PONE-D-24-06909A qualitative study of health visitors’ family focused practice with mothers with mental illness: perspectives of health visitors, mothers and spousesPLOS ONE

Dear Dr. Grant,

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 Jul 04 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,

Sudarshan Subedi

Academic Editor

PLOS ONE

Journal Requirements:

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

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

2. We note that you have referenced Bunting L, McCartan C, Davidson G, Grant A, McBride O, Mulholland C, et al. which has currently not yet been accepted for publication. Please remove this from your References and amend this to state in the body of your manuscript: (Bunting L, McCartan C, Davidson G, Grant A, McBride O, Mulholland C, et al. [Unpublished]) as detailed online in our guide for authors

http://journals.plos.org/plosone/s/submission-guidelines#loc-reference-style 

Additional Editor Comments:

Thank you for submitting the manuscript. This is well written and I enjoyed reading this. In addition to the reviewer's comments, here are some comments.

- The title and/or the abstract should reflect where the study was carried out (country and region).

- Excellent introduction with relevant background information

- The design and method section indicates that this paper is based on the qualitative findings of a larger mixed methods study. However, it doesn’t say in details about the study approach of the qualitative part. Is it just a simple descriptive or analytical qualitative study or based on any theoretical approach?

- Sampling and data collection techniques are clear and specific. Better to write the average time (as stated 60 minutes) with minimum time and maximum time of the interview. I don't suggest using the term 'generally lasted'.

- Data analysis and rigour is well-explained.

- In the first para of 'discussion' section, it states "findings highlighted low level of FFP". This needs to be elaborated as the findings are qualitative and it's hard to say the low level in specific. It would be better if you provide some additional information in the data analysis section to support this claim. Since the low levels of FFP is one of the conclusions of the study, I suggest to make it clearer and more specific.

- I also suggest to illustrate the themes and relevant codes in a diagram as diagrammatic illustrations are very beneficial for the audience/readers to get a glimpse of the findings and guide them thoroughly in understanding the findings/discussion

[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. 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

**********

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

**********

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 very well-written manuscript covering an interesting and important topic. It gathers the perspectives of mothers, partners, and health visitors which provides a holistic view of the topic.

My main observation from reading this manuscript is that health visitors show dedication, expertise and compassion when treating mothers with mental illness (particularly PND). The main barrier to providing care for more serious mental illnesses and for treating partners would seem to stem from a shortage of resources (training, and particularly time). In the final sentence of the conclusion, it is mentioned that all the health visitors in the study exceeded the recommended workloads. I feel like this information should have been mentioned earlier as it provides important context for the findings.

I will now go through the manuscript with comments/suggestions on each section.

Title: Should it say ‘partners’ rather than spouses?

Abstract: I thought that the abstract was very comprehensive but could perhaps highlight the shortage of resources as mentioned above.

Introduction.

Page 4. A brief explanation of psycho education would be helpful.

Final sentence only mentions mothers and partners but the interview questions (on page 9) suggest that health visitors were also asked about the adequacy of support.

Design and methods.

I’m not sure whether the description of the survey stage of the study needs to be detailed here, but that is for the editors to advise. The authors might just need to refer to the survey results as providing criteria for selecting the sample of health visitors.

Page 6. The authors assigned pseudonyms to the participants but did not use them when reporting the findings. I wondered why this might be?

Data collection

Page 7, penultimate sentence says ‘both’ [perspectives] which implies 2 rather than the 3 that were gathered.

Page 8. Only the topic guide for the health visitor interviews is included. It would be helpful to see the topic guide(s) used in mothers’ and partners’ interviews.

Findings

Research participants. Page 12. It would be helpful to know how many of the health visitor participants were trained in FFP.

Themes

Pages 15 – 17. It would be easier to follow if some of the longer quotes were indented. There are also some long complex sentences which might be better broken up (e.g. the sentence beginning ‘Relatedly’ on page 16).

Page 18. The final sentence on the page is a good example of the dedication of health visitors.

Page 21. This section highlights resource issues relating to training (when is mental illness beyond their professional boundaries?) and workload. It was interesting that health visitors also alluded to their own needs (e.g. ‘mentally drained’) and I wondered if/how these were being met. This could be picked up in the discussion.

Page 23. This section highlights how health visitors are able to empathise with the women in their care. It made me wonder whether recommendations to employ more male health visitors were appropriate.

Discussion

P24. I realise I keep mentioning this, but I think that the issue of workload should be mentioned in the first paragraph. It might explain why health visitors prioritised the needs of mothers rather than partners’ needs.

P25. I liked the suggestions for promoting engagement with fathers. The findings indicate that partners would like information that would enable them to support mothers more effectively.

Fathers as financial providers is a bit of a gender stereotype – it needs to be clearer that that is their perception of themselves (if indeed that was the case for all partner participants).

Overall, I think that the manuscript is very well-presented, and I do not wish my suggestions to be taken as unduly critical. The authors are free to disregard my alternative interpretations of the findings which come from my own research with healthcare professionals who often struggle to provide the level of care that they would like to within time/resource constraints.

**********

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: 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.

A qualitative study of health visitors’ family focused practice with mothers with mental illness in Northern Ireland: perspectives of health visitors, mothers and partners

PONE-D-24-06909R1

Dear Dr. Grant,

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,

Sudarshan Subedi

Academic Editor

PLOS ONE