PONE-D-24-54894Self-reported life experiences of members of the LGBTQ+ community in Accra, GhanaPLOS ONE

Dear Dr. Konlan,

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The reviews were very positive, seeing lots of merit with the article, but provide useful suggestions for improvements that I would encourage you to address thoroughly before resubmitting. 

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Daryl Higgins, PhD

Academic Editor

PLOS ONE

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Reviewers' comments:

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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: N/A

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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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: Many thanks to the authors for this study. The authors explored rampant issues the world is experiencing today. Social disapproval, inequality, stigma, and discrimination, among other adversities experienced by individuals or groups of individuals based on their social identities, are critical concerns in today’s world, as it has been. The experiences of social disapproval and stigma endured by the LGBTQ + community because of their gender identities and sexual orientation in Ghana documented in this study reflect the global inequalities, discrimination and oppression due to individual identities, which has a profound negative impact on the well-being of people worldwide. Besides sexual orientation and gender identities, other identities include race, ethnicity, poverty, and geographical location identities. Individuals with minor identities experience various hardships, fuelling health disparities and poor quality of life.

Also, this study underscores the importance of qualitative research in understanding complex experiences of the human race to inform policymakers, civil societies and community members. By exploring everyday experiences, the study shed light on how cultural, social structure and politics intersect to influence daily experiences of individuals/groups of people at different levels.

The authors have described the basic requirements for conducting qualitative research in the manuscript. However, there are areas the authors need to improve, and I have presented minor comments in the following sections and in the text:

Minor comments

• Abstract

The abstract provides a useful overview and the background of the study and covers the content of the study. However, there are areas in the results and conclusions sections that need to be revised.

In the result section where the authors wrote “...as well as other geographical settings”, the word “other” as it has an indefinite meaning, creates confusion, wondering what those other settings are. It would be better to focus on the experiences in the three areas you have reported–in family, public and LGBTQ+ community in this section.

I would suggest replacing it with “within their families” which is the third sub-theme identified in the study. Otherwise, they will need to elaborate more on those “other geographical settings” they referred to.

• Conclusion

The authors have provided recommendations, but it would be useful to indicate to whom they need to be directed, for example, the government, policymakers, or the global community this can help the use of the study findings.

• Introduction

The authors have given a good background on the situation of the acceptance of the LGBTQ+ community at global, regional and country levels. However, the authors did not clearly describe the current gaps and the problem they want to solve. I would recommend highlighting the gaps, the problem this study is trying to solve and the significance of this study to the LGBTQ+ community in Ghana, and at the global scale.

The term life experience is a central topic of this study, but it emerges at the end of the introduction, while it would have come earlier. The life experience should be placed in the very first paragraph for the reader to know what this study is about and give discuss it. The authors should engage with the literature on life experience in the introduction section and discuss why you want to explore it in relation to LGBTQ+ community, as this will help the authors to discuss their contribution and to ensure the integrity of the study.

The authors discussed a lot about laws and policies concerning LGBTQ+ in Ghana and elsewhere, it would be good to connect them [laws and policies] with the everyday life of LGBTQ+ community discussing how policies [at macro level] shape individual experience [micro level] justifying the significance of exploring the life experience of LBGTQ+ community to advocate for their inclusion in society.

Also, the sentence “There is little information in the literature on the life experiences of LGBTQ+ persons in the Ghanaian society.” emerges abruptly toward the end of the section of the introduction, it does not link with the previous sentence. It would be better to have a smooth transition.

• Methods

The authors have prettily described the methods and tools used in this study. However, there are a lot of repetitions and misplacement of contents. I would recommend revising the subtitles and placing the contents appropriately. My detailed comments are presented in the following section and the text:

Study setting

The description of the characteristics of a study setting is important in qualitative research, as it gives insights into the contextual information, which is essential in understanding the findings and can inform the transferability of the study findings. The authors have described and justified the geographical setting, which is very important. However, it would be useful to briefly talk about the background of gender and sexual orientation in the study setting to help readers understand the context and implication this can have on the findings.

Population, sampling and sample size.

All the information related to the selection of participants, and sample size should be covered in this section, if the authors want to keep this sub-title.

The authors said that they selected the first participant at a clinic while receiving treatment. I found an ethical breach in this sentence. Given that the security of the LGBTQ+ community members was at threat as described in the manuscript, it is important to discuss briefly how you got access to the participants and the ethical challenges faced during the selection of participants.

The authors need to explain whether the participant was informed beforehand, and how they got access to the participant at a clinic. Was the clinic a study site? If the authors selected participants from clinics, homes or other places, it would be good to describe those sub-settings and explain how they got access to the study participants.

Under this section, the authors wrote “Data collection from participants was done until no new information emerged [12]. The data saturation in this research was achieved after the 15th participant’s interview.” , this information would fit better under the data collection section.

Selection of participants and data collection

This section should cover the information related to data collection, not a mixture of selection of participants as this has been discussed under “Population, sampling and sample size section”. I would suggest revising this sub-title “Selection of participants and Data Collection as “Data collection and tools”, because the authors have already discussed the selection process in the previous section.

The authors mentioned the duration of the interview, which is important. Equally, knowing where the places interviews happened is important. I would recommend the authors indicate places where the interviews occurred and how the decisions on selecting interview locations were made to ensure that interviews were run naturally, which is critical in qualitative research.

Data analysis

The relationship between researcher and researched/study participants plays a significant role in qualitative research as it influences research in many ways, including data collection, analysis and interpretation process. Power dynamics and hierarchy that exist between researchers and participants influence the type of data collected and the findings of the study. Reflexivity is important, as it sheds light on how the relationship between researchers and participants played a role in the study and measures taken by researchers to mitigate their biases. The authors have mentioned how they dealt with their biases, assumptions, and positions in the analysis, and their identities in the methodological rigour in the manuscript, I would suggest writing a separate section on reflexivity to briefly discuss their identities, positions, assumptions and backgrounds and how they affected the study.

Methodological rigour

The authors mentioned that the description of data collection procedures ensures transferability. Transferability in qualitative research is more about transferring the study findings to a setting with similar context and characteristics. The authors need to explain how they define transferability in this context.

The authors said that they bracketed their experiences in this study. Many scholars, including Heidegger, argue that it is almost impossible to distance from one’s self [values, experiences, beliefs etc] in research, it would be helpful to hear from the authors how they applied the concept of bracketing and how it has affected the study.

Results

The authors have well presented the study results and the interpretation of the findings, which are supported by the data. However, there is an issue concerning the selection and allocation of quotes. For example, in many areas, the authors assigned more than one quote from different participants where they talked about the experience of one participant.

Also, adding a summary concluding each theme would add value to the results.

In table 2, the authors presented the overarching theme identified in this study. However, the theme does not reflect the experience of the LGBTQ+ community specifically. I would suggest checking and re-defining this theme.

Life in the family

On p. 9, the authors said: “Another participant narrated how the mother loves….” however, they appended 2 quotes from 2 participants. I would recommend the authors revise this repeating errors throughout the results section.

• Conclusion

The authors have summarised the findings of the study, but this section does not provide the meanings and significance of the study. I would recommend revising the conclusion section to state the implications of the study on policy-making and practices in the study setting, and how this study can be used to address social disapproval and stigma experienced by the LGBTQ+ community members.

Also, I would recommend the authors direct specific recommendations to specific institutions, individuals, communities etc according to the study findings.

• Limitations of the study

Limitations of the study should be discussed before conclusions are made. I would suggest moving this section.

Reviewer #2: Overall, this study was properly conducted and well-written.

1.The introduction, aim, and method section were clearly written. Starting from the concise introduction, an explicit statement of the research aim, appropriate research design, clear description of the study area and population, appropriate sample size, data collection techniques, and data analysis.

2.The results were adequately analyzed and presented, with the major finding being the stigma the LQBTQ community undergo from the general public and their families were stated. This stigma led to this group having inadequate mental health. However, they got support from the other member of their community.

3.The discussion was well-detailed, comparing the findings with the broader literature.

4.A limitation of the study, where only a limited members of the study population (LQBTQ) was identified, was also noted. The authors highlighted the few implications to practice and policy.

5.However, no implications were stated for future research.

6.The conclusion effectively addressed the aim of the research, with the recommendations also provided.

7.The individual contribution of each of the authors were not found.

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Reviewer #1: Yes:  Jean Paul Bikorimana

Reviewer #2: No

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Submitted filename: MAR 23 2025-Konlan.docx

Self-reported life experiences of members of the LGBTQ+ community in Accra, Ghana

PONE-D-24-54894R1

Dear Dr. Konlan,

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,

Daryl Higgins, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Please note there is a small typographical error in the Limitations section. it says: "...particularly none residents of Accra." but should be "...particularly non-residents of Accra."

Reviewers' comments: