PONE-D-24-44279Towards Equitable Mental Health Care: A Scoping Review Protocol on Immigrant Experiences in CanadaPLOS ONE

Dear Dr. Eboreime,

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PLOS ONE

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This work was funded by a QE II Foundation Translating Research into Care (TRIC) grant awarded to EE (Grant number 1029792). The funders played no role in the study design, decisions to publish or preparation of the manuscript.

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Eboreime E. 

This work was funded by the QEII Foundation Translating Research into Care (TRIC) Award 1029792. The funders played no role in the study design, data collection, data extraction, results, and discussion.

https://qe2foundation.ca/qeii-health-sciences-centre-staff/grants-health-centre-staff-physicians/translating-research-care-tric-grant-program

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Additional Editor Comments :

Dear authors, we have received all required reviewers, and we recommend major revisions to address reviewer's comments. Please note that if there are comments you disagree with, please provide a rationale. We invite you to re submit your manuscript once you have attended to the recommendations.

There are some additional comments I would like to make regarding updating references.

1. For example, reference to mental health commission of Canada strategies see 2016 vs 2009 line 71. https://www.mentalhealthcommission.ca/wp-content/uploads/drupal/2016-10/case_for_diversity_oct_2016_eng.pdf

2. Please also clarify what is meant related to intergenerational stress throughout you make reference to youth however is the scoping review focused on all ages or youth only?

3. Also, if the scope of the review is to understand immigrant's experiences of mental health services and address their needs; would you consider explaining if and why people with lived experience are or are not included in the review? I would recommend explaining also inclusion criteria related to who are newcomers? e.g. are refugees included as a subcategory see line 133, because their experiences maybe different in terms of equity?

4. The overall focus on experience, it is not clear why quantitative studies will also be included unless you are focusing on structural issues related to health outcomes? This could be addressed in the ethics section.

5. I appreciate the inclusion of inter-rater reliability however it is a quantitative method you may want to consider intercoder ICR reliability but that is up to you line 158 see article by O'Connor: https://journals.sagepub.com/doi/full/10.1177/1609406919899220

6. p.9 Table 1 there is nothing listed under mental health characteristics? do you mean mental health problems based on DSM V criteria? you may wish to exclude this as you already have a category listed below this one?

Integration of findings should relate to equity centred design or approach to analysis? - analysis should be equity focused.

7. Re healthy immigrant effect, research has also documented same effects for mental health over time for immigrants you want to include a reference to this https://www.researchgate.net/publication/325338568_Canadian_Immigrant_Mental_Health and or other references related to mental health decline specifically.

Again, thank you for this important work, I hope the reviewer's comments and these recommendations will be helpful in your work,

We look forward in receiving your revised manuscript,

Kindest regards,

Nancy Clark PhD

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions?

The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field.

Reviewer #1: Partly

Reviewer #2: Partly

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2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses?

The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory.

Reviewer #1: Partly

Reviewer #2: Partly

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3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable?

Descriptions of methods and materials in the protocol should be reported in sufficient detail for another researcher to reproduce all experiments and analyses. The protocol should describe the appropriate controls, sample size calculations, and replication needed to ensure that the data are robust and reproducible.

Reviewer #1: No

Reviewer #2: Yes

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4. Have the authors described where all data underlying the findings will be made available when the study is complete?

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Reviewer #1: Yes

Reviewer #2: No

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Reviewer #1: Yes

Reviewer #2: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics.

You may also provide optional suggestions and comments to authors that they might find helpful in planning their study.

(Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Dear authors,

Thank you for the opportunity to review the manuscript #PONE-D-24-44279. I agreed to review this scoping review protocol as it has a focus on mental health care for immigrant communities in Canada.

I would like to commend the reviewers on this very important work and congratulations on receiving funding.

Please see my recommendations below.

Abstract:

- Please clarify if you are focusing on immigrants or newcomers. Please make this clear throughout the protocol.

- For example, you have stated, “There is a dearth of articles around newcomer experiences while accessing mental health and psychosocial support which has necessitated our current study.”, but then focus on “immigrants”.

- This sentence is not clear: “Therefore, to better address the needs of a diverse immigrant population, we are conducting a scoping review is to map out the scope of literature available on the experiences of immigrants while accessing mental health services and psychosocial support in Canada.” While the study appears to be sound, the language at times is unclear, making it difficult to follow. I advise the authors work with a writing coach or copyeditor to improve the flow and readability of the text.

- I am not sure references are used in abstract. I will defer this to the editor’s decision.

Introduction:

Please provide a reference for the following:

- “healthy immigrant effect”

- Not clear on “diverse immigrant population” is meant. Please clarify your definition of diversity for the reader.

- The word ‘migrant’ is introduced here. Please see my suggestion above in clarifying terminology for the reader.

- Although important, this is a very broad topic. There is extensive diversity within the immigrant communities. I would suggest a much narrower focus. Are you focusing on a category of immigrants? Within that category, are you focusing on a particular group (e.g. ethnicity, age, religion, gender identity and expression, sexual orientation, education, those who escaped war, etc.)?

Review question:

- The word “experience” lend itself to a qualitative systematic review

Method:

- Please clarify the rational for not using a more up to date scoping review approaches (e.g. JBI) compared to Arksey and O'Malley's

Search strategy:

- You have stated, “search strategy will be developed in consultation with a health sciences librarian…” Has this librarian been involved in the methods of this scoping review protocol? Please clarify who developed the search strategy in Appendix B.

- Please provide references to support the limitation for the last 10 years

- Are you selecting studies or articles? At times you have said articles and other times you have stated studies. Please clarify this for the reader. Would you only be selecting research studies or go beyond studies? What about grey literature? What about relevant websites and etc.

- As this is a Scoping review, please provide a rational for only selecting peer-reviewed journal articles.

- The reason for excluding the following for a scoping review is not clear: “Case reports, systematic reviews, meta-analyses, interventional studies, commentaries, editorials, opinion pieces, and grey literature”

- Please provide a detail plan for pilot testing of each stage of review and data extraction. E.g. how many will be pilot tested for each stage, what inter-rater reliability will you consider satisfactory?

Data extraction:

- Please add “Notes” and “relevant articles from the reference list” for your data extraction table

Data analysis and results:

- Usually “thematic analysis” is not used in SR because we are not interpreting the extracted data. This would fall within qualitative Systematic review. I would suggest the team to consider content analysis. There is a newly published scoping review by Limoges et al. that you may find extremely helpful in your data analysis approach.

- You may find these helpful: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0295914

- Limoges J, Chiu P, Dordunoo D, Puddester R, Pike A, Wonsiak T, Zakher B, Carlsson L, Mussell JK. Nursing strategies to address health disparities in genomics-informed care: a scoping review. JBI Evid Synth. 2024 Sep 11;22(11):2267–312. doi: 10.11124/JBIES-24-00009. Epub ahead of print. PMID: 39258479; PMCID: PMC11554251.

Discussion:

- It is not clear how this will be ‘comprehensive’ with a limited focused on peer-reviewed research articles.

- There is a lot of information in the discussion section. Please note that you cannot take anything verbatim from your protocol into your paper that will be focused on the report of scoping review. I would suggest the authors to consider condensing this section.

Timeline:

- I am not clear on the timeline section. I think it can be removed, but I will leave it for the editor’s decision.

I hope you find this feedback helpful as you continue publishing your work.

Reviewer #2: General comments

Check for grammar throughout the manuscript

Specific comments

Title: the idea of equitable as used in the title is not explicit in the body of the manuscript. Is it assumed that immigrants don’t have equitable access to mental health services? If so, that should be evident in the text. It should be argued in the background section.

Introduction

The intext reference starts at [2]. Please indicate reference for [1].

Page 3 line 55- give example of these incidences and elaborate on how they compare with the general population

Line 61- healthy immigrant effect is often applied to physical health. Please provide a brief writeup on how immigrants have better mental health status at the time of migration and worsen with the length of stay, to demonstrate how this concept is relevant to mental health.

Line 63- there are other factors that determine the access to services that deserve mention. Perhaps doing a thorough review will unearth them- including cultural competency of providers, mental health literacy, stigma, misconception, differences in the way mental health is conceptualised between home and host country, differences in culture etc.

Substantiate all the statements you make- like in line 66.

Page 4 line 71- more information about mental health strategy and if it has any reference to immigrant mental health is warranted.

Line 74- too long and would read better if divided into two

Line 77- statement on comprehension curriculum is stigmatising and blaming the student and prejudicial. Consider changing the language to different learning style and approaches.

Line 80- clarify what you mean with inadequate accessibility, and statement as expressed by other reviewers- do you mean scholars or researchers?

Line 88 clarify what one size fits all approach looks like

Page 5- a justification statement is required on what necessitated the study. A case study drawn from a clinical experience with immigrants would suffice. Also, if authors are themselves immigrants, they can draw from their own lived experiences.

Line 95- clinical significance of this work is vital.

Research questions are broad and need to be revised and made more focussed

Focussing on Canada alone may not give adequate materials to work with. In addition, you need to make a justification as to why you are limiting to Canada and not traditionally to other immigrant accepting countries.

Page 7- line 139. Why limit the search to 10 years?

Table 1- broad and are at risk of not finding the information you are looking for if you intend to populate each section. A typical data extraction sheet usually has 8 columns. Might be better to familiarise yourself with a similar scoping review and learn what information ends to be extracted for analysis.

Line 189- develop the section on analysis further

Line 195- what will be the component of the conceptual framework? This section needs to be developed further.

Line 204- be specific on who the stakeholders are and where the consultation will be and how it will be conducted.

Results- line 266- not necessary for a protocol as there are none to report.

Discussion- should be summarised and focus on what the scoping review will achieve especially on implication for clinical practice. Two paragraph are adequate.

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Reviewer #1: No

Reviewer #2: No

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Experiences of immigrants when assessing mental health services and psychosocial support in Canada: Protocol for a scoping review

PONE-D-24-44279R1

Dear Dr. Eboreime

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Kind regards,

Nancy Clark, PhD

Academic Editor

PLOS ONE

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Thank you for your updated and detailed response to the reviewers that were integrated into the manuscript. I have read the updated manuscript and your response to reviewers and find it satisfactory for publication.

Reviewers' comments: