PONE-D-23-25467Tande nou gwonde! (Hear us roar!)- Youth perspectives of maternal near-misses: protocol for a photovoice study of young childbearing people’s perspectives of maternal near-misses in northwest HaitiPLOS ONE

Dear Dr. MacDonald,

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 Feb 22 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.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

We look forward to receiving your revised manuscript.

Kind regards,

Joseph Adu, PhD, MSc., Mphil

Academic Editor

PLOS ONE

Journal Requirements:

When submitting your revision, we need you to address these additional requirements.

1. 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

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2. Please include your full ethics statement in the ‘Methods’ section of your manuscript file. In your statement, please include the full name of the IRB or ethics committee who approved or waived your study, as well as whether or not you obtained informed written or verbal consent. If consent was waived for your study, please include this information in your statement as well.

3. We note that the original protocol that you have uploaded as a Supporting Information file contains an institutional logo. As this logo is likely copyrighted, we ask that you please remove it from this file and upload an updated version upon resubmission.

4. 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.

Reviewer 1

This is will be an interesting study if conducted, however, I have a few comments which if the authors address will help strengthen the protocol and the future study.

Introduction

In line 81, the authors should capitalize each word in the low-middle income country to read Low-Middle Income Country (LMIC)

In line 82, the reference [5] should come before the full stop. The same change should be made in 121 for reference [18].

Photovoice methodology

The description of the process of the photovoice, how many photographs will each participant take at a point?

Data collection

What is the operational definition for maternal near-misses in this particular study? What variable are authors looking at in defining this maternal near-misses? Will there be a review of maternal records from the health facilities? If yes. What about the participant that have not attended health facility but will be involved in this study?

Ethical issues

How will the photographs and other data collected by the participants be handled, stored and managed to ensure the confidentiality and privacy of the participants themselves and those that might appear in the photographs? And what will happen to those photographs taken after the study?

How will the consenting of the participants who could be under 18 years old be taken? Or the authors do not anticipate that? This is a case where the study is among young women

Analysis

How will the analysis of the narrative of transcripts be done? Will there be the use of any qualitative analysis software? If there is one, which one will be used?

Reviewer 2

This is a very well written research protocol on an important and understudied topic. The authors make a clear justification for why the collection of qualitative data about maternal near-misses among youth in Haiti is warranted (i.e.: survivors of maternal near-misses act as a ‘proxy’ group). Definitions of youth/adolescence are well described as is the explanation for including gender diverse childbearing people in recruitment. Excellent justification for the use of Photovoice methodology and CBPR framework. Good inclusion of a positionality statement. The authors provided a very detailed and thoughtful explanation about the empowering and emancipatory potential of this research study.

Below are some minor comments/suggestions:

Introduction:

Lines 85-86: The sentence: “One of the four leading causes of death for those 20-24 years old is pregnancy, childbirth and the weeks after birth or at the end of a pregnancy” is awkward. Could it be re-worded to say: “One of the four leading causes of death for those 20-24 years old is pregnancy, childbirth and the weeks after birth”.

Sampling:

Lines 233-234: Is there any information that can be included as to whether more births in Haiti occur in healthcare facilities or in the community / at home?

Recruitment:

Access to a cell phone should be listed as an inclusion criterion to participate. Is it assumed that the majority of youth (of all socioeconomic statuses) in Haiti have access to cell phones with adequate storage for photos and access to data plans and chargers for their phones?

Compensation:

Line 319: Nice explanation. Is the total maximum monetary compensation USD$30? (workshop, photo taking/interview and focus group discussion)? Please provide some context about the small gift of cellphone minutes.

[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

********** 

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

********** 

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

********** 

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: 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

********** 

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: This is will be an interesting study if conducted, However, I have a few comments which if the authors address will help strengthen the protocol and the future study.

Introduction

In line 81, the authors should capitalize each word in the low-middle income country to read Low-Middle Income Country (LMIC)

In line 82, the reference [5] should come before the full stop. The same change should be made in 121 for reference [18].

Photovoice methodology

The description of the process of the photovoice, how many photographs will each participant take at a point?

Data collection

What is the operational definition for maternal near-misses in this particular study? What variable are authors looking at in defining this maternal near-misses? Will there be a review of maternal records from the health facilities? If yes. What about the participant that have not attended health facility but will be involved in this study?

Ethical issues

How will the photographs and other data collected by the participants be handled, stored and managed to ensure the confidentiality and privacy of the participants themselves and those that might appear in the photographs? And what will happen to those photographs taken after the study?

How will the consenting of the participants who could be under 18 years old be taken? Or the authors do not anticipate that? This is a case where the study is among young women

Analysis

How will the analysis of the narrative of transcripts be done? Will there be the use of any qualitative analysis software? If there is one, which one will be used?

Reviewer #2: This is a very well written research protocol on an important and understudied topic. The authors make a clear justification for why the collection of qualitative data about maternal near-misses among youth in Haiti is warranted (i.e.: survivors of maternal near-misses act as a ‘proxy’ group). Definitions of youth/adolescence are well described as is the explanation for including gender diverse childbearing people in recruitment. Excellent justification for the use of Photovoice methodology and CBPR framework. Good inclusion of a positionality statement. The authors provided a very detailed and thoughtful explanation about the empowering and emancipatory potential of this research study.

Below are some minor comments/suggestions:

Introduction:

Lines 85-86: The sentence: “One of the four leading causes of death for those 20-24 years old is pregnancy, childbirth and the weeks after birth or at the end of a pregnancy” is awkward. Could it be re-worded to say: “One of the four leading causes of death for those 20-24 years old is pregnancy, childbirth and the weeks after birth”.

Sampling:

Lines 233-234: Is there any information that can be included as to whether more births in Haiti occur in healthcare facilities or in the community / at home?

Recruitment:

Access to a cell phone should be listed as an inclusion criterion to participate. Is it assumed that the majority of youth (of all socioeconomic statuses) in Haiti have access to cell phones with adequate storage for photos and access to data plans and chargers for their phones?

Compensation:

Line 319: Nice explanation. Is the total maximum monetary compensation USD$30? (workshop, photo taking/interview and focus group discussion)? Please provide some context about the small gift of cellphone minutes.

********** 

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: No

Reviewer #2: 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.

PONE-D-23-25467R1Tande nou gwonde! (Hear us roar!)- Youth perspectives of maternal near-misses: protocol for a photovoice study of young childbearing people’s perspectives of maternal near-misses in northwest HaitiPLOS ONE

Dear Dr. MacDonald,

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 19 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.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Joseph Adu, PhD, MSc., Mphil

Academic Editor

PLOS ONE

Journal Requirements:

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.

[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

********** 

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

********** 

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

********** 

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

********** 

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

********** 

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: I commend you on your efforts to address all the previous comments, however, I still have a few clarifications and suggestions. I pray you can accept this in good faith and address them

Line 98: Are the Haitian Traditional Birth Attendants (TBAs) an officially recognised part of the Haitian health system? Are they regulated? If yes, it should be indicated, or otherwise, a statement of clarification should be indicated of their clandestine and unauthorized nature

Line 296: The full meaning of LO should be provided when being used for the first time before the subsequent use of the abbreviation

Ethics

I am still not satisfied by the justification given on the consent/parental ascent for participants that are below 16 years

You mention that "In Haiti the capacity to provide consent is likewise not based on age but on the

person’s competency" It will be very helpful if the authors can provide any reference to this statement

********** 

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: Robert Kokou Dowou

**********

[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.

Tande nou gwonde! (Hear us roar!)- Youth perspectives of maternal near-misses: protocol for a photovoice study of young childbearing people’s perspectives of maternal near-misses in northwest Haiti

PONE-D-23-25467R2

Dear Dr. Tonya Ann MacDonald

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,

Joseph Adu, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: