PONE-D-23-42586Study protocol: Examining sexual and reproductive health literacy in Mexican American young women using a positive deviance approachPLOS ONE

Dear Dr. Batek,

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 08 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. The reviewers and I have extremely similar comments about redundancy. Hopefully with the three you can see how to streamline that a bit in the manuscript. It is a nice framework to see positive deviance used to empower rather than continue with what marginalized groups need to do to change, especially in the medical profession. Thanks for allowing us to review your article.  

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Mary Diane Clark, PhD

Academic Editor

PLOS ONE

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 [This study was supported by a grant to LB by the University of Rochester CTSA (UL1 TR000042) from the National Center for Advancing Translational Sciences of the National Institutes of Health. (https://www.urmc.rochester.edu/clinical-translational-science-institute.aspx).].  

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[This study was supported by a grant to Dr. Batek by the University of Rochester CTSA (UL1 TR000042) from the National Center for Advancing Translational Sciences of the National Institutes of Health.]

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Additional Editor Comments:

Thank you for allowing us to review you piece. It is critical and the positive framework is nice to see utilized.

I have a few comments here

Can we avoid abbreviations? PD and RMAYW then SRHL next SRHC. And then later CAC (for this one -- you introduce it and then don’t use it in the next time)

APA suggest using only that that are common knowledge to those outside of your area

So STI works as that is a known abbreviation

I also have others directly on the manuscript.

The reviewers also made some comments---many of them overlap with redundancy.

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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

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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

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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

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4. Have the authors described where all data underlying the findings will be made available when the study is complete?

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Reviewer #1: No

Reviewer #2: No

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Reviewer #1: Yes

Reviewer #2: Yes

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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.

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(Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Dear authors,

Thank you for your efforts in studying marginalized groups and individuals who speak languages other than English, such as Spanish. There is still much more work to be done beyond solely including English speakers. Your efforts are appreciated.

Every research endeavor demands a significant investment of effort; therefore, maximizing its validity whenever possible is essential. Two key suggestions to enhance validity include referencing the (1) mixed-method research protocol outlined by Venkatesh, V., Brown, S.A., and Sullivan, Y.W. (2016) in the "Guidelines for Conducting Mixed-methods Research: An Extension and Illustration," Journal of the AIS (17:7), 435-495, and (2) utilizing the forward-backward translation technique proposed by Guillemin F, Bombardier C, and Beaton D. in "Crosscultural adaptation of health-related quality of life measures: literature review and proposed guidelines," J Clin Epidemiol. 1993;46:1417-1432.

Other comments are as follows:

1. In lines 36-38, to clarify the role of the Community Advisory Committee (CAC) in this study, it may be beneficial to explicitly state that the CAC will be formed to provide community-engaged guidance and support for the recruitment of participants.

2. In line 87, does "successful" refer to the criteria detailed in lines 212-215? If so, it would enhance clarity for readers to provide examples of what is meant by "success" immediately. This is important as "success" is one of your main definitions.

3. Line 90-94: Are these two sentences the same?

4. In line 128-132, according to Figure 1, "environmental" is one of the variables, but it is omitted in Aim 1. Is this intentional, and if so, why?

5. In line 143, to ensure the validity of the mixed method protocol, please consider incorporating the mixed-method protocol suggested by Venkatesh, V., Brown, S.A., and Sullivan, Y.W. (2016) in the "Guidelines for Conducting Mixed-methods Research: An Extension and Illustration," Journal of the AIS (17:7), 435-495. For instance, questions regarding the property of mixed-method research, such as whether quantitative and qualitative data collection occur sequentially or concurrently, are not explicitly addressed.

6. In line 161-164, according to Figure 1, "environmental" is one of the variables, but it is omitted in Aim 1. Is this intentional, and if so, why?

7. In line 188, are "medical providers" and "healthcare providers" referring to the same group of individuals? This question arises because in Figure 2, "medical providers" are not included.

8. In line 264, could you please clarify what occurs if participants choose to withdraw after completing the interview?

Line 269: What is HIPAA? Do you mean the Health Insurance Portability and Accountability Act? Please clarify the full term for readers who may not be familiar with the abbreviation.

9. Line 295: Is it 5 or 6 options? Please double-check.

10. In line 302, why are only 3 questions out of the 5 items from the Centrality of Religiosity Scale (CRS-5) being used to measure religiosity? Please clarify

11. In line 307, could you explain how the validity of the translation is ensured, particularly considering the utilization of forward and back translation techniques?

12. In lines 328 and 329, please consider including forward and back translation techniques to ensure validity.

Line 364: "RYMAW," is this a typo?

13. Please clarify if the data collected would be share with the journal or not

14. Please check the labeling of Fig 2.

Reviewer #2: Thank you very much for the opportunity to review this protocol. I found it to be a well-written article that provides a helpful description of both the rationale and planned steps for the research to be conducted. My suggestions below are mostly to clarify several pieces of information articulated in the protocol to enhance the consistency with which similar concepts are portrayed throughout the article and to further distinguish between concepts that would benefit from clearer separation from one another.

1. Introduction section, 3rd paragraph, 3rd to last and 2nd to last sentences: It was not clear what distinct information is being conveyed by these two sentences (one starting with “While barriers and facilitators to healthcare …” and the other with “While barriers and facilitators to care …”). Please consider either combining them or further differentiating their content from one another.

2. Near the end of the Introduction section, where the three specific aims are mentioned, please consider sharpening the distinction between Specific Aims 2 and 3.

3. Throughout the Methods section, please consider making clearer the exact study tasks to be carried out for each specific aim.

4. The Study Design section’s 5th sentence (which starts with “National data indicate low health literacy … for these women …”) seems to contradict the Introduction section’s 3rd paragraph’s 3rd sentence, which states that “statistics regarding the health literacy of this specific group are unavailable.” Please consider resolving this seeming discrepancy.

5. The Study Participants and Eligibility section’s 3rd sentence states that “precautions will be taken not to obtain any personal identifying information,” while the Eligibility Screening and Enrollment section’s last sentence mentions the storage of identifying information. Please consider clarifying how these planned tasks are consistent.

6. In the Recruitment section, please consider elaborating on whether the study information disseminated through the flyers and posters will be made available to potential participants electronically/virtually as well (and if so, how), in addition to being displayed and distributed at clinic locations and extra flyers being available for potential participants to physically pick up.

7. Data Collection section: Please consider providing a justification for why the extra layer of protection using the voice changing platform is by choice of the participant and only offered to some participants, rather than being uniformly applied to all participants.

8. Regarding data availability, this submission is accompanied by the statement “All relevant data from this study will be made available upon study completion.” It is unclear how this will be done and what steps will be taken to protect participant confidentiality in doing so, especially given the potentially sensitive topics covered by the semi-structured interviews.

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Reviewer #1: No

Reviewer #2: Yes: Bo Kim

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Submitted filename: Study protocol.pdf

Study protocol: Examining sexual and reproductive health literacy in Mexican American young women using a positive deviance approach

PONE-D-23-42586R1

Dear Dr. Batek,

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.

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Kind regards,

Mary Diane Clark, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Thank you for the careful revisions. The paper reads much better and with fewer abbreviations it is easier to access. Nice work

Reviewers' comments: