Health-related stigma among Indigenous Peoples in Canada: A scoping review

Liam Rourke; Ronald Damant; Janice Y. Kung; Chantell Widney

doi:10.1371/journal.pone.0318618

Peer Review History

Original SubmissionNovember 11, 2024
11 Nov 2024 Author Response https://doi.org/10.1371/journal.pone.0318618.r001
22 Dec 2024 Decision Letter - Julia Morgan, Editor PONE-D-24-51625Health-Related Stigma Among Indigenous Peoples in Canada: A Scoping ReviewPLOS ONE Dear Dr. Liam Rourke, 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 Feb 05 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. 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If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.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.] 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 ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: N/A Reviewer #2: N/A ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? 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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: The article presents a compelling examination of health-related stigma among Indigenous populations in Canada. The introduction is well-structured and effectively articulated; however, it would benefit from further enrichment through additional references that contextualize the socio-cultural dimensions of stigma and its profound impact on the health outcomes of these populations. The study objectives are clearly delineated, and the methodology is robust; however, the inclusion of a PRISMA flow diagram to illustrate the study selection process would enhance the clarity of the methodological approach. Additionally, the article would be strengthened by the inclusion of a conclusion section, which would offer a synthesis of the key findings, along with a discussion of the study's limitations. It would also be valuable to incorporate recommendations for future research in this area to guide subsequent investigations and foster deeper understanding of the subject matter. Reviewer #2: Thank you for this informative and well written article. I have the following minor suggestions: 1. In the introduction, I would like a bit more rationale for why you chose to focus on Indigenous Peoples in Canada, and not other countries. 2. For international readers, you may want to include in the introduction about the inter-generational trauma experienced by this group and how this could impact both health and stigma and health-seeking behaviours. 3. For the inclusion criteria, you stated you included primary research articles, but did you have any restriction on methods of the primary research articles (i.e. only qualitative articles)? If you did, this should be stated n the inclusion criteria. If you looked at any methodology that was primary research, this should be stated in the inclusion criteria. 4. Regardless of the answer for question 3 above, I would like the type of methods to be specified in the data that were extracted, and information about methods of the included studies to be included in the table of articles. 5. I would like a table title and number for all the tables in the manuscript. 6. I wonder if any of the articles included in the synthesis had a definition of stigma: if some did, this should be included in the data extraction. If none of them had a definition of stigma, this should be stated. ****** 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: Yes: Dr. Manisha Gore Reviewer #2: 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. https://doi.org/10.1371/journal.pone.0318618.r002
Revision 1
14 Jan 2025 Author Response Thank you for the close and thoughtful reading of our manuscript and for the offering suggestions that have improved the work and our ability to communicate with readers. Below, we respond to each of the 16 suggestions we received in the following order: Editor (items 1 - 8) > Reviewer 1 (items 9 - 11) > Reviewer 2 (items 12 - 16 with a reference to item 9). Your comments are italicized, our responses follow. Please note that the information provided here duplicates the information in our attached document "response to reviewers". Its format may be easier to read. Dear Editor We appreciate the thoughtful suggestions from you and your reviewers. They have improved our manuscript. Below, we detail the revisions. Please ensure that your manuscript meets PLOS ONE's style requirements. Completed. Please ensure that your PRISMA flow diagram is included in your main manuscript file as Figure 1. We have had considerable difficulty positioning the PRISMA flow diagram in the main manuscript, so we have added it as a separate word document and identified its position in the main manuscript in the hope that the skilled staff at PLOS ONE can assist with this task. Please also provide non-author contact information (phone/email/hyperlink) for data access. We have now included all of our data as Supplemental Information. The only data we did not submit originally was a table presenting all of the fulltext articles that were assessed for inclusion, along with the decision to include or exclude, and the data that was extracted from each of the included articles. That table is now available as an excel file named S1 Fulltext articles assessed for inclusion, and listed in the Supplemental Information section of the main manuscript. Please remove any funding-related text from the manuscript. We removed the text from the manuscript and identified our funders appropriately within the Editorial Manager submission forms. Please include captions for your Supporting Information files at the end of your manuscript. We have presented our titles and captions for our three supporting information files (p. 30), titled them appropriately, added captions, and updated the corresponding in-text citations correctly (p. 6-7). Please ensure your manuscript or supplementary information includes a numbered table of all studies identified in the literature search, including those that were excluded from the analyses. List the reason(s) for exclusion. We included a table of all 997 studies assessed for inclusion, the decision that was made for each, by whom, when, and the data that was extracted (from the articles that were included). The table is included as a Supplement. (S3 Table. Articles assessed for eligibility.) If applicable for your analysis, a table showing the completed risk of bias and quality/certainty assessments. Assessments of this nature are not required or conventional in scoping reviews. It is one quality that distinguishes scoping reviews from systematic reviews. Please review your reference list to ensure that it is complete and correct. We reviewed and updated our reference list so that all in-text citations are included in the references list, the in-text citations are numbered consecutively, and the appropriate square-bracket format is used. The manuscript would benefit from additional references that contextualize the socio-cultural dimensions of stigma and its profound impact on the health outcomes of [Indigenous Peoples living in Canada]. In the final section of the Introduction (last paragraph of page 5) we added a brief discussion of the systematic racism and institutional stigma experienced by First Nations, Inuit, and Métis Peoples, and index the Canada’s Truth and Reconciliation Commission and the Canadian Medical Association’s 2024 apology for harms to Indigenous Peoples . We note too that our review focuses on the labelling, stereotyping, and discrimination that stems specifically from one’s health condition. This is in contrast to other discourses whose concern is the stigma that arises from gender, sexuality, ethnicity, a combination of these (i.e., intersectional stigma) or other factors. The inclusion of a PRISMA flow diagram would enhance the clarity of the methodological approach. We have included our PRISMA flow diagram. The article would be strengthened by the inclusion of a conclusion section, a synthesis of key findings, and recommendations for future research in this area. Pages 17 through 20 conclude the report, and they include i) a synthesis of key findings vis a vis our four research objectives in the 6 paragraphs following the heading Discussion. Suggestions for future research (and for practice) are presented in paragraphs 1 and 2 on page 19. I would like a bit more rationale for why you chose to focus on Indigenous Peoples in Canada, and not other countries. Our study emphasizes the cultural nature of health-related stigma, and the Indigenous Peoples in Canada, comprising over 600 distinct communities, encompassing many different languages and ways of life that respond to remarkably different physical environments, presents an excellent opportunity to explore cross-cultural constructions of illness. At the same time, our selection bounded the study in ways that made it feasible and conceptually coherent. For international readers, you may want to include in the introduction about the inter-generational trauma experienced by this group and how this could impact both health and stigma and health-seeking behaviours. We have implemented this important revision and described it in our response to a similar request in number point 9 (above). The new information is added to the stipulation in our original submission that: “ . . . we excluded articles in which the participants’ experiences of stigma stemmed primarily from qualities other than their health condition; most frequently, these included the participants’ occupation, sexual orientation, gender, and cultural or ethnic identity. Stigma that arises at the intersection of these factors is a pressing topic for research; however, it was not the focus of this review.” For the inclusion criteria, you stated you included primary research articles, but you did not stipulate whether you have any restriction on methods of the primary research articles (i.e. only qualitative articles)? If you did, this should be stated in the inclusion criteria. We did not have any restrictions on “qualitative” or “quantitative” studies, and we have added a short qualification in the pertinent text in the Methods section. With the revision, it now reads: “We included only primary research (both post-positivist and interpretivist), and excluded articles categorized as essays, commentaries, position statements, letters, or reviews.” I would like a table title and number for all the tables in the manuscript. Table 2. Characteristics of included studies (p. 10) lists all of the studies included in the manuscript, along with the relevant data that was extracted from each. Supporting Information S3 Table Articles assessed for eligibility presents the complete list of 997 articles that underwent fulltext screening. If some articles had a definition of stigma, this should be included in the data extraction. If none of them had a definition of stigma, this should be stated. Some articles presented a definition of stigma and this was included in the data extraction. S3 Table, which is included for readers as supporting information, includes all of the data that was abstracted from the studies used in the scoping review, including the definitions of stigma. Attachments Attachment Submitted filename: Response to reviewers.docx https://doi.org/10.1371/journal.pone.0318618.r003
19 Jan 2025 Decision Letter - Julia Morgan, Editor Health-Related Stigma Among Indigenous Peoples in Canada: A Scoping Review PONE-D-24-51625R1 Dear Dr. Liam Rourke, 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, Julia Morgan Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0318618.r004
Formally Accepted
Acceptance Letter - Julia Morgan, Editor PONE-D-24-51625R1 PLOS ONE Dear Dr. Rourke, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. 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. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Julia Morgan Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0318618.r005

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