Barriers and limitations to the development of a telemental health service for workers in Peru- A user-centered approach

John Astete Cornejo; Liliana Cruz-Ausejo; Jimmy Cainamarks Alejandro; Miguel Angel Burgos-Flores; Juan Ambrosio-Melgarejo; Jaime Rosales Rimache; Sebastián García Cruz

doi:10.1371/journal.pone.0321401

Peer Review History

Original SubmissionJanuary 9, 2024
9 Jan 2024 Author Response Attachments Attachment Submitted filename: RESPONSE LETTER.pdf https://doi.org/10.1371/journal.pone.0321401.r001
14 May 2024 Decision Letter - Josep Vidal-Alaball, Editor PONE-D-23-44037Barriers and limitations to the development of a tele-mental health service for workers - A user-centered approachPLOS ONE Dear Dr. Cruz- Ausejo, 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. ============================== Upon careful consideration of the reviewers' comments, it has become apparent that significant revisions are necessary before we can proceed towards acceptance. In particular, Reviewer 2 has raised a critical point regarding the lack of a theoretical framework underpinning your work. This is a fundamental aspect that needs to be addressed to strengthen the manuscript. ============================== Please submit your revised manuscript by Jun 28 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, Josep Vidal-Alaball, MD, PdD, MPH Academic Editor PLOS ONE Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. Thank you for stating the following financial disclosure: "Funding: This work was funded by the Agencia Española de Cooperación Internacional para el Desarrollo (AECID, in Spanish) by Programa Nacional de Investigación Científica y Estudios Avanzados- CONCYTEC- Perú, under contract: N° 076-2021-PROCIENCIA." Please state what role the funders took in the study. If the funders had no role, please state: ""The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript."" If this statement is not correct you must amend it as needed. Please include this amended Role of Funder statement in your cover letter; we will change the online submission form on your behalf. 3. We note that you have indicated that there are restrictions to data sharing for this study. For studies involving human research participant data or other sensitive data, we encourage authors to share de-identified or anonymized data. However, when data cannot be publicly shared for ethical reasons, we allow authors to make their data sets available upon request. For information on unacceptable data access restrictions, please see http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. Before we proceed with your manuscript, please address the following prompts: a) If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially identifying or sensitive patient information, data are owned by a third-party organization, etc.) and who has imposed them (e.g., a Research Ethics Committee or Institutional Review Board, etc.). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent. b) If there are no restrictions, please upload the minimal anonymized data set necessary to replicate your study findings to a stable, public repository and provide us with the relevant URLs, DOIs, or accession numbers. Please see http://www.bmj.com/content/340/bmj.c181.long for guidelines on how to de-identify and prepare clinical data for publication. For a list of recommended repositories, please see https://journals.plos.org/plosone/s/recommended-repositories. You also have the option of uploading the data as Supporting Information files, but we would recommend depositing data directly to a data repository if possible. Please update your Data Availability statement in the submission form accordingly. Additional Editor Comments: Dear Authors, Thank you for submitting your manuscript to our journal. We have completed the review process and received valuable feedback from our reviewers. Upon careful consideration of the reviewers' comments, it has become apparent that major significant revisions are necessary before we can proceed towards acceptance. In particular, Reviewer 2 has raised a critical point regarding the lack of a theoretical framework underpinning your work. This is a fundamental aspect that needs to be addressed to strengthen the manuscript. [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: Partly Reviewer #2: Partly ******** 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? 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: No ****** 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 ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: 1. Abstract: Well written. However, the authors need to provide a further breakdown of the number of participants, i.e.15, 5 and three, so that the characteristics of the participants are clear. The last sentence of the introduction in the abstract could read better if simplified and shortened. It loses meaning in its current state. 2. Introduction Clear and to the point. Please check line 78 if the percentage is well represented. 3. Data collection Although the authors mention that they used semi-structured interviews, the following is not clear: - What was the opening question? What were some of the probing questions used? - At what point did the interviews stop or at what point was the data sufficient or what guided the authors to stop data collection at 23 with different types of participants (15,5 and 3)? 4. Discussion While the implications and future directions are outlined clearly, the discussion is scanty. There is a need to broaden it as, in its current form, it is narrow-focused. Reviewer #2: This study address an important topic: Which barriers and facilitators exist for telemental health services for vulnerable workers in countries were telecommunication may be limited or lacking. They conducted 23 semi-structured interviews with receivers (police officers and teachers) and planners/providers (healthcare personnel and administrators). Here are my comments: General comments: I think language should receive more attention, preferrably using an authorized translator. I think the scientific basis is lacking, and there is no attempt to describe the theoretical basis on which the identification og barriers and facilitators were identified and sorted. Full Title: Barriers and limitations to the development of a tele-mental health service for workers - A user-centered approach I think the findings in this study apply to Peru, which is also stated in the abstract, and the title should refer to Peru. Suggested change: Barriers and limitations to the development of a telemental health service for workers in Peru - A user-centered approach Abstract 32 users and attendance The meaning of «attendance» here is unclear 33 mental telehealth Why not continue calling it telemental health 37 some of them were related to user dissatisfaction emphasizing the need for personalized solutions beyond technical aspects This could be specified more, what kind of dissatisfaction? 38 Scheduling issues call for flexibility and improved communication Meaning? Introduction General comment: I think the authors should define their use of the telemental health service term, and they should describe the plethora of teleservices that may be available 51 is disrupting global healthcare services Is disrupt the preferred verb? Consider using terms like challenging or altering. Disrupt definition: to prevent something, especially a system, process, or event, from continuing as usual or as expected 65 It is noteworthy, however, that the Ministry of Health faces certain limitations as the sole regulatory entity for telehealth in Peru Reference? 69 Consequently, the imperative to attend to these concerns remotely Meaning? 71 Notably, the global experience underscores that, despite the widespread activation of various e-screening initiatives in routine clinical practice throughout the COVID 19 era, comprehensive studies evaluating their appropriateness, efficiency, and efficacy remain notably scarce Avoid using notably twice in one sentence. MATERIAL AND METHODS 91 Spanning durations of 10 to 35 minutes, the interviews were conducted to comprehend perceptions, needs, barriers, and 99 facilitators related to the implementation of mental telehealth services On what theoretical ground were barriers and facilitators identified? Who conducted the interviews – what professional background did they have? Did you recruit interviewees from urban or rural areas, or both? 117 Decision makers How where these recruited? 125 Upon orally expressing their agreement to participate, audiovisual or voice recording, as applicable, was initiated. A Did you not receive written consent? 133 . Adopting a phenomenological approach, the codes have been tailored to align with the nuances apparent in our dataset Meaning? 134 This dynamic process has enhanced our coding framework, directing our focus towards the four key themes associated with the mental health telecare and screening service. The primary themes and subthemes that emerged from this process are detailed in Table 1 Wouldn’t this be more appropriately put in results section, including table? Results General comment: From 23 interviews 8 quotes are presented, for instance the reference to «healthcare worker» does not clarify whether it is quotes from the same healthcare worker or various (that is: it is impossible for the reader to assess it). The same problem arises for «Decision-maker». One could extend the characterization of each responder, by indicating if rural or urban, if not in conflict with anonymity. General comment: The healthcare workers represent a completely different position as compared to the other interviewees, since these represent the service and not the receiver of services. Thus, I find it problematic that their experiences are included in the same table. See suggestion above. 137 Table 1 1.2. Lack of medical record Where this issue addressed? If not, consider omitting it from the table 137 Table 1 Consider revising the table, indicating that item 1 and 2 represent «Receiver of the services» and 3 and 4 represent «Provider/planner of the services» Discussion General comments: In discussion there is a chance to discuss strengths and limitations of the study. They should also compare their own findings with existing literature, and they should make an attempt to guide clinicians and decision makers, base don theri findings. In addition, the discussion addresses to a very limited degree the challenges that were identified in the results section. Rather than describing approaches to improve telehealthcare in Peru in very general terms, they should use this section to develop more specific thoughts on the significance of their findings 270 The study's outcomes underscore the imperative shift toward a holistic and user-centered approach to 271 telehealth implementation How? ****** 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: Andile Glodin Mokoena-de Beer Reviewer #2: Yes: Eivind Aakhus ******** [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. Attachments Attachment Submitted filename: PONE-D-23-44037.pdf Attachment Submitted filename: Recommendations from reviewer PLOS ONE.doc https://doi.org/10.1371/journal.pone.0321401.r002
Revision 1
7 Jan 2025 Author Response Dear Editor, Thank you for the opportunity to review the manuscript entitled “Barriers and limitations to the development of a tele-mental health service for workers- A user-centered approach”. In the following paragraphs, we proceed to comment on the changes made according to each observation made by the reviewers and Academic Editor. Academic Editor Comments: 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf Answer: All the changes suggested by the reviewers have been made. 2. Thank you for stating the following financial disclosure: "Funding: This work was funded by the Agencia Española de Cooperación Internacional para el Desarrollo (AECID, in Spanish) by Programa Nacional de Investigación Científica y Estudios Avanzados- CONCYTEC- Perú, under contract: N° 076-2021-PROCIENCIA." Please state what role the funders took in the study. If the funders had no role, please state: ""The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript."" If this statement is not correct you must amend it as needed. Please include this amended Role of Funder statement in your cover letter; we will change the online submission form on your behalf. Answer: The statement of non-involvement by the funders in the study was included. 3. We note that you have indicated that there are restrictions to data sharing for this study. For studies involving human research participant data or other sensitive data, we encourage authors to share de-identified or anonymized data. However, when data cannot be publicly shared for ethical reasons, we allow authors to make their data sets available upon request. For information on unacceptable data access restrictions, please see http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. Before we proceed with your manuscript, please address the following prompts: a) If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially identifying or sensitive patient information, data are owned by a third-party organization, etc.) and who has imposed them (e.g., a Research Ethics Committee or Institutional Review Board, etc.). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent. b) If there are no restrictions, please upload the minimal anonymized data set necessary to replicate your study findings to a stable, public repository and provide us with the relevant URLs, DOIs, or accession numbers. Please see http://www.bmj.com/content/340/bmj.c181.long for guidelines on how to de-identify and prepare clinical data for publication. For a list of recommended repositories, please see https://journals.plos.org/plosone/s/recommended-repositories. You also have the option of uploading the data as Supporting Information files, but we would recommend depositing data directly to a data repository if possible. Please update your Data Availability statement in the submission form accordingly. Answer: There are no restrictions on sharing the anonymized data obtained in the study. Accordingly, the full transcripts of the interviews conducted with the participants, along with the Atlas.TI code file, are attached as a Supporting information file. Reviewer #1: The manuscript reflects a justifiable need for this study to be conducted and dissemination of data thereof. The methodology used is appropriate to elicit information from the participants. However, the discussion is scanty and does not clear overview of the findings against existing studies in other countries. As such, this manuscript requires minor revisions to give it more meaning at a standard that could be published by the journal. Answer: The discussion topics in the manuscript were expanded according to subtopics. The discussion was expanded to consider different international contexts. Abstract: Well written. However, the authors need to provide a further breakdown of the number of participants, i.e.15, 5 and three, so that the characteristics of the participants are clear. The last sentence of the introduction in the abstract could read better if simplified and shortened. It loses meaning in its current state. Answer: The observation has been acknowledged and modified in the abstract. Introduction Clear and to the point. Please check line 78 if the percentage is well represented. Answer: The referred percentage was the one reported by the government in the official gazette. Data collection Although the authors mention that they used semi-structured interviews, the following is not clear: What was the opening question? What were some of the probing questions used? At what point did the interviews stop or at what point was the data sufficient or what guided the authors to stop data collection at 23 with different types of participants (15,5 and 3)? Answer: The base questions of the semi-structured interview, as approved in the research protocol, are attached as a Supporting information file. These questions introduced the topic, and as can be observed in the interview transcripts, they allowed the interviewer to ask follow-up questions and explore certain criteria in greater depth. The interviews ceased upon reaching the sample approved by the ethics and research committee, as the three groups contribute to the identification of development requirements for the same software. Discussion While the implications and future directions are outlined clearly, the discussion is scanty. There is a need to broaden it as, in its current form, it is narrow-focused. Answer: The discussion was extended. Reviewer #2: This study address an important topic: Which barriers and facilitators exist for telemental health services for vulnerable workers in countries were telecommunication may be limited or lacking. They conducted 23 semi-structured interviews with receivers (police officers and teachers) and planners/providers (healthcare personnel and administrators). General comments: I think language should receive more attention, preferrably using an authorized translator. I think the scientific basis is lacking, and there is no attempt to describe the theoretical basis on which the identification of barriers and facilitators were identified and sorted. Answer: Thank you very much for your feedback. We strive to take all of your observations into account when making the necessary corrections. Grammar corrections were also made to improve comprehension. Full Title: Barriers and limitations to the development of a tele-mental health service for workers - A user-centered approach I think the findings in this study apply to Peru, which is also stated in the abstract, and the title should refer to Peru. Suggested change: Barriers and limitations to the development of a telemental health service for workers in Peru - A user-centered approach Answer: The observation has been resolved as “Barriers and limitations to the development of a telemental health service for workers in Peru - A user-centered approach.” Abstract 32 users and attendance The meaning of «attendance» here is unclear 33 mental telehealth Why not continue calling it telemental health 37 some of them were related to user dissatisfaction emphasizing the need for personalized solutions beyond technical aspects This could be specified more, what kind of dissatisfaction? 38 Scheduling issues call for flexibility and improved communication Meaning? Answer: Text related to “attendance” was replacing by “providers of mental telehealth”. The user's dissatisfaction centered on the lack of customizable solutions, like fast communication. The grammar was revised to clarify this. Introduction General comment: I think the authors should define their use of the telemental health service term, and they should describe the plethora of teleservices that may be available 51 is disrupting global healthcare services Is disrupt the preferred verb? Consider using terms like challenging or altering. Answer: The definition and services related to telemental health were included, as well as the correction in the term "disrupting." Disrupt definition: to prevent something, especially a system, process, or event, from continuing as usual or as expected 65 It is noteworthy, however, that the Ministry of Health faces certain limitations as the sole regulatory entity for telehealth in Peru Reference? 69 Consequently, the imperative to attend to these concerns remotely Meaning? 71 Notably, the global experience underscores that, despite the widespread activation of various e-screening initiatives in routine clinical practice throughout the COVID 19 era, comprehensive studies evaluating their appropriateness, efficiency, and efficacy remain notably scarce Avoid using notably twice in one sentence. Answer: The recommendations were adopted, including the references and improving the writing according to the suggestions. MATERIAL AND METHODS 91 Spanning durations of 10 to 35 minutes, the interviews were conducted to comprehend perceptions, needs, barriers, and 99 facilitators related to the implementation of mental telehealth services On what theoretical ground were barriers and facilitators identified? Who conducted the interviews – what professional background did they have? Did you recruit interviewees from urban or rural areas, or both? Answer: The barriers and facilitators were identified using a holistic and user-centered approach. The interviews were conducted by the study's researchers, all of whom were trained in qualitative research methodologies. Additionally, all interviewees were recruited from urban areas. These aspects were incorporated into the writing of Material and Methods. 117 Decision makers How where these recruited? Answer: The indicated precision was included in the writing. 125 Upon orally expressing their agreement to participate, audiovisual or voice recording, as applicable, was initiated. A Did you not receive written consent? Answer:The prior application of consent is described in the section "Ethical Statement and Informed Consent." 133 . Adopting a phenomenological approach, the codes have been tailored to align with the nuances apparent in our dataset Meaning? Answer: The barriers and facilitators were identified using a holistic and user-centered approach. 134 This dynamic process has enhanced our coding framework, directing our focus towards the four key themes associated with the mental health telecare and screening service. The primary themes and subthemes that emerged from this process are detailed in Table 1 Wouldn’t this be more appropriately put in results section, including table? Answer: Table 1 was moved to the Results section. Results General comment: From 23 interviews 8 quotes are presented, for instance the reference to «healthcare worker» does not clarify whether it is quotes from the same healthcare worker or various (that is: it is impossible for the reader to assess it). The same problem arises for «Decision-maker». One could extend the characterization of each responder, by indicating if rural or urban, if not in conflict with anonymity. Answer: Modifications were made to the presentation of the interviewees by assigning them alfanumerical identifiers (D#) to distinguish between them. General comment: The healthcare workers represent a completely different position as compared to the other interviewees, since these represent the service and not the receiver of services. Thus, I find it problematic that their experiences are included in the same table. See suggestion above. 137 Table 1 1.2. Lack of medical record Where this issue addressed? If not, consider omitting it from the table 137 Table 1 Consider revising the table, indicating that item 1 and 2 represent «Receiver of the services» and 3 and 4 represent «Provider/planner of the services» Answer: The changes were made according to the suggestions. Discussion General comments: In discussion there is a chance to discuss strengths and limitations of the study. They should also compare their own findings with existing literature, and they should make an attempt to guide clinicians and decision makers, base don theri findings. In addition, the discussion addresses to a very limited degree the challenges that were identified in the results section. Rather than describing approaches to improve telehealthcare in Peru in very general terms, they should use this section to develop more specific thoughts on the significance of their findings 270 The study's outcomes underscore the imperative shift toward a holistic and user-centered approach to 271 telehealth implementation How? Answer: More details were added based on feedback. The authors consider that we have provided a response to all the observations made to the manuscript; Therefore, we send this document for your review. Kind regards Attachments Attachment Submitted filename: Response to Reviewers v2 (1).pdf https://doi.org/10.1371/journal.pone.0321401.r003
24 Jan 2025 Decision Letter - Josep Vidal-Alaball, Editor PONE-D-23-44037R1Barriers and limitations to the development of a telemental health service for workers in Peru- A user-centered approachPLOS ONE Dear Dr. Cruz- Ausejo, 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 Mar 10 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, Josep Vidal-Alaball, MD, PdD, MPH Academic Editor PLOS ONE Additional Editor Comments (if provided): Dear Authors, PLOS ONE considers qualitative and mixed-methods studies for publication. We recommend that authors use the COREQ checklist, or other relevant checklists listed by the Equator Network, such as the SRQR, to ensure complete reporting (http://journals.plos.org/plosone/s/submission-guidelines#loc-qualitative-research). In general, we would expect qualitative studies to include the following: 1) defined objectives or research questions; 2) description of the sampling strategy, including rationale for the recruitment method, participant inclusion/exclusion criteria and the number of participants recruited; 3) detailed reporting of the data collection procedures; 4) data analysis procedures described in sufficient detail to enable replication; 5) a discussion of potential sources of bias; and 6) a discussion of limitations. [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. https://doi.org/10.1371/journal.pone.0321401.r004
Revision 2
3 Mar 2025 Author Response Thank you for the opportunity to review the manuscript entitled “Barriers and limitations to the development of a tele-mental health service for workers- A user-centered approach”. The following section addresses the resolution of the received comments: 1. Abstract: Well written. However, the authors need to provide a further breakdown of the number of participants, i.e.15, 5 and three, so that the characteristics of the participants are clear. The last sentence of the introduction in the abstract could read better if simplified and shortened. It loses meaning in its current state. Response: The observations had already been resolved in the last version sent 2. Introduction Clear and to the point. Please check line 78 if the percentage is well represented. Response: Although this is the percentage figure provided by an official source, the wording has been modified according to the observation. 3. Data collection Although the authors mention that they used semi-structured interviews, the following is not clear: - What was the opening question? What were some of the probing questions used? - At what point did the interviews stop or at what point was the data sufficient or what guided the authors to stop data collection at 23 with different types of participants (15,5 and 3)? Response: The interview began with introductory questions designed to explore general perceptions of telehealth in mental health. Subsequently, probing questions were used to delve deeper into participants' experiences and their perspectives on the care process. Additionally, the Supporting Information section of the manuscript includes S1 File: Semi-Structured Interview Format, which contains the interview guide used in this study. The interviews were conducted until data saturation was reached, meaning no new themes or additional relevant information emerged. The sample included three decision-makers, who represented the entirety of the actors responsible for the regulation and implementation of telehealth at that time, a nascent service in the Peruvian context. Although three distinct groups participated (users, providers, and decision-makers), their contributions were integrated into the formulation of a single telemental health service, confirming that data saturation had been achieved. 4. Discussion While the implications and future directions are outlined clearly, the discussion is scanty. There is a need to broaden it as, in its current form, it is narrow-focused. Response: More discussion elements were incorporated into the manuscript. Additional Editor Comments (if provided): Dear Authors, PLOS ONE considers qualitative and mixed-methods studies for publication. We recommend that authors use the COREQ checklist, or other relevant checklists listed by the Equator Network, such as the SRQR, to ensure complete reporting (http://journals.plos.org/plosone/s/submission-guidelines#loc-qualitative-research). In general, we would expect qualitative studies to include the following: 1) defined objectives or research questions; 2) description of the sampling strategy, including rationale for the recruitment method, participant inclusion/exclusion criteria and the number of participants recruited; 3) detailed reporting of the data collection procedures; 4) data analysis procedures described in sufficient detail to enable replication; 5) a discussion of potential sources of bias; and 6) a discussion of limitations. Response: We applied the COREQ guidelines for reporting qualitative research in this manuscript. A copy of the checklist is attached with the submission. Furthermore, we believe that the editorial requirements have been met. We have addressed all submitted observations and believe the manuscript is now ready for further review and to proceed with the publication process. Best regards, The Authors. Attachments Attachment Submitted filename: Response to reviewers.docx https://doi.org/10.1371/journal.pone.0321401.r005
5 Mar 2025 Decision Letter - Josep Vidal-Alaball, Editor Barriers and limitations to the development of a telemental health service for workers in Peru- A user-centered approach PONE-D-23-44037R2 Dear Dr. Cruz- Ausejo, 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, Josep Vidal-Alaball, MD, PdD, MPH Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0321401.r006
Formally Accepted
Acceptance Letter - Josep Vidal-Alaball, Editor PONE-D-23-44037R2 PLOS ONE Dear Dr. Cruz-Ausejo, 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. Josep Vidal-Alaball Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0321401.r007

Open letter on the publication of peer review reports

PLOS recognizes the benefits of transparency in the peer review process. Therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. Reviewers remain anonymous, unless they choose to reveal their names.

We encourage other journals to join us in this initiative. We hope that our action inspires the community, including researchers, research funders, and research institutions, to recognize the benefits of published peer review reports for all parts of the research system.

Learn more at ASAPbio .