 - Does this mean health care providers in public and private health facilities?" We mean providers in both public and private health facilities. We’ve changed the language in line 134 to reflect this. "Methods and analysis – Clearly presented. Specific study design not mentioned - Is it a descriptive cross-sectional study?" We clarify in line 159 that this is a cross-sectional mixed methods study. "Study setting, target population, sampling techniques and data management are well described Line 155 - It is desirable to state where the piloting will be done." We clarify in lines 269 and 295 where the piloting will be done. "Line 250 - Please indicate the number of respondents targeted for the pilot survey. Also indicate geographical locations of the pilot survey." We clarify in lines 269 and 295 the number of persons intended to pilot the instruments and where the piloting will be done. "Line 323 - It is not clear if this will be Key Informant Interview or In-Depth Interview. It needs to be clearly stated." We clarify in lines 149-153 and lines 163-167 that these will be in-depth interviews. "Discussion – Inappropriate for proposal as a sub-section. Most of the content is Limitation of the study. This can be made the sub-section title." We inserted a separate Limitations sub-heading for heightened reader clarification within the larger discussion around the impact of this study. "References - Adequate" Additional edits: We provide more specific objectives in the Study question and objective section. We would be happy to make any additional clarifications as needed. Kind regards, Amish Talwar, MD, MPH Attachments Attachment Submitted filename: PLOS ONE reviewer letter.docx https://doi.org/10.1371/journal.pone.0300077.r002
13 Aug 2024 Decision Letter - Olushayo Oluseun Olu, Editor Investigating the barriers and enablers to outbreak reporting in the Asia-Pacific region: a mixed-methods study protocol PONE-D-24-06613R1 Dear Dr. Talwar, 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 will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. If you have any questions relating to publication charges, 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, Olushayo Oluseun Olu Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0300077.r003
Formally Accepted
19 Aug 2024 Acceptance Letter - Olushayo Oluseun Olu, Editor PONE-D-24-06613R1 PLOS ONE Dear Dr. Talwar, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps. Lastly, 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 customercare@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 Dr. Olushayo Oluseun Olu Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0300077.r004

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