PONE-D-24-23224Addressing organizational learning to increase readiness for physical activity promotion in seven German nursing homesPLOS ONE

Dear Dr. Frahsa,

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 Sep 09 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.

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We look forward to receiving your revised manuscript.

Kind regards,

Pradeep Paraman

Academic Editor

PLOS ONE

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

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2. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

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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

Reviewer #3: Partly

Reviewer #4: No

Reviewer #5: Yes

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: No

Reviewer #4: I Don't Know

Reviewer #5: Yes

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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: Yes

Reviewer #2: Yes

Reviewer #3: No

Reviewer #4: No

Reviewer #5: Yes

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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: Yes

Reviewer #3: No

Reviewer #4: Yes

Reviewer #5: 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: The article is of excellent quality, addressing a highly important topic for the scientific community. To further enhance the manuscript, I suggest the following improvements:

1) Provide an international overview of the topic in the introduction, highlighting what has been done in other countries or what remains unexplored;

2) Elaborate on the practical implications of the study, clarifying its significance for society, professionals in the field, and the healthcare system, among other aspects.

3) I suggest reading the studies listed below, as I believe they can contribute to the introduction and/or discussion of the article, and if possible, cite any of them:

GOUVÊA, JOSÉ ALÍPIO GARCIA ; ANTUNES, MATEUS DIAS ; BORTOLOZZI, FLAVIO ; MARQUES, ANDREA GRANO ; BERTOLINI, SÔNIA MARIA MARQUES GOMES . Impact of Senior Dance on emotional and motor parameters and quality of life of the elderly. Rev Rene, v. 18, p. 51-58, 2017. Disponível em: https://www.redalyc.org/pdf/3240/324049855008.pdf

OLIVEIRA, D. V. ; GIACOMIN, L. L. ; ANTUNES, M. D. ; GRANJA, C. T. L. ; SILVA, E. C. ; NASCIMENTO, K. V. M. O. ; NASCIMENTO JUNIOR, J. R. A. . Physical fitness of elderly persons with systemic arterial hypertension users of academies of the third age of Maringá-pr. JOURNAL OF PHYSICAL EDUCATION (ONLINE), v. 31, p. e-3130, 2020. https://periodicos.uem.br/ojs/index.php/RevEducFis/article/view/46391

ACENCIO, Fábio Ricardo et al. Influência do exercício físico na qualidade de vida de idosas de um grupo social de Tapejara, PR. Revista da Universidade Vale do Rio Verde, v. 15, n. 2, p. 658-666, 2017. Avaliable: http://periodicos.unincor.br/index.php/revistaunincor/article/view/3893

OLIVEIRA, D. V. ; MUZOLON, L. G. ; ANTUNES, M. D. ; NASCIMENTO JUNIOR, J. R. A. . Impact of swimming initiation on the physical fitness and mental health of elderly women. ACTA SCIENTIARUM. HEALTH SCIENCES (ONLINE), v. 41, p. 43221, 2019. https://periodicos.uem.br/ojs/index.php/ActaSciHealthSci/article/view/43221

OLIVEIRA, D. V. ; RODRIGUES, A. R. ; FERREIRA, A. G. ; PIVETTA, N. R. S. ; ANTUNES, M. D. ; NASCIMENTO JUNIOR, J. R. A. . Sintomas de Ansiedade e Indicativos de Depressão em Idosas Praticantes do Método Pilates no Solo. REVISTA PSICOLOGIA E SAÚDE, v. 12, p. 3-12, 2020. http://pepsic.bvsalud.org/scielo.php?script=sci_abstract&pid=S2177-093X2020000400002

OLIVEIRA, D. V. ; RODRIGUES, A. R. ; FERREIRA, A. G. ; PIVETTA, N. R. S. ; ANTUNES, M. D. ; NASCIMENTO JUNIOR, J. R. A. . Sintomas de Ansiedade e Indicativos de Depressão em Idosas Praticantes do Método Pilates no Solo. REVISTA PSICOLOGIA E SAÚDE, v. 12, p. 3-12, 2020. http://pepsic.bvsalud.org/scielo.php?script=sci_abstract&pid=S2177-093X2020000400002

VICENTINI DE OLIVEIRA, DANIEL ; DOS SANTOS CAMPOS, RENAN ; DIAS ANTUNES, MATEUS ; PACHECO REIS BATISTA, ROSEANA ; ANDRADE DO NASCIMENTO JÚNIOR, JOSÉ ROBERTO . Efeito de um programa de treinamento funcional sobre a ansiedade e autoestima de idosas. REVISTA BRASILEIRA DE PSICOLOGIA DO ESPORTE, v. 9, p. 1-11, 2019. https://portalrevistas.ucb.br/index.php/RBPE/article/view/9614

OLIVEIRA, D. V. ; FERREIRA, A. A. M. ; OLIVEIRA, D. C. ; LEME, D. E. C. ; ANTUNES, M. D. ; NASCIMENTO JUNIOR, J. R. A. . Association of the practice of physical activity and of health status on the quality of life of women with fibromyalgia. JOURNAL OF PHYSICAL EDUCATION (ONLINE), v. 30, p. 3027, 2019. Doi: https://doi.org/10.4025/jphyseduc.v30i1.3027  Disponível em: https://www.scielo.br/j/jpe/a/qDN85jP7dZ6dVBCGPHvdqYv/abstract/?lang=en

Reviewer #2: The manuscript is worth to read, present in clear and detail on how the study was conducted and the data was presented. it is an excellent teamwork to realize this paper. There is no issue on research ethics or publication ethics.

One unclear statement on how hours of systematic observation were determined? This comment is referred to the data collection section.

Reviewer #3: Title: This is a great topic.

Introduction:

Great! You provided the background, included the gap in previous studies, and stated objectives and specific questions. You mentioned that PA related structures and learning process increase the organizational readiness for PA promotion, please describe how it can do so.

Methodology

Please change study sampling into Sampling method and write setting before the sampling. Adhere to the PLOS guidelines for writing the report

You have reported that you chose 8 NHS but did not specify how you chose the 4 non-profit care organisations and 8 NHS

Data collection: is it a face to face interview? What were the main informations sought by the interview schedule?

How did you ensure the validity and reliability of the tool and the study?

How did you maintain reflexivity of the results?

What information did you seek from documents in all NHS and mentions clearly what documents did you look?

Specify clearly about the processes you used in mixed method analysis

Results:

The results are presented subjectively, please describe how you went through the process of generating results. What were the themes and subthemes? Describe the findings under main domains of the collected data using each of the methods in the table. What are the findings from each of the data collection methods you mentioned in the methodology?

Discussion: Revise discussion based on the findings

Strengths and limitations: well written

Conclusion: Summarise the findings based on your objectives.

Reviewer #4: Although I share your point of view that promoting physical activity among nursing home residents is essential and that actually physical activity is insufficiently incorporated into organizational structures, it is non clear the type of physical exercise or the difference between physical exercise and mobilization. The topic is very interesting but it is not getting to the point and the mixed methods for data collection are a little bit confusing. I

Reviewer #5: The benefit of PA for NH residents and how PA is operationalized in the study were not clearly indicated. The ethical statement should be included with the ethical consideration because they are the same. Research question number two should be rephrased indicating post intervention assessment. It is best to avoid using "1 out of 7, 2 out of 7,..." by indicating the n=7 on the title of the tables. The PA promoting action should be stated clearly. Correct the referencing error e.g. page 13 and 17.

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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

Reviewer #2: No

Reviewer #3: No

Reviewer #4: No

Reviewer #5: No

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[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.

PONE-D-24-23224R1Addressing organizational learning to increase readiness for physical activity promotion in seven German nursing homesPLOS ONE

Dear Dr. Frahsa,

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. Thank you for your detailed revisions and the substantial improvements made to the manuscript. Your efforts to address the reviewers' comments are greatly appreciated and have enhanced the clarity and depth of the study.

However, there are a few minor issues that still require attention:

1. Redundancy in Conclusion : There is some repetition in the conclusion section regarding the prioritization of PA promotion within organizational structures. Please revise to eliminate redundancy and ensure clarity.
2. Specific Examples : Providing specific examples or metrics to illustrate the changes in organizational readiness and the impact of PA-promoting actions would strengthen the findings.
3. Clear Integration : Ensure that the connection between the study’s objectives, findings, and how they address the research questions is explicitly clear.
4. Future Directions : A brief discussion on future research or implications for other NH settings would be valuable.

Specifically:

The revised abstract addresses several of the reviewers' comments, but it may still require further adjustments to fully meet all the suggestions:

<h3>Areas for Further Improvement </h3>

1. Sampling and Methodology Details : Although the abstract mentions a mixed-methods approach, it does not detail how the sampling was conducted or provide specifics on the selection of NHS and non-profit care organizations. This is something Reviewer #3 highlighted.
2. Ethical Statement : The abstract does not include information about the ethical considerations of the study, which was noted by Reviewer #5.
3. Terminology Clarity : While the abstract touches on physical activity promotion and organizational readiness, it does not clearly define the types of physical exercises or differentiate between physical exercise and mobilization as suggested by Reviewer #4.
4. Reflexivity and Validity : The abstract does not address how reflexivity was maintained or the validity and reliability of the tools used, which were concerns raised by Reviewer #3.
5. Referencing Errors : The abstract does not address referencing errors. While these may not be directly relevant to the abstract itself, ensuring that all references are correct in the full manuscript is important (Reviewer #5).

The revised abstract meets several of the reviewers' comments, particularly in explaining the significance of the study, outlining the mixed-methods approach, and summarizing the findings. However, it could be further refined by providing additional details on sampling methods, ethical considerations, and clarifying terminology. Additionally, addressing how reflexivity and validity were handled in the study would strengthen the abstract further.

The revised introduction addresses several of the reviewers' comments, but there are still some areas where further improvement could be made. 

<h3>Areas for Further Improvement </h3>

1. Clarity and Structure :
   
   • The text would benefit from a more structured presentation of how PA benefits have been observed in various studies and how these findings relate to the NH context.
2. Definition and Differentiation :
   
   • The introduction could more clearly define the types of PA and differentiate between physical exercise and mobilization, as noted by Reviewer #4. This will help clarify the focus of the study.
3. Specific Focus on PA Promotion in NHs :
   
   • Although the introduction discusses general PA benefits and examples from other studies, it could more explicitly state how these findings are relevant to promoting PA specifically within nursing homes (NHs). More emphasis on how the study addresses the gap in PA promotion within NHs would strengthen this section.
4. Practical Implications and Framework :
   
   • While the practical implications are mentioned, a more detailed framework or example of how PA can be integrated into NH routines would be beneficial. This would provide a clearer connection between the study’s findings and practical applications, as suggested by Reviewer #1.

<h3>The revised introduction largely satisfies the reviewers' comments by providing an international perspective and addressing the practical implications of the study. However, further refinement is needed to improve clarity, address formatting issues, and provide a more detailed explanation of how PA benefits specifically apply to the NH context. Ensure that the text is well-structured, free of typos, and clearly delineates the types of PA and their relevance to the study’s focus on NHs.</h3>

The revised data collection section makes several improvements, but there are still some areas to address based on the reviewers' comments. 

<h3>Areas for Further Improvement </h3>

1. Methodological Details :
   
   • Face-to-Face Interviews : Although the interviews are mentioned, further details on how the interviews were conducted (e.g., main topics or questions) would enhance clarity. This was part of Reviewer #3's comment.
   • Validity and Reliability : There is no mention of how the validity and reliability of the data collection methods were ensured. Adding this information would address Reviewer #3's concern about ensuring the validity and reliability of the tools used.
2. Reflexivity :
   
   • The section does not address how reflexivity was maintained during the data collection process. Including a statement on how the researchers accounted for their own biases and perspectives would be important (Reviewer #3).
3. Detailed Analysis Process :
   
   • The specific processes used in mixed-method analysis are not described. Including details on how the data from different methods were integrated and analyzed would address Reviewer #3’s request for clarity on mixed-method analysis.
4. Formatting and Consistency :
   
   • There are some formatting and clarity issues, such as redundant parentheses and incomplete sentences. Ensure the text is polished for readability.
5. Ethnographic Fieldnotes :
   
   • Clarify the role and purpose of the ethnographic fieldnotes in the systematic observations. This will help in understanding how these notes contributed to the analysis (Reviewer #3).

<h3>The revised data collection section makes significant strides in addressing the reviewers' comments by specifying methods, detailing observation hours, and listing document types analyzed. However, it still needs to include information on the validity and reliability of the methods, reflexivity, and a detailed description of the mixed-method analysis process. Addressing these additional aspects will help meet all the reviewers' comments more comprehensively.</h3>

The revised data analysis section addresses many of the reviewers' comments but could still be enhanced in a few areas. 

<h3>Areas for Further Improvement </h3>

1. Reflexivity :
   
   • The section does not mention how reflexivity was maintained during the analysis. Including a statement about how researchers accounted for their own biases and perspectives would strengthen this part of the analysis (Reviewer #3).
2. Mixed-Method Analysis Integration :
   
   • While the section details the qualitative analysis, it does not explain how the results from different data collection methods (e.g., interviews, observations, document analysis) were integrated. This is important for understanding the mixed-method analysis process (Reviewer #3).
3. Ethical Considerations :
   
   • There is no mention of ethical considerations related to data analysis. Including a brief statement on how ethical issues were handled during the analysis would be beneficial (Reviewer #5).

<h3>The revised data analysis section provides a detailed and structured explanation of the analytical methods used, including the development and application of the PAIAN tool, and the use of qualitative content analysis. It addresses several of the reviewers' comments, particularly regarding the clarity of the analysis process and methodological rigor. However, it could be further improved by including information on reflexivity, integrating mixed-method analysis results, addressing ethical considerations. </h3>

The revised section on the analysis of organizational and individual learning processes addresses several key points raised by the reviewers. 

<h3>Areas for Further Improvement </h3>

1. Detailed Description of Learning Processes :
   
   • The revised section mentions identifying which learning processes were initiated but does not provide specific details about these processes or their impact on organizational readiness. Including examples or more detailed descriptions of the learning processes would strengthen the analysis (Reviewer #3).
2. Ethical Considerations :
   
   • The section still does not explicitly mention how ethical considerations were handled during the analysis phase. Adding a brief statement on this aspect would fulfill Reviewer #5's comment about including ethical considerations (even if these are included in the ethical statement).
3. Clarify Integration with Kim’s Model :
   
   • While the section explains the use of Kim's model, it would benefit from a clearer explanation of how the model was applied to the data specifically. More details on how the learning processes were mapped to the changes in organizational readiness would be useful.
4. Formatting and Clarity :
   
   • Ensure that the text is well-organized and free from any grammatical issues or awkward phrasing. For instance, the phrase "provided comprehensive, supportive, and scientific guidance" could be rephrased for clarity.

<h3>The revised section on the analysis of organizational and individual learning processes effectively addresses several of the reviewers' comments, particularly regarding the theoretical framework, reflexivity, and integration of data sources. However, further improvements could be made by providing more detailed descriptions of the learning processes, clarifying the application of Kim's model, addressing ethical considerations, and ensuring clarity and readability in the text.</h3>

The revised section on ethical considerations covers several important aspects of the study’s ethical framework. 

<h3>Areas for Further Improvement </h3>

1. Repetition and Clarity :
   
   • The text repeats the ethical approval information. This redundancy should be removed to avoid confusion and enhance clarity.
2. Detail on Data Handling :
   
   • Although the text mentions data protection, it would be helpful to provide a brief overview of how data were securely stored and managed beyond pseudonymization. This adds completeness to the ethical considerations.
3. Ethical Considerations in Analysis :
   
   • There is no mention of how ethical considerations were integrated into the data analysis process, such as how the analysis was conducted ethically. Including this information would provide a more comprehensive view of ethical practices throughout the study.

<h3>The revised ethical considerations section effectively addresses several key aspects, including ethical approval, data protection, informed consent, and voluntary participation. To fully address all concerns, it is important to remove redundancy, provide additional details on data handling, and include information on how ethical considerations were maintained during the analysis phase.</h3>

The revised "Results" section provides a structured outline of how the findings are presented, addressing several of the reviewers' comments. 

<h3>Areas for Further Improvement</h3>

1. Detail on Results :
2. The section provides a high-level overview but lacks specific details about the findings. For a comprehensive presentation, include more detailed results on each part. Specifically:For the pre-post analysis, provide key findings on changes in organizational readiness.
3. For the learning processes, outline specific processes and their impact.
4. For the implementation and learning processes, describe key actions and their effects on PA promoting structures.
5. Findings from Data Collection Methods :
   
   • Describe the results obtained from different data collection methods (e.g., interviews, observations) in detail. This addresses Reviewer #3’s comment about describing the findings from each method.
6. Integration of Results :
   
   • Explain how the findings from the different parts are integrated and how they contribute to the overall understanding of the study. This helps in understanding the coherence and impact of the results.
7. Refinement and Clarity :
   
   • Ensure that the section is free from jargon or overly complex language. For instance, clarify terms like "PA promoting structures" and "PA-friendly built and social environments" for readability.

<h3>The revised "Results" section outlines a clear structure for presenting the findings, which addresses the need for organization and clarity. However, it would benefit from additional details on the specific findings of each part, a more explicit integration of results, and a clear presentation of how results from different data collection methods contribute to the overall conclusions. Adding these details will make the results more comprehensive and aligned with the reviewers' feedback.</h3>

The revised "Conclusion" section provides a summary of the study's findings and their implications.

<h3>Areas for Further Improvement </h3>

1. Redundancy :
   
   • The sentence "PA promotion is now prioritized and part of the organization's structures and culture and does not depend on a few individual members or is just an informal agreement between staff" is repeated. This redundancy should be removed for clarity and conciseness.
2. Specific Findings :
   
   • Include specific examples or metrics to illustrate the changes in organizational readiness and the impact of the implemented PA-promoting structures. This adds depth to the summary and shows concrete outcomes.
3. Clear Integration of Results :
   
   • Explicitly connect the findings to the study’s objectives and the changes observed. This helps clarify how the results address the research questions and how the study contributes to the field.
4. Future Directions :
   
   • Consider adding a brief statement on future research or implications for other NHs. This could provide additional value by suggesting how the findings could be applied or extended.

<h3>The revised conclusion addresses most of the reviewers' comments, including summarizing findings, discussing practical implications, and emphasizing the role of learning processes. By removing redundancy, specifying findings, integrating results, and suggesting future directions, the conclusion can be further strengthened to provide a comprehensive and impactful summary of the study.</h3>

Once these minor issues are addressed, the manuscript will be well-positioned for further consideration. Thank you again for your dedication to improving the quality of this work.

Please submit your revised manuscript by Oct 24 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,

Pradeep Paraman

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

[Note: HTML markup is below. Please do not edit.]

[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.

PONE-D-24-23224R2Addressing organizational learning to increase readiness for physical activity promotion in seven German nursing homesPLOS ONE

Dear Dr. Frahsa,

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 note that we have only been able to secure a single reviewer to assess your manuscript. We are issuing a decision on your manuscript at this point to prevent further delays in the evaluation of your manuscript. Please be aware that the editor who handles your revised manuscript might find it necessary to invite additional reviewers to assess this work once the revised manuscript is submitted. However, we will aim to proceed on the basis of this single review if possible.

Please submit your revised manuscript by Mar 01 2025 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,

Avanti Dey, PhD

Staff Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

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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 #6: (No Response)

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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 #6: Yes

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

Reviewer #6: N/A

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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 #6: Yes

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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 #6: 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 #6: I realize that this manuscript has now been reviewed two different times by five reviewers in total, and so I will be mindful of that with my comments. My suggestions (which are at the discretion of the authors) focus mainly on readability and making sure that this manuscript is as accessible and understandable as possible for readers.

Abstract

• I would suggest defining KIM

Introduction

• There is a very long first paragraph. Can this be broken into smaller, more readily sub-sections for the reader?

• You have defined both NHs (nursing home contexts) and NH (nursing homes) somewhat differently. Consider changing to avoid confusing (or perhaps not using NH). I do not believe it is necessary to define both the singular (nursing home; NH) and the plural (nursing homes; NHs) use of a word.

Methods

• One thing that was not clear to me was what happened to cause the organizational changes between 2020 and 2023? There is some mention of this in the three phases that are briefly described, but it is not very detailed. As a reader, I do not understand what caused the shift in organizational changes between these two time points. Was it the PA promoting actions in phase 2? If so, this information is nearly as important to describe in the methods (what was done) to help illustrate why there were changes in these nursing homes. The important ‘story’ here should be the explanation of what caused these changes in readiness, not the change itself.

• I would suggest creating (re-labeling) a section earlier in the methods that describes the three phases of the study. Currently, this is mixed in with the ‘Analysis of Change’. It might help the reader better understand the sequence of these events first, then the sections on the tools used and how organizational change was assessed.

Results

• Please see an error with a citation on line 301 of the results. There seems to be other places in the results and discussion with a similar error with the citation.

Discussion

• Lines 383-384: I believe you mean to say ‘in agreement with Abbott et al’ instead of ‘we can confirm with Abbott et al’

• Line 415: I believe you mean to say ‘oversaw’ instead of ‘overviewed’

• Line 422: I believe you might want to say ‘potential opportunities for…’

• Line 438: Instead of ‘irritations’ you may want to say ‘which led to several challenges with the study’

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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 #6: Yes:  Mark Stoutenberg

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PONE-D-24-23224R3Addressing organizational learning to increase readiness for physical activity promotion in seven German nursing homesPLOS ONE

Dear Dr. Frahsa,

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 Apr 18 2025 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,

Amal Diab Ghanem Atalla, ph.D

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments :

Dear Author,

Thank you for submitting your manuscrip to PLOS ONE Journal. After careful evaluation by our reviewers and the editorial team, we have determined that your manuscript has merit but requires substantial revisions before it can be considered for publication.

The reviewers have identified several key areas that need significant improvement, including [briefly mention the main concerns, e.g., methodological limitations, insufficient data analysis, unclear presentation of results, or inadequate discussion]. We encourage you to carefully address each of the reviewers' comments and provide a detailed response outlining the changes made. If any suggestions cannot be implemented, please provide a clear justification.

Given the extent of the required revisions, your manuscript will undergo another round of peer review upon resubmission. Please ensure that your revised manuscript adheres to the journal’s formatting and reporting guidelines.

We appreciate your efforts and look forward to receiving your revised manuscript. Please do not hesitate to reach out if you require any clarification.

Best regards,

[Amal Diab Ghanem Atalla]

[Academic editor at PLOS ONE journal]

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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 #7: (No Response)

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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 #7: Yes

**********

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

Reviewer #7: Yes

**********

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 #7: Yes

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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 #7: Yes

**********

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 #7: Strengths:

✅ Relevance and Importance: The study addresses a crucial issue—physical activity promotion in nursing homes—which has significant implications for residents' physical and mental well-being.

✅ Clear Research Aim: The abstract effectively outlines the study’s goal: investigating organizational and individual learning processes to enhance readiness for physical activity promotion.

✅ Methodological Rigor: The mixed-methods approach (interviews, documents, surveys, photologs, and fieldnotes) is well-justified, demonstrating a robust and comprehensive data collection strategy.

✅ Findings and Contribution: The study identifies key learning processes and highlights the role of leadership and shared values, contributing to both theory and practice in nursing home management.

Areas for Improvement:

Clarity and Readability:

Some sentences are long and complex, making it harder to grasp key points quickly. Consider breaking them down for better readability.

Example:

"Applying a theoretical model of organizational learning from public management, we identified key learning processes driving these changes."

Suggestion: "Using a public management organizational learning model, we identified key processes that drove these changes."

Results Could Be More Explicit:

While the abstract mentions “notable shifts” in organizational readiness, more specificity would strengthen the impact. What were the most significant changes? Were there measurable improvements?

Avoid Jargon Without Explanation:

Terms like "single and double-loop learning" are used without prior explanation. A brief clarification (or examples) would make the findings more accessible.

Conclusion Could Be More Concise:

The final sentences could be streamlined to reinforce the study’s impact without redundancy.

introduction is well-structured, provides a strong background on the topic, and effectively situates your study within the existing literature. However, there are areas where clarity, conciseness, and coherence can be improved. Below is a detailed review, including strengths and areas for improvement.

Strengths

✅ Clear Research Context & Justification: You effectively distinguish between physical activity (PA) and mobilization, and you highlight the well-documented benefits of PA in nursing homes (NHs). The discussion of prior studies across different regions strengthens the argument.

✅ Identification of Research Gap: The introduction successfully points out that while PA benefits are well established, little is known about the organizational and individual learning processes necessary for PA promotion in NHs. This gap justifies your study’s focus.

✅ Integration of Theoretical Frameworks: Your discussion on organizational readiness, learning processes, and Kim’s OADI-SMM model demonstrates a strong theoretical foundation. The distinction between single-loop and double-loop learning is well explained.

✅ Clearly Stated Research Questions: The three research questions at the end provide a precise direction for the study.

Areas for Improvement

Clarity and Readability

Long and Complex Sentences

Several sentences are dense and could be broken down for better readability. Example:

“Despite this well-documented evidence base of the physical and mental health benefits of PA among older people, current practice in NHs tends to prioritize basic care over PA, and residents are restricted in organizing their own daily routines or choosing their activities.”

Suggestion:

“Despite strong evidence of PA’s benefits, NHs still prioritize basic care over PA. Residents have limited autonomy in organizing their daily routines or selecting activities.”

Repetitive Phrasing

The concept of PA benefits and organizational readiness is mentioned multiple times in slightly different ways. Consider condensing these discussions to maintain flow.

Literature Review Integration

Global Context Could Be Streamlined

The mention of South American studies on PA interventions (dancing, swimming) is interesting but might not be directly relevant to NHs. If these studies do not involve nursing home residents, they might be better referenced briefly or moved to a discussion section.

The German study on sarcopenia is useful but could be linked more explicitly to your research questions.

Better Integration of Theoretical Models

The organizational readiness dimensions (motivation, capacity, intervention-specific capacities) are well described but could be tied more directly to the research questions to clarify their relevance.

Consistency in Terminology and Concepts

Use Consistent Terminology for PA Promotion

You use “PA promotion,” “activity-promoting programs,” and “PA interventions” interchangeably. It might help to define and consistently use a single term.

Clarify “Pseudo-Total Institution”

The phrase “NHs can be described as pseudo-total institutions” is not clearly explained. Some readers may not be familiar with this sociological concept. Briefly defining how it applies to NHs would enhance comprehension.

4� Stronger Transition to Research Questions

The introduction ends with a strong set of research questions, but the transition could be smoother. Consider adding a summary statement before presenting them, such as:

“Given the knowledge gap in understanding learning processes within NHs, this study aims to explore organizational readiness and its evolution through individual and organizational learning. Specifically, we ask the following research questions:”

Strengths:

Addresses Research Objectives:

The discussion effectively ties the findings to the study’s main aim—examining organizational readiness for PA promotion in NHs and identifying individual and organizational learning processes.

It acknowledges the research gap and provides meaningful contributions to theory and practice.

Engagement with Literature:

The discussion references relevant studies (Dewar & Sharp, Lyman et al., Abbott et al.), reinforcing the study's claims.

Prior studies are used to validate findings, demonstrating a strong theoretical foundation.

Clear Thematic Breakdown:

Organized into distinct sections: the initial state of PA promotion, learning processes, barriers (personnel shortages), and leadership’s role.

This structure makes it easy to follow the progression of findings and their implications.

Recognition of Barriers and Challenges:

The discussion does not merely highlight positive changes but also acknowledges implementation difficulties, especially due to staff shortages.

This balanced approach adds credibility and practical relevance.

Areas for Improvement:

Clarity and Readability:

Some sentences are overly long and complex, reducing readability. For example:

“The general interest in PA promotion underlined the ORGANIZATIONAL and INDIVIDUAL DOUBLE LOOP LEARNING processes.”

→ Consider rewording to: “The widespread interest in PA promotion highlighted both organizational and individual double-loop learning processes.”

Reduce unnecessary repetition (e.g., “staff and management developed a shared sense of readiness” is repeated in various forms).

More Explicit Discussion of Theoretical Frameworks:

The discussion mentions double-loop learning but does not deeply analyze how the study contributes to or challenges this framework.

Consider explicitly connecting findings to Kim’s OADI-SMM model.

Inconsistent Terminology:

There is inconsistency in how PA promotion is described (e.g., “activity-friendly organization,” “PA-promoting organization”). Standardize terms for clarity.

The phrase “PA promoting actions” is frequently used—consider varying the wording (e.g., “PA-focused initiatives”).

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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 #7: No

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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.

The research paper presents a novel and well-structured study with significant contributions to its field. The methodology is rigorous, and the findings are well-supported by comprehensive data analysis. The manuscript is clearly written, logically organized, and adheres to academic standards. The research addresses a relevant and timely topic, offering valuable insights for future studies. Overall, the paper meets the criteria for publication and is recommended for acceptance.