PONE-D-23-36992Clarifying Terminology and Definitions in Education services for Mental Health Users: A Disambiguation StudyPLOS ONE

Dear Dr. Gutierrez-Colosia,

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.

==============================

ACADEMIC EDITOR:

Editor’s comments:

After a thorough examination of your manuscript, it is apparent that your work exhibits significant potential. I kindly request some minor revisions to further enhance the manuscript. These suggestions are tailored to pinpoint specific areas where refinement could enhance overall clarity and amplify the impact of your work. The detailed suggestions are provided below, and I kindly ask you to respond to both the editor and the reviewers. Please address each suggestion individually in a separate file and highlight the modifications made in the manuscript. Your attention to these revisions is greatly appreciated.

Editor’s comments:

After a thorough examination of your manuscript, it is apparent that your work exhibits significant potential. I kindly request some minor revisions to further enhance the manuscript. These suggestions are tailored to pinpoint specific areas where refinement could enhance overall clarity and amplify the impact of your work. The detailed suggestions are provided below, and I kindly ask you to respond to both the editor and the reviewers. Please address each suggestion individually in a separate file and highlight the modifications made in the manuscript. Your attention to these revisions is greatly appreciated.

Abstract

The abstract, while informative, can be improved for clarity and conciseness. Here are some specific suggestions:

1. Clearer Structure: Begin with a concise statement on the issue of terminological comparability and the need for standardized classifications in service research. Follow with a brief explanation of the study's focus on education services and its alignment with the PECUNIA project.
2. Streamlined Methodology Explanation: Condense the explanation of the ontoterminology approach, focusing on the key steps without overwhelming detail. Emphasize the importance of accurate identification and disambiguation of services.
3. Results Highlight: Clearly state the key findings, such as the low percentage of accurate services after disambiguation. This will help readers quickly grasp the study's outcomes.
4. Impact Statement: Conclude with a concise statement on the significance of standardized methodologies and classifications in promoting comparability across sectors and ensuring a nuanced understanding of diverse services.
5. Revised Keywords: Ensure that the keywords reflect the main concepts of the abstract, such as disambiguation, education services, service research, and the DESDE system.

Introduction section

The introduction provides a comprehensive overview of service science and its multidisciplinary nature, emphasizing the interconnectedness of various service sectors. Consider streamlining the introduction for better readability:

1. Concise Background: Condense the background information on service science and its multidisciplinary nature, focusing on its relevance to understanding complex interventions.
2. Clarity on Systems Thinking: Clearly articulate the concept of systems thinking and its application to service provision, giving examples without delving too deeply into specific empirical studies.
3. Streamlined Structure: Organize the introduction into shorter paragraphs, each addressing a specific aspect of service science, systems thinking, and the need for operational classifications. This will enhance overall clarity and engagement.
4. Transition to the DESDE System: Introduce the DESDE system and its role in providing a standardized classification for services, setting the stage for the study's focus on education services.

The methods section

It provides a comprehensive overview of the study's design, context, and application of the DESDE system. However, it can benefit from some improvements for clarity and conciseness:

1.  Alignment with PECUNIA Project Objectives:

   Ensure a more explicit connection between the study's methodology and the broader objectives of the PECUNIA project. Clearly state how the study contributes to the overarching goals of the project, providing a seamless transition from project context to the study design.

1. Axes in the DESDE System:

   Offer a more comprehensive explanation of the axes in the DESDE system. While a multiaxial code structure is mentioned, briefly describe each axis to aid readers unfamiliar with DESDE, enhancing overall clarity and understanding.

1. Expert Involvement Elaboration:

   Elaborate on the specific contributions of each expert working group (A, B, C). Specify the unique perspectives or expertise each group brought to the study, providing a more nuanced understanding of expert involvement and its impact on the classification process.

1. Qualitative Data Integration:

   If applicable, consider integrating qualitative data or quotes from expert consultations to enrich the narrative. This could offer a more vivid portrayal of the challenges faced and solutions proposed during the expert consultation process, enhancing the depth of the methodological description.

1. Contextual Clarification:

   Provide a brief, clear explanation of the PECUNIA project and its objectives before delving into the study design. This will help readers understand the broader context of the research and appreciate the study's relevance to the project's overarching goals.

1. Conciseness in Study Design:

   Streamline the description of the study design, emphasizing its alignment with the PECUNIA project. Highlight specific mental health disorders chosen for illustration without unnecessary detail, ensuring a balance between clarity and conciseness.

1. Clarity in DESDE Application:

   Clearly state the rationale for applying the DESDE classification to education services and explain how the coding process was conducted using a generic list of prototype services. Ensure that the application of DESDE is presented with clarity and relevance to the study.

1. Simplified Education Contexts:

   Condense detailed descriptions of education contexts in Spain and The Netherlands to focus on key aspects relevant to the study. Make the information more accessible to readers without overwhelming them with unnecessary details.

1. Streamlined Governance Structure:

   Streamline governance structure information for both countries, emphasizing key points relevant to education services. Ensure that the governance structure is presented in a clear and concise manner.

1. Professional Qualifications Overview:

    Briefly outline the qualifications and roles of key professionals in the education sector in Spain and The Netherlands. Ensure clarity and relevance to the study without delving into unnecessary details.

1. DESDE System Explanation:

    Provide a succinct yet comprehensive explanation of the DESDE system, its axes, and how it was utilized in the study. Include a concise description of the multiaxial code structure for a clearer understanding.

1. Procedure Overview Streamlining:

    Streamline the description of the assessment procedure, emphasizing key steps involved in service identification, disambiguation, and code development. Ensure clarity and simplicity in presenting the procedural overview.

1. Expert Involvement Clarification:

    Clearly outline the roles of the three working groups (A, B, C), providing a concise overview of their contributions to the study. Avoid redundancy and ensure that each group's role is distinctly communicated.

1. Step-by-Step Process Breakdown:

Break down the multistep process into clear, sequential steps, each with a succinct description. Ensure clarity in terminology, such as the distinction between disambiguation and development of prototype codes, for a more accessible presentation.

Results section

1. Lack of Clarity in Disambiguation Criteria:

The criteria for disambiguating services appear somewhat subjective and may benefit from a more explicit and standardized approach. Providing clearer guidelines for categorizing items as accurate, ambiguous, vague, or confusing could enhance the transparency and reproducibility of the classification process. Clearly articulate the criteria for classifying items into accurate, ambiguous, vague, or confusing categories. Consider providing illustrative examples to guide readers and potential future researchers in understanding the disambiguation process.

1. Limited Exploration of Ambiguous and Vague Categories:

The Results Section could delve deeper into the ambiguous and vague categories, providing more detailed examples and insights into why certain items fell into these classifications. A more in-depth analysis of these categories could shed light on the intricacies of classifying educational services. Dedicate more space to discussing items categorized as ambiguous or vague. Offer nuanced explanations for why certain items fell into these categories, providing contextual details that highlight the challenges faced during the classification process.

1. Insufficient Exploration of Expert Suggestions:

While expert opinions are briefly mentioned, the Results Section could benefit from a more comprehensive exploration of how expert feedback influenced the classification process. Explicitly linking expert comments to specific items in the disambiguation process would provide a clearer understanding of the impact of expert validation. Integrate expert comments more seamlessly into the narrative. Explicitly connect expert suggestions to specific items in the disambiguation process, emphasizing the role of expert validation in refining the classification criteria.

1. Inconsistent Terminology:

The use of terms like "accurate," "ambiguous," "vague," and "confusing" could be standardized throughout the section for better coherence. Ensuring consistent language will improve the overall readability and interpretation of the results. Ensure consistent use of terminology throughout the Results Section. Streamline the language used to describe the classification outcomes, making it easier for readers to follow and interpret the findings.

The Discussion Section

1. Limited Exploration of Expert Suggestions:

While the discussion briefly touches upon expert suggestions, it could benefit from a more detailed examination of how expert consultations influenced the refinement of service descriptions and the application of DESDE codes. Explicitly linking expert feedback to specific challenges or improvements in the classification system would enhance the discussion. Dedicate a section to thoroughly explore the impact of expert consultations on the classification system. Provide specific examples of services that were refined based on expert input and discuss how this collaboration improved the accuracy of the classification.

1. Insufficient Exploration of Service Accuracy Levels:

The discussion provides the overall percentage of services accurate at different levels of disambiguation, but a deeper analysis of the implications and challenges associated with these accuracy levels is warranted. Discussing specific examples or patterns in services that were accurate or faced challenges at different levels would provide a richer understanding. Conduct a more nuanced analysis of the accuracy levels reported, discussing specific services that excelled or faced challenges at different stages of disambiguation. This would provide a more comprehensive understanding of the classification process.

