PONE-D-23-43695The Feasibility, Appropriateness, and Usability of Mobile Neuro Clinics in Addressing the Neurosurgical and Neurological Demand in UgandaPLOS ONE

Dear Dr. Ukachukwu,

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"BM received funding from the Duke Global Health Institute (DGHI), [website: https://globalhealth.duke.edu], and Duke Global Neurosurgery and Neurology (DGNN) [website: https://www.dukeglobalneurosurgery.com]. Members of the DGNN played active roles in the study design, data collection and analysis, manuscript preparation, and decision to publish."

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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

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: N/A

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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: No

Reviewer #2: No

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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: No

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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: Thank you for the opportunity to review this article on examining the feasibility, appropriateness, and usability of mobile neuro clinics (MNCs) in Uganda. I found the article to be very well written, and I especially appreciated the clearly described Ugandan context at multiple levels, which would help readers less familiar with the context better understand the various influences at play when implementing an intervention such as MNCs. The authors provide a good reason for not making available all data underlying their findings. My suggestions below are mostly to provide additional explanations for the reader regarding the use of the sentiment-weighted scale and further considerations in moving the MNC effort forward.

1. Please consider explaining how it was decided that the positive valence of the sentiment-weighted scale signals feasibility, appropriateness, and usability of MNCs. Each of these measures have several components that are often considered to be part of the whole measure – e.g.: usability is commonly thought to encompass relative efficiency, ease of learning, etc.; and feasibility is commonly thought to encompass perceived burden, reasons for non-use, etc. It would be helpful to see a clearer articulation of how the data and approaches to analysis enabled assessment of such multiple components per measure to deem MNCs feasible, appropriate, and usable.

2. Please consider addressing potential biases introduced from basing the calculation of average sentiment scores only on those who responded to a particular theme/code.

3. Please consider elaborating in the Discussion section on practical alternatives to MNCs in addressing Uganda’s neurosurgical/neurological care needs, as such alternatives’ relative advantages and disadvantages can be expected to be a key consideration in preparing for MNC implementation.

4. Please consider including as a limitation how the study data do not speak to perspectives of non-frontline providers (e.g., administrators/leadership at multiple levels), similar to how the article already acknowledges how the study data do not include insights from other medical specialties.

5. (Minor) Second paragraph of the Data Collection section: The 1st sentence seems to say that the first section of the interviews was about demographic information, while the 2nd sentence seems to say that the first section assessed providers’ understanding of healthcare. Please consider clarifying.

6. (Minor) Last paragraph of the Introduction section, 2nd sentence: Please consider checking this sentence for any unintended grammatical errors.

Reviewer #2: Overall

Thank you for inviting me to review manuscript ID PONE-D-23-43695. This manuscript describes the potential of mobile health clinics as a strategy for improving access to neurological services for people in rural and remote areas of Uganda. I congratulate the authors on conducting an important study. In my opinion, the manuscript requires major revisions prior to being considered suitable for publication. I hope my reflections and suggestions help to strengthen the manuscript.

Abstract

The abstract is well written.

Introduction

The section introduces the concept of inequitable access to healthcare for people living in rural and remote communities. However, I wonder if the authors would consider teasing out the specific barriers or complexities surrounding access to healthcare in these communities, as noted in the first paragraph. The authors draw on mobile health clinic literature from different countries to argue the need for the adaption of MNCs in Uganda. The sentence straddling pages 3 and 4 may require revisiting to ensure clarity. The sentence following uses an acronym (CCHU) without first writing the term out in full.

Methods

The methods section is written clearly. It surprises me that ethics exemption was provided, given the study captured the experiences of health professionals delivering services in rural areas, where it is common for the anonymity of rural people to be reduced via dual relationships. The first sentence in the ethics statement section on page 5 requires revisiting for clarity.

Would the authors consider adding information about the primary geographic work location of participants in terms of rurality? In Australia, MMM categories are used to categorize rurality (https://www.health.gov.au/topics/rural-health-workforce/classifications/mmm), although there may be a more suitable approach to use.

On page 6, the authors note that thematic analysis was conducted to develop the code books, however it is not clear how many transcripts were used to identify codes and/or themes comprised in the code books.

The last sentence under the title “Figure 1” on page 7 requires some attention for clarity.

Results

The results section, along with the figures, describes the data according to the CFIR domains and stakeholder analysis. The figures capture significant detail that could be teased out into paragraphs for the reader.

It might also be useful to include more detail within the stakeholder analysis section, if possible.

Discussion

The authors have broken the discussion section into individual sections relating to the CFIR domains and the sentiment weighted scale. Under many of these headings, the authors have provided interesting content that, in my perspective, fit better under the respective headings in the results section (the first discussion paragraph under the heading ‘Innovation Domain’ starting on page 17 is a good example of this). The authors may wish to consider reworking their discussion section by removing subheadings, revisiting their study aim on page 4, and using this section along with the results to identify and address the main discussion points arising from the study. This will help to give the section direction and clarity.

Conclusion

The first sentence in the conclusion does not mention the topic of the study, but instead, notes the valence of the CFIR domains. The authors may wish to revise this.

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Reviewer #1: Yes: Bo Kim

Reviewer #2: No

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The Feasibility, Appropriateness, and Usability of Mobile Neuro Clinics in Addressing the Neurosurgical and Neurological Demand in Uganda

PONE-D-23-43695R1

Dear Dr. Ukachukwu,

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,

Nicholas Aderinto Oluwaseyi

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

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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: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

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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

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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

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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)

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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: Bo Kim

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