PONE-D-24-30763Opening the digital doorway to sexual healthcare: Recommendations from a Behaviour Change Wheel analysis of barriers and facilitators to seeking online sexual health information and support among underserved populationsPLOS ONE

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Additional Editor Comments:

Dear Authors,

Thank you for submitting your manuscript titled “Opening the digital doorway to sexual healthcare: Recommendations from a Behaviour Change Wheel analysis of barriers and facilitators to seeking online sexual health information and support among underserved populations” for consideration. Your work addresses a crucial issue, and the findings have the potential to make a significant impact. However, I recommend the following specific revisions:

1. Enhance the Global Relevance

Action: Expand the discussion to address how the findings might be applicable in non-UK contexts, particularly in low- and middle-income countries.

Specific Examples: Include a paragraph in the discussion section that explores how the barriers and facilitators identified in your study could manifest differently in healthcare systems outside the UK, especially where digital infrastructure may be less developed. Suggest possible adaptations of your recommendations for these settings.

2. Address Overestimation and Underestimation of Data

Action: Revisit the discussion section to ensure that the recommendations are appropriately scaled to the study’s sample size and qualitative nature. Explicitly state the limitations in generalizing the findings across all underserved populations.

Specific Examples: When discussing recommendations like improving digital literacy or providing video/audio options, clarify that these are based on the specific experiences of your participants and may need further validation in other contexts. You could add language such as, “While these recommendations are grounded in the data from our study sample, further research is needed to confirm their applicability across diverse underserved populations.”

3. Explicitly Acknowledge the Study’s Limitations

Action: Include a dedicated subsection on limitations within the discussion to transparently address the study’s constraints.

4. Provide a More Nuanced Data Interpretation

Action: Refine the interpretation of your findings to avoid broad generalizations. Highlight the complexity and variability of barriers and facilitators across different subgroups within the underserved populations.

Specific Examples: In the results section, when discussing barriers such as privacy concerns, acknowledge that these concerns might vary significantly depending on cultural background, age, and digital literacy levels. Consider adding a sentence like, “Privacy concerns were significant among our sample; however, these concerns may differ in intensity and nature among other subgroups not represented in this study.”

5. Detail Methodological Rigor

Action: Provide more transparency regarding the thematic analysis process. Detail how themes were validated and whether any checks for inter-rater reliability were conducted.

Specific Examples: In the methods section, add a brief description of the coding process and whether multiple researchers were involved in analyzing the data. If inter-rater reliability was not assessed, consider acknowledging this as a limitation and suggest that future research could incorporate this step for enhanced rigor.

The manuscript does not mention whether data saturation was achieved. Qualitative research does not aim for generalizability in the same way as quantitative studies, but transferability (the applicability of findings to other contexts) is important. The manuscript does not sufficiently discuss how the findings might transfer to other underserved populations or settings.

6. Discuss Policy and Practice Implications

Action: Expand the discussion on the practical implications of your findings, particularly focusing on how your recommendations could be implemented in real-world settings.

Specific Examples: For each major recommendation (e.g., improving digital literacy, increasing inclusivity), include a brief discussion of the steps needed for implementation at various levels. For instance, “To implement our recommendation of increasing digital literacy, local health authorities could collaborate with community organizations to deliver targeted training programs that are culturally and linguistically appropriate.”

I look forward to reviewing the revised manuscript

Best regards,

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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: Partly

Reviewer #2: Yes

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

Reviewer #1: N/A

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

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Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

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Reviewer #1: Yes

Reviewer #2: Yes

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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: 1. Which of the qualitative methods has been used?

2. Add interview questions

3. Reference should be given for the steps of data reduction

4. The criteria used to validate the findings should be added.

5. In a table, the process of abstraction should be mentioned (for a one them from the interview text

6.

You can also use the following Qualitative articles

1. Taghipour, A., Karimi, F., Latifnejad Roudsari, R., Mazlom, S. Coping Strategies of Women Following the Diagnosis of Infertility in Their Spouses: A Qualitative Study. Evidence Based Care, 2020; 10(1): 15-24. doi: 10.22038/ebcj.2020.42136.2120

2. Taghipour A, Karimi FZ, Roudsari RL. Exploring iranian women’s perceptions and experiences of their spouses’ behavior towards male factor infertility: A qualitative study. Current Women's Health Reviews. 2020 Feb 1;16(1):60-8.

Reviewer #2: Overall this is a well written manuscript with sound qualitative methodology. The authors aim to identify barriers and facilitators for seeking online sexual health information and support, and use their findings from semi-structured interviews to make recommendations to support underserved populations.

I do feel that the findings from this study add to the medical literature to advance access to online sexual health services for vulnerable or marginalized populations.

The main limitation is with the participants-- while diverse in age, ethnicity and education, such wide diversity may limit applicability of the findings to specific populations (ie young adults). Moreover, certain demographic factors were not included, such as urban/rural location, distance to medical services or establishment with a primary care physician. The authors state 51% lived in "most deprived areas of the UK". How is this defined-- average income? percentage falling below poverty level?

I would encourage the authors to acknowledge these limitations in the discussion section.

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Reviewer #1: No

Reviewer #2: No

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Opening the digital doorway to sexual healthcare: Recommendations from a Behaviour Change Wheel analysis of barriers and facilitators to seeking online sexual health information and support among underserved populations

PONE-D-24-30763R1

Dear Dr. McLeod

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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Ilhem Berrou, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Thank you for addressing the reviewers' comments. Please review the link posted on page 10 and here: (https://www.bct-taxonomy.com/) and provide a current reference if available.