1. Limited Exploration of Code Adaptation Suggestions:

The discussion briefly mentions suggestions for adapting the DESDE system to the education sector, such as the need for new codes to differentiate day and evening school. Further exploration and discussion of these suggested adaptations, including potential implications and challenges, would enhance the completeness of the discussion. Elaborate on the suggestions for adapting the DESDE system to the education sector. Discuss the rationale behind proposed changes, potential benefits, and challenges associated with incorporating new codes or modifying existing ones.

1. Incomplete Integration of ISCED System:

The discussion mentions the potential complementarity of international classifications like DESDE and ISCED but does not delve into the practical implications of integrating these systems. Further exploration of how combining information from DESDE and ISCED could enhance the understanding of the education sector would strengthen the discussion. Explore in detail how integrating information from the DESDE and ISCED systems can provide a more holistic view of the education sector. Discuss specific examples where this combination could enhance the classification and understanding of educational services.

1. Practical Implications:

Expand on the practical implications of the study's findings for policymakers, educators, or researchers. Discuss how the standardized classification system could contribute to more effective educational service planning and delivery.

==============================

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We look forward to receiving your revised manuscript.

Kind regards,

Faten Amer, PhD in Health Sciences , MBA, Pharmacy

Academic Editor

PLOS ONE

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This study also received financial support by a grant from the Carlos III Health Institute (PI18/01521). The funding agreement ensured the authors’ independence in designing the study, interpreting the data, and writing and publishing the report."

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Additional Editor Comments: 

Editor’s comments:

After a thorough examination of your manuscript, it is apparent that your work exhibits significant potential. I kindly request some minor revisions to further enhance the manuscript. These suggestions are tailored to pinpoint specific areas where refinement could enhance overall clarity and amplify the impact of your work. The detailed suggestions are provided below, and I kindly ask you to respond to both the editor and the reviewers. Please address each suggestion individually in a separate file and highlight the modifications made in the manuscript. Your attention to these revisions is greatly appreciated.

Abstract

The abstract, while informative, can be improved for clarity and conciseness. Here are some specific suggestions:

1. Clearer Structure: Begin with a concise statement on the issue of terminological comparability and the need for standardized classifications in service research. Follow with a brief explanation of the study's focus on education services and its alignment with the PECUNIA project.

2. Streamlined Methodology Explanation: Condense the explanation of the ontoterminology approach, focusing on the key steps without overwhelming detail. Emphasize the importance of accurate identification and disambiguation of services.

3. Results Highlight: Clearly state the key findings, such as the low percentage of accurate services after disambiguation. This will help readers quickly grasp the study's outcomes.

4. Impact Statement: Conclude with a concise statement on the significance of standardized methodologies and classifications in promoting comparability across sectors and ensuring a nuanced understanding of diverse services.

5. Revised Keywords: Ensure that the keywords reflect the main concepts of the abstract, such as disambiguation, education services, service research, and the DESDE system.

Introduction section

The introduction provides a comprehensive overview of service science and its multidisciplinary nature, emphasizing the interconnectedness of various service sectors. Consider streamlining the introduction for better readability:

1. Concise Background: Condense the background information on service science and its multidisciplinary nature, focusing on its relevance to understanding complex interventions.

2. Clarity on Systems Thinking: Clearly articulate the concept of systems thinking and its application to service provision, giving examples without delving too deeply into specific empirical studies.

3. Streamlined Structure: Organize the introduction into shorter paragraphs, each addressing a specific aspect of service science, systems thinking, and the need for operational classifications. This will enhance overall clarity and engagement.

4. Transition to the DESDE System: Introduce the DESDE system and its role in providing a standardized classification for services, setting the stage for the study's focus on education services.

The methods section

It provides a comprehensive overview of the study's design, context, and application of the DESDE system. However, it can benefit from some improvements for clarity and conciseness:

1. Alignment with PECUNIA Project Objectives:

Ensure a more explicit connection between the study's methodology and the broader objectives of the PECUNIA project. Clearly state how the study contributes to the overarching goals of the project, providing a seamless transition from project context to the study design.

2. Axes in the DESDE System:

Offer a more comprehensive explanation of the axes in the DESDE system. While a multiaxial code structure is mentioned, briefly describe each axis to aid readers unfamiliar with DESDE, enhancing overall clarity and understanding.

3. Expert Involvement Elaboration:

Elaborate on the specific contributions of each expert working group (A, B, C). Specify the unique perspectives or expertise each group brought to the study, providing a more nuanced understanding of expert involvement and its impact on the classification process.

4. Qualitative Data Integration:

If applicable, consider integrating qualitative data or quotes from expert consultations to enrich the narrative. This could offer a more vivid portrayal of the challenges faced and solutions proposed during the expert consultation process, enhancing the depth of the methodological description.

5. Contextual Clarification:

Provide a brief, clear explanation of the PECUNIA project and its objectives before delving into the study design. This will help readers understand the broader context of the research and appreciate the study's relevance to the project's overarching goals.

6. Conciseness in Study Design:

Streamline the description of the study design, emphasizing its alignment with the PECUNIA project. Highlight specific mental health disorders chosen for illustration without unnecessary detail, ensuring a balance between clarity and conciseness.

7. Clarity in DESDE Application:

Clearly state the rationale for applying the DESDE classification to education services and explain how the coding process was conducted using a generic list of prototype services. Ensure that the application of DESDE is presented with clarity and relevance to the study.

8. Simplified Education Contexts:

Condense detailed descriptions of education contexts in Spain and The Netherlands to focus on key aspects relevant to the study. Make the information more accessible to readers without overwhelming them with unnecessary details.

9. Streamlined Governance Structure:

Streamline governance structure information for both countries, emphasizing key points relevant to education services. Ensure that the governance structure is presented in a clear and concise manner.

10. Professional Qualifications Overview:

Briefly outline the qualifications and roles of key professionals in the education sector in Spain and The Netherlands. Ensure clarity and relevance to the study without delving into unnecessary details.

11. DESDE System Explanation:

Provide a succinct yet comprehensive explanation of the DESDE system, its axes, and how it was utilized in the study. Include a concise description of the multiaxial code structure for a clearer understanding.

12. Procedure Overview Streamlining:

Streamline the description of the assessment procedure, emphasizing key steps involved in service identification, disambiguation, and code development. Ensure clarity and simplicity in presenting the procedural overview.

13. Expert Involvement Clarification:

Clearly outline the roles of the three working groups (A, B, C), providing a concise overview of their contributions to the study. Avoid redundancy and ensure that each group's role is distinctly communicated.

14. Step-by-Step Process Breakdown:

Break down the multistep process into clear, sequential steps, each with a succinct description. Ensure clarity in terminology, such as the distinction between disambiguation and development of prototype codes, for a more accessible presentation.

Results section

1. Lack of Clarity in Disambiguation Criteria:

The criteria for disambiguating services appear somewhat subjective and may benefit from a more explicit and standardized approach. Providing clearer guidelines for categorizing items as accurate, ambiguous, vague, or confusing could enhance the transparency and reproducibility of the classification process. Clearly articulate the criteria for classifying items into accurate, ambiguous, vague, or confusing categories. Consider providing illustrative examples to guide readers and potential future researchers in understanding the disambiguation process.

2. Limited Exploration of Ambiguous and Vague Categories:

The Results Section could delve deeper into the ambiguous and vague categories, providing more detailed examples and insights into why certain items fell into these classifications. A more in-depth analysis of these categories could shed light on the intricacies of classifying educational services. Dedicate more space to discussing items categorized as ambiguous or vague. Offer nuanced explanations for why certain items fell into these categories, providing contextual details that highlight the challenges faced during the classification process.

3. Insufficient Exploration of Expert Suggestions:

While expert opinions are briefly mentioned, the Results Section could benefit from a more comprehensive exploration of how expert feedback influenced the classification process. Explicitly linking expert comments to specific items in the disambiguation process would provide a clearer understanding of the impact of expert validation. Integrate expert comments more seamlessly into the narrative. Explicitly connect expert suggestions to specific items in the disambiguation process, emphasizing the role of expert validation in refining the classification criteria.

4. Inconsistent Terminology:

The use of terms like "accurate," "ambiguous," "vague," and "confusing" could be standardized throughout the section for better coherence. Ensuring consistent language will improve the overall readability and interpretation of the results. Ensure consistent use of terminology throughout the Results Section. Streamline the language used to describe the classification outcomes, making it easier for readers to follow and interpret the findings.

The Discussion Section

1. Limited Exploration of Expert Suggestions:

While the discussion briefly touches upon expert suggestions, it could benefit from a more detailed examination of how expert consultations influenced the refinement of service descriptions and the application of DESDE codes. Explicitly linking expert feedback to specific challenges or improvements in the classification system would enhance the discussion. Dedicate a section to thoroughly explore the impact of expert consultations on the classification system. Provide specific examples of services that were refined based on expert input and discuss how this collaboration improved the accuracy of the classification.

2. Insufficient Exploration of Service Accuracy Levels:

The discussion provides the overall percentage of services accurate at different levels of disambiguation, but a deeper analysis of the implications and challenges associated with these accuracy levels is warranted. Discussing specific examples or patterns in services that were accurate or faced challenges at different levels would provide a richer understanding. Conduct a more nuanced analysis of the accuracy levels reported, discussing specific services that excelled or faced challenges at different stages of disambiguation. This would provide a more comprehensive understanding of the classification process.

3. Limited Exploration of Code Adaptation Suggestions:

The discussion briefly mentions suggestions for adapting the DESDE system to the education sector, such as the need for new codes to differentiate day and evening school. Further exploration and discussion of these suggested adaptations, including potential implications and challenges, would enhance the completeness of the discussion. Elaborate on the suggestions for adapting the DESDE system to the education sector. Discuss the rationale behind proposed changes, potential benefits, and challenges associated with incorporating new codes or modifying existing ones.

4. Incomplete Integration of ISCED System:

The discussion mentions the potential complementarity of international classifications like DESDE and ISCED but does not delve into the practical implications of integrating these systems. Further exploration of how combining information from DESDE and ISCED could enhance the understanding of the education sector would strengthen the discussion. Explore in detail how integrating information from the DESDE and ISCED systems can provide a more holistic view of the education sector. Discuss specific examples where this combination could enhance the classification and understanding of educational services.

5. Practical Implications:

Expand on the practical implications of the study's findings for policymakers, educators, or researchers. Discuss how the standardized classification system could contribute to more effective educational service planning and delivery.

[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: Partly

**********

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: This is a highly worth while study establishing a proof of concept in relation to the use of robust classification and terminology (taxonomical framework) to the area of school/education services for mental health service users with broader implications for systems analysis in education.

The authors have used existing an evidence based tools with expert analysis to assess the terminology used in education services and found considerable ambiguity and confusion. The outcomes of this work lay a basis for the development of standardised classification systems for comparison, planning and decision making in a key area of human services, namely education.

One minor point, the authors refer to three levels in the proc less of disambiguation - but there appeared to be four in the tables and discussion - namely accurate, vague, confusing and ambiguous. This needs to be clearer in the outline of "The Procedure" Step 2.

Reviewer #2: Dear Editor,

I hope this letter finds you well.

I would like to express my gratefulness for your trust and for giving me the opportunity to review the manuscript titled "Clarifying Terminology and Definitions in Education. no. PONE-D-23-36992 ".

According to objectives of the study "to test the applicability of a standard classification", and the Description and Evaluation of Services and DirectoriEs (DESDE), to evaluate education services for mental health users in the context of Spain and The Netherlands.

The title holds significant importance, as do the objectives of the study. However, here are some comments about where enhancements can be made to the manuscript.

1- Method need to clarify and demonstrate the structural formula employed in comparing the educational services between the two countries under examination. This clarification will provide a clearer understanding of the methodology employed and facilitate a more comprehensive analysis of our findings.

2- In the discussion part need to provide a detailed comparison between Spain and The Netherlands. This comparative analysis will light on any differences and contribute to a deeper understanding of the study’s outcomes.

Thank you once again for your consideration.

Sincerely,

Ahmad Hanani

**********

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Reviewer #1: No

Reviewer #2: No

**********

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Submitted filename: Article report 25.02.2024.pdf

Clarifying Terminology and Definitions in Education services for Mental Health Users: A Disambiguation Study

PONE-D-23-36992R1

Dear Dr. Gutierrez-Colosia,

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.

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Kind regards,

Faten Amer, PhD in Health Sciences

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

The authors have done all the required revisions and the manuscript is ready for publication.

Reviewers' comments: