PONE-D-24-56086Implementation of a smoking cessation intervention for people with severe mental illness in ambulatory mental healthcare (KISMET): a process evaluationPLOS ONE

Dear Dr. Küçükaksu,

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.

ACADEMIC EDITOR: This is very important study that contributes to efforts in reducing smoking among mental healthcare professionals and patients. The findings are critical not only for people with severe mental illness but also can be adapted to general population. The quality of the study and presentation is near satisfactory. The authors should please address the following observations as well as the comments provided by Reviewer 1 (see below). Funding statement :

Please add agreement/contract number. Also indicate whether the funder played any role in conducting the study.

Methods:

• MHPs and patient selection and recruitment:

The selection of MHPs and patients is not clearly defined. Please provide inclusion and exclusion criteria for both MHPs and patients selection. This is in addition to the variations provided.

• Data analysis:

Please clearly explain the approach used in coding the transcripts – inductive/deductive or both. Was coding framework developed? E.t.c

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Kind regards,

Ibrahim Jahun, MD, MSC, PhD

Academic Editor

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: Yes

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

Reviewer #1: I Don't Know

Reviewer #2: 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: No

Reviewer #2: 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

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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 current project aimed to explore the perceptions of patients and mental health providers on the implementation of a smoking cessation intervention for individuals with severe mental illness. The mixed methods design provides critical insights for implementing smoking cessation interventions with difficult to treat populations. Overall, this very strong and sound study provides important information including the successes and difficulties of the KISMET program. A couple of minor notes: P3 L66-68 states that research on the combination of CBT, MI and NRT for smoking cessation is lacking; however several studies have begun looking at the effectiveness of these combined approaches (albeit in different populations, different timescales, and/or selective components of CBT, MI, pharmacotherapy) (see Brett et al., 2021; okuyemi et al., 2013 Wittchen et al., 2011; Zhou et al., 2023. Additionally, P20 L453-454 stated that shorter intervention periods may compromise the intervention effects. Brett et al (2021) found encouraging results for up to 6months after a single-session brief intervention. Although different, this suggests that shorter interventions may merit consideration and investigation, given the high drop out in the current project. Finally, L480-481 discuses the impact of CO monitoring. The paper may benefit from research on other substance use on how self-monitoring can lead to reductions in substance use (e.g., Gass et al., 2021).

Brett, E. I., Chavarria, J., Liu, M., Hedeker, D., & King, A. C. (2021). Effects of a brief motivational smoking intervention in non-treatment seeking disadvantaged Black smokers. Journal of Consulting and Clinical Psychology, 89(4), 241.

Gass, J. C., Funderburk, J. S., Shepardson, R., Kosiba, J. D., Rodriguez, L., & Maisto, S. A. (2021). The use and impact of self-monitoring on substance use outcomes: A descriptive systematic review. Substance Abuse, 42(4), 512-526.

Okuyemi, K. S., Goldade, K., Whembolua, G. L., Thomas, J. L., Eischen, S., Sewali, B., ... & Des Jarlais, D. (2013). Motivational interviewing to enhance nicotine patch treatment for smoking cessation among homeless smokers: a randomized controlled trial. Addiction, 108(6), 1136-1144.

Wittchen, H. U., Hoch, E., Klotsche, J., & Muehlig, S. (2011). Smoking cessation in primary care–a randomized controlled trial of bupropione, nicotine replacements, CBT and a minimal intervention. International journal of methods in psychiatric research, 20(1), 28-39.

Zhou, L., Guo, K., Deng, X., Shang, X., E, F., Xu, M., ... & Li, X. (2023). Effects of different combined behavioral and pharmacological interventions on smoking cessation: a network meta-analysis of 103 randomized controlled trials. Journal of Public Health, 1-11.

Reviewer #2: This insightful study examines the implementation of the KISMET smoking cessation program in Dutch mental healthcare. Recruitment and retention posed significant challenges, with a high drop-out rate (58%) emphasizing the need for stronger motivational strategies. Patients found group and peer support valuable, though inconsistent attendance affected engagement. While pharmacological treatment was beneficial, better facilitation was needed, and staff shortages, along with limited collaboration, hindered implementation. The findings highlight the crucial role of teamwork, structured support, and effective supervision in strengthening smoking cessation programs for individuals with severe mental illness.

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Reviewer #1: No

Reviewer #2: No

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Implementation of a smoking cessation intervention for people with severe mental illness in ambulatory mental healthcare (KISMET): a process evaluation

PONE-D-24-56086R1

Dear Dr. Handan Küçükaksu,

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,

Ibrahim Jahun, MD, MSC, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

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 #1: All comments have been addressed

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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 #1: Yes

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

Reviewer #1: 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 #1: 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 #1: 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 #1: The authors have addressed all of my concerns. This manuscript provides important context on the implementation of smoking cessation treatment among difficult to treat populations.

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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 #1: No

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