PONE-D-24-42336Key factors in supporting adolescents to achieve high self-esteem and a positive body image: A qualitative community-based studyPLOS ONE

Dear Dr. García Martínez,

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PLOS ONE

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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: Partly

Reviewer #3: Yes

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

Reviewer #1: Yes

Reviewer #2: N/A

Reviewer #3: 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: 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: No

Reviewer #2: Yes

Reviewer #3: 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: Manuscript Review

Dear Editor,

Thank you for sending the manuscript titled “Strategies to Improve Self-Esteem and Body Image Among Adolescents: Barriers and Facilitators to Intervention” for review. Here are the details of each aspect of the paper and my suggestions:

1. Rigor: The manuscript presents a qualitative study that carefully examines barriers and facilitators in improving self-esteem (SE) and body image (BI) among adolescents. It appears well-structured, with a clear presentation of themes derived from participant interviews. The qualitative methodology is appropriate for exploring personal experiences and perspectives. However, the description of the data collection methods could benefit from more detail. For example, elaborating on how participants were selected and how interviews were conducted would enhance the rigor by providing clearer context for the findings.

2. Coherence: The manuscript is coherent, with logical flow and organization. The themes derived from adolescents, parents, and teachers are clearly presented, highlighting the different perspectives on SE and BI interventions. The discussion effectively ties the qualitative findings back to the existing literature, enabling readers to understand the relevance and implications of the results. Nevertheless, some sections, especially the proposals for future interventions, could be more directly linked back to the barriers identified earlier in the document.

3. Scientific Integrity: The manuscript maintains a good level of scientific integrity. Participants seem to have been treated with respect, and the concerns about ethics are briefly acknowledged, e.g., regarding informed consent. However, providing more explicit details on ethical approval processes, participant anonymity, and potential biases in the research design would contribute to the transparency of the research. It may also be helpful to reflect on potential researcher biases in data interpretation.

4. Ethical Considerations: The manuscript acknowledges the sensitive nature of discussing issues like body image and self-esteem. However, ethical considerations warrant more thorough discussion, especially with regard to adolescent participation. More information about the age range of participants, parental consent, and how sensitive topics were handled during interviews would enhance the ethical robustness of the study. A discussion of how the researchers supported participants who may have experienced distress from topic discussions could also be considered.

5. Comments and Suggestions:

• Data Collection Details: IT would be good to offer more detail about the methods used for data collection, including sampling methods, interview guide structure, and how interviews were analyzed (e.g., thematic analysis approach).

• Linking Findings to Interventions: It is imperative to strengthen the reasoning behind proposed interventions by linking them back to specific barriers more explicitly. Discuss how each suggested intervention directly addresses identified barriers.

• Diversity of the Sample: While diversity is mentioned as a strength, discussing how it may affect the transferability of findings to urban settings or other cultural contexts could improve the discussion.

• Limitations and Future Research: While limitations are acknowledged, it would be valuable to suggest specific areas for future research based on the findings and limitations identified in this study.

Conclusion: Overall, this manuscript shows promise for publication after implementing the suggestions for enhancing rigor, coherence, and scientific integrity. For submission to a peer-reviewed journal, revising with attention to ethical considerations and linking recommendations to identified barriers will strengthen the work and enhance its contribution to the field of adolescent mental health and educational interventions.

The manuscript you provided outlines a qualitative study focused on improving self-esteem (SE) and body image (BI) among adolescents, identifying barriers and proposing interventions. While it contains valuable insights, it also has several shortcomings that can be improved upon. Below are some of the key shortcomings along with suggestions for enhancement:

Shortcomings of the Manuscript

1. Lack of Clarity and Structure:

o The manuscript is densely packed with ideas without clear transitions or headings that guide the reader. For instance, the transition between quotes, themes, and discussion points is often abrupt.

o Suggestion: Organize the manuscript into well-defined sections with headings and subheadings that reflect the key themes being discussed (e.g., introduction, methodology, findings, discussion, conclusion). This would enhance readability and provide a clearer flow of ideas.

2. Insufficient Detail on Methodology:

o The methodology section lacks specificity regarding how participants were selected, the criteria for inclusion, and the data analysis approach.

o Suggestion: Expand on the methodology by providing detailed descriptions of participant recruitment, demographic information, data collection methods, and the analytical framework used. This will allow readers to better understand the study's context and rigor.

3. Inconsistent Terminology:

o Terms such as "body diversity," "body disappointment" (BD), and "self-acceptance" are used but not consistently defined or explained.

o Suggestion: Define key terms and keep their usage consistent throughout the manuscript. This will help to avoid confusion and ensure that readers understand the concepts being presented.

4. Conclusions Lack Cohesion:

o The conclusions drawn do not seem to effectively summarize the main findings of the research or provide clear implications based on the results.

o Suggestion: Revise the conclusion to more closely reflect the primary findings and their implications for practice. Consider including clear recommendations for stakeholders (e.g., educators, parents, community leaders) based on the identified barriers and facilitators.

5. Limited Discussion of Social and Cultural Context:

o While the manuscript touches on sociocultural influences, it does not delve deeply into how differing cultural backgrounds might affect adolescents' experiences of SE and BI.

o Suggestion: Incorporate a discussion on how different cultural contexts may shape adolescents' perceptions and challenges regarding body image and self-esteem. This could broaden the applicability and relevance of your findings.

6. Neglect of Adolescent's Voices:

o The adolescents' quotes are valuable but lack a more profound contextual interpretation or analysis, leaving their voices somewhat isolated.

o Suggestion: Provide thematic analysis to draw connections between the quotes and broader themes within the literature. This will help to illustrate how the viewpoints of adolescents fit within established frameworks on body image and self-esteem.

7. Call for Future Research is Underdeveloped:

o The section on future research is brief and lacks depth regarding the specific areas of study that could be beneficial.

o Suggestion: Elaborate on future research avenues and propose specific questions or hypotheses that could further investigate the topics of SE and BI among adolescents.

Overall Recommendations for Improvement

• Engage in rigorous peer review: Before publication, ensure the manuscript is reviewed by peers familiar with adolescent psychology, to identify areas needing clarification or argumentation.

• Use visuals: Consider adding tables or figures to summarize data or model the proposed interventions visually.

• Incorporate feedback mechanisms: Post-study, include ways for participants to provide feedback on the workshops or interventions. This could add further depth to the ongoing research.

• Interdisciplinary Input: Collaborate with experts in psychology, sociology, and education during revisions for a more rounded approach to the manuscript's content.

By addressing these shortcomings and following the suggestions for improvement, the manuscript can provide clearer insights, stronger arguments, and a more compelling case for interventions aimed at improving self-esteem and body image among adolescents.

Reviewer #2: For question 1- The manuscript is technically sound in its design as a qualitative study, employing appropriate methods such as semi-structured interviews and thematic analysis. However as a qualitative study, it lacks quantitative data, controls, and replication, which are critical for generalizability and for demonstrating statistical significance of the conclusions. Thus, while the qualitative insights are valuable, the manuscript does not fully meet the criteria for "rigorous experimentation" as typically defined in technical research. As for those reasons manuscript is partly technically sound.

For question 2- The manuscript is a qualitative study and does not involve statistical analysis. Instead, it relies on thematic analysis to interpret qualitative data. Statistical analysis is not applicable for this manuscript.

For question 3- The manuscript states that data are available from the corresponding author upon reasonable request. So authors did not made all data underlying finding fully available.

For question 4- The manuscript is written in clear and standard English, with no significant typographical or grammatical errors that would create issue for understanding.

Reviewer #3: The manuscript addresses a topic that is extremely relevant to the fields of health and education. Overall, it is very well designed and presented, with all the elements required by the journal. Here are my considerations and suggestions.

Introduction and goal:

The introduction is robust and presents all the concepts needed to discuss the data. The goal of the study is adequately outlined.

Method

In view of the study participants, the constructivist theoretical-methodological approach is appropriate.

It presents all the necessary elements that justify conducting the study. I would highlight the use of data triangulation as a strong point.

Results

The categories of analysis are well delineated and consistent with the study proposal.

Discussion

The discussion is well laid out, focusing initially on the barriers. It then points out important elements that should be considered in the intervention, based on the results presented.

However, my consideration lies in one very significant result. In the results, “both parents and teachers perceived that adolescents did not listen to them, with their valuing their friends’ opinions more”. This opinion is also shared by adolescents.

The literature shows that adolescents in this period of life tend to get closer to their peers and distance themselves from adults. I therefore believe that this result should be taken into account in discussions.

As for the proposed design of the intervention, the socio-ecological model proposed as the intervention's methodological strategy seems to me to be appropriate, as it allows for an interconnection between the different contexts of the adolescents' lives. I also suggest considering peer support, as pointed out earlier.

Limitation

I suggest that the authors consider the disproportionate number of boys and girls as a limitation of the study. The results themselves show that adolescents understand that there are different perceptions between the sexes.

I congratulate the authors on this very significant study for the academic and educational community.

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Reviewer #1: Yes:  Muneeb A. Faiq

Reviewer #2: Yes:  Md Shafayat Hossain, PhD, Postdoc (UoB, UK)

Reviewer #3: No

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Key factors in supporting adolescents to achieve high self-esteem and a positive body image: A qualitative community-based study

PONE-D-24-42336R1

Dear Dr. Martinez,

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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Kind regards,

Mukhtiar Baig, Ph.D.

Academic Editor

PLOS ONE