Nurturing an organizational context that supports team-based primary mental health care: A grounded theory study

Rachelle Ashcroft; Matthew Menear; Simone Dahrouge; Jose Silveira; Monica Emode; Jocelyn Booton; Ravninder Bahniwal; Peter Sheffield; Kwame McKenzie

doi:10.1371/journal.pone.0301796

Peer Review History

Original SubmissionSeptember 15, 2023
1 Dec 2023 Decision Letter - Johanna Pruller, Editor PONE-D-23-28612Nurturing an Organizational Context that Supports Team-Based Primary Mental Health Care: A Grounded Theory StudyPLOS ONE Dear Dr. Ashcroft, 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. However, we will aim to proceed on the basis of this single review if possible. The reviewer has raised a number of minor concerns. They feel that the manuscript would benefit from additional details in the methods section, specifically to make the supplementary data available. They also feel that it would be useful to include a more thorough description of the results of the grounded theory phase. Could you please carefully revise the manuscript to address all comments raised? Please submit your revised manuscript by Jan 15 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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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 If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.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 ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: N/A ****** 3. 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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: Dear author, First of all, I enjoyed reading your manuscript. Overall it is a scientifically sound article. You present interesting results that may also help to improve primary mental health care in other countries. Nevertheless, I have a few questions (minor issues): 1. You describe a mixed methods approach. During the first phase grounded theory was applied. Following that a semistructured interview was used. My impression is that the results from the grounded theory phase are not extensively described. Is it possible to add a short paragraph on these results (a couple of sentences)? 2. To interpret the results it would help if the semistructured interview (or the topic list) was available as supplementary material. Is it possible to make this available (I might have overlooked)? 3. It surprises me that so many interviews were necessary to reach data saturation. Can you elaborate a bit on this? 4. I am not familiar with the Canadian health care system. I do know that distances in your country tend to be large, with large urban areas and more remote rural communities. I imagine that needs and availability of mental health care services may differ for these areas. Indeed, you reflect a bit on what is necessary in rural areas. Can you also reflect a bit on the needs in cities (were also teams from Toronto included?)? Do mental health care teams also hold conferences or have other meetings where they meet colleagues from other teams (as this also helps to learn from each other and improve the way care is delivered)? 5. It might be interesting to add a map of Ontario with the locations of the teams that were included in the study. Thank you for the opportunity to read your interesting work! ****** 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: Yes: Klaas Huijbregts ******** [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.0301796.r001
Revision 1
15 Jan 2024 Author Response Dr. Johanna Pruller Editor-in-Chief PLOS One January 02, 2024 Dear Dr. Pruller: We are pleased to submit revisions to our manuscript titled “Nurturing an Organizational Context that Supports Team-Based Primary Mental Health Care: A Grounded Theory Study”. We appreciate the editor and reviewer’s feedback and have revised the manuscript in a way that responds to all editor and reviewer comments. Please find below an itemized response to all reviewer and editor comments: Reviewer Comment: First of all, I enjoyed reading your manuscript. Overall it is a scientifically sound article. You present interesting results that may also help to improve primary mental health care in other countries. Response: Thank you, we appreciate your encouraging comments and also appreciate the time you took to review our manuscript. Reviewer Comment: You describe a mixed methods approach. During the first phase grounded theory was applied. Following that a semi-structured interview was used. My impression is that the results from the grounded theory phase are not extensively described. Is it possible to add a short paragraph on these results (a couple of sentences)? Response: We added mention of grounded theory in the methods and reorganized the data collection section to enhance clarity about the grounded theory methods. The following was added to the Data Collection section: “We devised the semi-structured interview guide using sensitizing concepts that helped by providing a starting point, and consistent with grounded theory the interview questions evolved over the course of the two phases of data collection. The sensitizing concepts were derived from our previous research [46]. Interview questions explored organizational features that help and/or hinder the delivery of mental health care for patients with depression and/or anxiety (S1).” Reviewer Comment: To interpret the results it would help if the semistructured interview (or the topic list) was available as supplementary material. Is it possible to make this available (I might have overlooked)? Response: Interview questions are now added as a supplementary file. The following sentence was added to the data collection section: “Interview questions explored organizational features that help and/or hinder the delivery of mental health care for patients with depression and/or anxiety (S1).” Reviewer Comment: It surprises me that so many interviews were necessary to reach data saturation. Can you elaborate a bit on this? Response: Thank you for raising this. We added the following to the Data Collection section to provide clarity: “The reason why so many interviews were necessary to reach data saturation is because this study was part of a larger qualitative study investigating the financial and non-financial incentives that influence the quality of mental health care in Family Health Teams [46]. We are in process of developing a model explaining the financial and non-financial incentives which required an understanding the organizational contexts. Lastly, it required so many interviews to reach saturation because of the commitment to include the range of disciplinary perspectives that comprise this interdisciplinary team-based model of primary care.” Reviewer Comment: I am not familiar with the Canadian health care system. I do know that distances in your country tend to be large, with large urban areas and more remote rural communities. I imagine that needs and availability of mental health care services may differ for these areas. Indeed, you reflect a bit on what is necessary in rural areas. Can you also reflect a bit on the needs in cities (were also teams from Toronto included?)? Do mental health care teams also hold conferences or have other meetings where they meet colleagues from other teams (as this also helps to learn from each other and improve the way care is delivered)? Response: We added the following sentences in Methods under the Setting sub-heading: “Canada is a geographically large country comprised of ten provinces and three territories, and is sparsely populated with just over 38 million people inhabiting approximately 10 million square kilometers of land (Figure 1). With approximately 18.9% of Canadians residing in rural areas, the majority of Canadians reside in urban settings.” Additionally, we added a map of Canada that illustrates Ontario. Also, the following is now added to the results section: “There were n = 18 Family Health Teams represented in our sample, with n = 11 located in urban settings and n = 7 located in rural settings situated across all six of Ontario health regions (North East, North West, East, Central, Toronto, and West).” The following was also added to the discussion section: “Rural and urban primary care teams are facing various challenges in the human resources crisis. Geospacing analysis has demonstrated that there is an unbalanced distribution of primary care providers across the urban-rural continuum which created gaps in access even prior to the immediate crisis at hand [81]. In urban settings, however, coordinated interventions and intersectoral collaboration are needed across institutions are needed to build up the urban environment as a component of the solution [82].” Reviewer Comment: It might be interesting to add a map of Ontario with the locations of the teams that were included in the study. Response: We added a map of Canada that highlights Ontario. Although we agree it would be helpful to illustrate the locations of the teams, we did not add the locations to the map because it would then identify the study participants. Instead, we added the following sentence to the results section: “There were n = 18 Family Health Teams represented in our sample, with n = 11 located in urban settings and n = 7 located in rural settings situated across all six of Ontario health regions (North East, North West, East, Central, Toronto, and West).” Editor Comment: Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf Response: The manuscript was revised throughout to meet the PLOS ONE’s style requirements including headings, references, and title page. Editor Comment: Please ensure that you have specified a) Did participants provide their written or verbal informed consent to participate in this study? b) If consent was verbal, please explain i) why written consent was not obtained, ii) how you documented participant consent, and iii) whether the ethics committees/IRB approved this consent procedure. Response: The following sentence was added to Data Collection section: “Informed written consent was obtained in prior to the conducting of all in-person interviews.” Editor Comment: In your Data Availability statement, you have not specified where the minimal data set underlying the results described in your manuscript can be found. PLOS defines a study's minimal data set as the underlying data used to reach the conclusions drawn in the manuscript and any additional data required to replicate the reported study findings in their entirety. All PLOS journals require that the minimal data set be made fully available. For more information about our data policy, please see http://journals.plos.org/plosone/s/data-availability. Response: We are unable to publicly share our data set because although we have removed identifiable information from transcripts, we cannot remove all information that could potentially be used to identify participants. Responses to questions contain information describing Family Health Team communities, practice settings, and providers’ personal roles and responsibilities, some of whom live in small rural communities where such information could be used to identify individuals. Upon reasonable request, the corresponding author is able provide de-identified data. Editor Comment: Your ethics statement should only appear in the Methods section of your manuscript. If your ethics statement is written in any section besides the Methods, please delete it from any other section. Response: The following statement is located under a subheading titled "Ethical Considerations" in the Methods section of the manuscript: “Research Ethics Board (REB) approval for this study was obtained from Bruyère Continuing Care (#M16–16-001), the Centre for Addiction and Mental Health (CAMH) (#140/2015), St. Joseph’s Health Centre/Unity Health Toronto (#15–830), the University of Waterloo (#20973), the University of Toronto (#33175), and Université Laval (#2016–2877).” Editor Comment: 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. Response: The reference list was reviewed and revised. No retracted papers currently appear in the reference list. Attachments Attachment Submitted filename: Response to Reviewers.pdf https://doi.org/10.1371/journal.pone.0301796.r002
25 Mar 2024 Decision Letter - Nabeel Al-Yateem, Editor Nurturing an Organizational Context that Supports Team-Based Primary Mental Health Care: A Grounded Theory Study PONE-D-23-28612R1 Dear Dr. Ashcroft, 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, Nabeel Al-Yateem, PhD Academic Editor PLOS ONE Additional Editor Comments (optional): 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 #1: 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 #1: (No Response) ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: (No Response) ****** 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 #1: (No Response) ****** 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: (No Response) ****** 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 #1: (No Response) ****** 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 #1: Yes: Klaas Huijbregts ******** https://doi.org/10.1371/journal.pone.0301796.r003
Formally Accepted
4 Apr 2024 Acceptance Letter - Nabeel Al-Yateem, Editor PONE-D-23-28612R1 PLOS ONE Dear Dr. Ashcroft, 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. Nabeel Al-Yateem Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0301796.r004

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