Feasibility and acceptability of integrating a multicomponent breastfeeding promotion intervention into routine health services in private health facilities in Lagos State, Nigeria: A mixed methods process evaluation

Diana Allotey; Valerie L. Flax; Abiodun F. Ipadeola; Olatoun Adeola; Katie Grimes; Linda S. Adair; Carmina G. Valle; Margaret E. Bentley; Sujata Bose; Stephanie L. Martin

doi:10.1371/journal.pone.0301695

Peer Review History

Original SubmissionSeptember 20, 2022
5 Jul 2023 Decision Letter - Martin Wiredu Agyekum, Editor PONE-D-22-26127Feasibility and acceptability of integrating a multicomponent breastfeeding promotion intervention into routine health services in private health facilities in Lagos State, Nigeria: A mixed methods process evaluationPLOS ONE Dear Dr. Allotey, 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 31st August, 2023. 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. 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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 If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [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: Yes 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: The paper presents the findings of a robust intervention. The introduction is adequate. The methods did not mention why the authors used the specific number of women that were interviewed for each component (structured observation/exit interviews) There are no concerns regarding research ethics. The line numbering in the document is not continuous (page 20 ended at 354, page 21 started at 332) In the discussion: It will be helpful if Line 352 - 354 on page 23 in the discussion can throw more light on line 352 - 354 on page 20 (result), Explain why in spite of the counseling "fewer mothers in the intervention (77%) compared with comparison health facilities (87%) reported feeling very confident they could carry out the advice they had received". Looking at all the things that were put in place in this study to achieve success, did any of the respondents give information regarding sustainability? If yes, can it be included? Reviewer #2: The article adds to the need for critical interventions related to breastfeeding support and promotion and is therefore a much needed study at this time, particularly in a busy metropolitan city like Lagos. Please note that: (1) sub Saharan Africa as a region should begin with caps..eg. Sub NOT sub. See indications throughout the work and revise accordingly. (2). Details regarding the frequency of text messages including number of messages /texts daily/weekly should be mentioned within the section where it is described to provide better reading and easy replicability ****** 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: Ajike Saratu O ******** [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.0301695.r001
Revision 1
19 Aug 2023 Author Response i. The manuscript has been revised to ensure it meets PLOS ONE’s style requirements. ii. A copy of PLOS’ questionnaire on inclusivity in global research has been uploaded as supporting information. iii. No minors were included in the study. All study participants were ≥ 18 years. We have included the following statement in the Methods section: “Women were eligible at enrollment to participate in the cohort if they were ≥ 18 years, in their third trimester of pregnancy, and were currently clients of a private health facility selected for the study.” iv. The Funding Statement has been revised to read: “This research was funded by The Alive & Thrive initiative, managed by FHI Solutions, and funded by the Bill & Melinda Gates Foundation (INV-029432 and OPP 1135932), Irish Aid, the Tanoto Foundation, UNICEF, and the World Bank. Alive & Thrive initiative provided support in the form of salary for Author SB but did not have any additional role in the design, data collection and analysis, decision to publish, or preparation of the manuscript. Equitable Health Access Initiative provided support in the form of salary for Author OA but did not have any additional role in the design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section.” v. The Competing Interests Statement has been revised to read: “SB is employed by Alive & Thrive initiative. SB was involved in managing the evaluation of the intervention but was not involved in the design, data collection and analysis of the study. OA is employed by Equitable Health Access Initiative. OA was involved in the design and implementation of the intervention, but not in data collection or analysis for this study. OA’s affiliation with Equitable Health Access Initiative does not alter our adherence to PLOS ONE policies on sharing data and materials. All other authors have no conflicts of interest.” vi. The authors have confirmed in the Competing Interests Statement that our commercial affiliation does not alter our adherence to all of PLOS ONE’s policies on sharing data and materials. vii. There are no legal or ethical restrictions on sharing the data used in this manuscript publicly. As such all relevant data needed to replicate our study’s findings have been uploaded as supporting information files. viii. The authors have reviewed the reference list to ensure completeness and correctness. ix. In response to Reviewer #1’s comments on why we used the specific number of women that were interviewed for each component (structured observation/exit interviews), the authors clarify that the sample sizes were chosen to equally represent all the facilities in the study and also allow for comparison between the intervention and comparison health facilities. The authors have included the following description of the study’s processes used in selecting the specific number of women who were interviewed for each component of the study in the Methods Section: “The sample sizes of 20 for the IDIs and 179 for the structured observations and exit interviews were selected to allow for representation of all facilities and comparisons between intervention and comparison facilities.” Lines 193-195 x. The line numbers have been updated to ensure they are continuous. xi. In response to the Reviewer #1’s comments to throw more light on Line 352-354, the authors provide the explanation that during the 6 weeks postpartum visits exit interviews, more mothers from the intervention health facilities (77%) reported receiving counseling on not feeding infants water or other liquids to infants before 6 months, compared to mothers from the comparison health facilities (73%). The authors believe that the health providers’ emphasis on mothers refraining from giving water and other liquids to babies < 6 months, a predominant cultural practice in Nigeria, contributed to fewer mothers from the intervention health facilities (77%) feeling very confident they could carry out the advice they had received compared to the comparison health facilities (87%). xii. In response to the Reviewer #1’s comments on sustainability of the intervention as being mentioned in the IDIs with the health providers, the authors offer the explanation that sustainability of the intervention was discussed in the IDIs and have added the following text to the Results and Discussion Sections: RESULTS “Many of the health providers reported that breastfeeding counseling and support for pregnant women and lactating mothers would continue even after the intervention period ended: “Well, we have already started [thinking about] continuity. At least we have discussed with the MD[Managing Director] about it and he has approved it and we have created a [Whatsapp] group for our mothers. So, we have been adding them and educating them. That one has come to stay. There’s no way we can stop it.” (Female health provider, 2 years at health facility).”” Lines 314-320 DISCUSSION “Many of the health providers reported plans to systematize providing breastfeeding counseling and support to pregnant women and lactating mothers.” Lines 405-406 xiii. In response to the comment from Reviewer # 2 that sub Saharan Africa as a region should begin with caps..eg. Sub NOT sub, all the relevant texts in the manuscript have been revised accordingly. xiv. In response to Reviewer #2’s comments about the lack of details regarding the frequency of receipt and number of messages/texts, the authors have revised the methods section of the manuscript to include more details: “The intervention also included an mHealth component in which pregnant women and lactating mothers received one breastfeeding message per day shared via bulk text messages/SMS; and could participate in breastfeeding support groups on WhatsApp, led by an assigned ‘Breastfeeding Champion.’” Lines 157-160 xv. All figure files have been uploaded to PACE to ensure that the figures meet PLOS requirements. xvi. Finally, the authors have updated the financial disclosure and competing interests statements as follows: FUNDING STATEMENT This research was funded by The Alive & Thrive initiative, managed by FHI Solutions, and funded by the Bill & Melinda Gates Foundation (INV-029432 and OPP 1135932), Irish Aid, the Tanoto Foundation, UNICEF, and the World Bank. Alive & Thrive initiative provided support in the form of salary for Author SB but did not have any additional role in the design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section. COMPETING INTERESTS STATEMENT Author SB is employed by Alive & Thrive initiative. SB was involved in managing the evaluation of the intervention but was not involved in the design, data collection and analysis of the study. OA is employed by Equitable Health Access Initiative. OA was involved in the design and implementation of the intervention, but not in data collection or analysis for this study. OA’s affiliation with Equitable Health Access Initiative does not alter our adherence to PLOS ONE policies on sharing data and materials. All other authors have no conflicts of interest. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0301695.r002
20 Mar 2024 Decision Letter - Martin Wiredu Agyekum, Editor Feasibility and acceptability of integrating a multicomponent breastfeeding promotion intervention into routine health services in private health facilities in Lagos State, Nigeria: A mixed methods process evaluation PONE-D-22-26127R1 Dear Dr. Allotey, 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. 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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 #2: All comments have been addressed ******** 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 #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? 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 #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 #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 #2: All comments addressed. the authors noted and it was checked. The work is novel and provides guidance for others who might want to explore this area more It also provides insights into breastfeeding feasibility collaborations with other sectors. Breastfeeding remains a concern in the local area and needs continuous prompts to achieve the local and international goals The Mixed method approach provides a robust outlook into the the phenomenon of interest. The text messaging technique for health communication is once again featured here which shows promise for continued use in health promotion research ****** 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 #2: Yes: Ajike Saratu Omagbemi ******** https://doi.org/10.1371/journal.pone.0301695.r003

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