PONE-D-24-43039Mental health related stigma in a primary care setting in rural India: service user and carer perspectivesPLOS ONE

Dear Dr. Gronholm,

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.

Along with the Reviewers' comments please add some more information on the included figure

Please submit your revised manuscript by Mar 20 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.

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We look forward to receiving your revised manuscript.

Kind regards,

Eleni Petkari

Academic Editor

PLOS ONE

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3. Thank you for stating in your Funding Statement: 

GT, MK, and PCG were supported by the UK Medical Research Council (UKRI) for the Indigo Partnership (MR/R023697/1) award. GT has recently been supported by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration South London (NIHR ARC South London) at King’s College Hospital NHS Foundation Trust. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. For the purpose of open access, the author has applied a Creative Commons Attribution (CC BY) licence (where permitted by UKRI, ‘Open Government Licence’ or ‘Creative Commons Attribution No-derivatives (CC BY-ND) licence’ may be stated instead) to any Author Accepted Author Manuscript version arising from this submission.

AC received funding from an Intra mural grant from National Institute of Mental Health and Neuroscience, Bengalaru, India.

Please provide an amended statement that declares *all* the funding or sources of support (whether external or internal to your organization) received during this study, as detailed online in our guide for authors at http://journals.plos.org/plosone/s/submit-now.  Please also include the statement “There was no additional external funding received for this study.” in your updated Funding Statement. 

Please include your amended Funding Statement within your cover letter. We will change the online submission form on your behalf.

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5. Your ethics statement should only appear in the Methods section of your manuscript. If your ethics statement is written in any section besides the Methods, please delete it from any other section. 

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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: Partly

Reviewer #2: Yes

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

Reviewer #1: No

Reviewer #2: No

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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: No

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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 topic is timely and interesting. However, the paper at this version lacks completeness and requires revion as suggested point by point in the document attached. All section of the paper required revision

Reviewer #2:  The subject of the study is quite interesting with the findings and the framework developed through the inductive process being impactful. However, there are still areas of improvement in the methodology, discussion and conclusion section.

Major focus is required on further literature review as the manuscript lacks global, regional and local background on the subject matter as well as compare and contrasts in discussion. Studies from LMICs, especially in South East Asia region, with similar study objectives requires to be reviewed and presented throughout the manuscript where reasonable.

Kindly address all the comments within the pdf file as well to refine the manuscript.

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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.

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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:  Hailemariam Mamo Hassen

Reviewer #2: No

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[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.]

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Attachments

Attachment

Submitted filename: PONE-D-24-43039.pdf

Attachment

Submitted filename: PONE-D-24-43039_reviewer.pdf

PONE-D-24-43039R1Mental health related stigma in a primary care setting in Karnataka, rural India: service user and carer perspectivesPLOS ONE

Dear Dr. Gronholm,

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 check the Reviewers' suggestions for amending the Methods section by adding the information as required and for adapting the Discussion as suggested==============================

Please submit your revised manuscript by Aug 29 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,

Eleni Petkari

Academic Editor

PLOS ONE

Journal Requirements:

If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise. 

[Note: HTML markup is below. Please do not edit.]

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

Reviewer #2: (No Response)

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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

Reviewer #2: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: No

**********

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

Reviewer #2: Yes

**********

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

Reviewer #2: Yes

**********

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: Comments for the manuscript titled "Mental health related stigma in a primary care setting in Karnataka, rural India: service user and carer perspectives"

The authors have provided a "Response to previous round of review and revisions, which is a positive sign of engagement with feedback. However, a thorough review against PLOS ONE's criteria reveals several areas requiring improvement. While the study addresses a valid research question, clarity, methodological rigor in reporting, and comprehensive engagement with existing literature need to be strengthened.

Literature Review: The current version of the manuscript should be carefully re-evaluated to ensure the literature review comprehensively places the claims in context and fairly treats prior work.

Methods: The manuscript should clearly detail the specific qualitative methodology used (e.g., thematic analysis, grounded theory) and justify its selection. More extensive details on the interview guide, how interviews were conducted (e.g., duration, setting, language, who conducted them), and how data saturation was determined would enhance reproducibility. The data analysis process needs to be explained with greater rigor. This includes details on coding procedures, theme development, and how trustworthiness (e.g., credibility, transferability, dependability, confirmability) was ensured.

Ethics Statement: Ensure it clearly states how informed consent was obtained.

Data Availability: The manuscript needs to explicitly state where the data can be found, or if there are restrictions (e.g., due to participant privacy in qualitative data), these must be clearly specified and justified. For qualitative studies, this often involves depositing anonymized transcripts or a detailed data dictionary and codebook in a recognized repository.

Results

Support for Conclusions: Ensure the results directly answer the research questions posed in the introduction.

Discussion

Interpretation and Comparison: The discussion section should interpret the findings in light of previous research and their implications. The "Response to Reviewers" mentions that the discussion was revised to reflect the authors' interpretation of findings as related to the field. This is a good improvement, but the reviewer should critically assess if these comparisons are robust and if the discussion avoids being overly opinionated without sufficient comparative analysis.

Good Luck!!

Reviewer #2: The manuscript reads better after addressal of the comments from the reviewers. However, there are some major comment that needs to be highlighted:

1. It seems like the current study methodology is reviewing of the transcript available from previous multinational study (DOI: 10.1371/journal.pone.0258729). Therefore, the methods section may require rewriting as it is not a new study but using data and information from prior study. Consider secondary information review type of methodology highlighting the information availability through previous study.

2. Intercoder reliability or similar objective approaches would strengthen the rigor of the study rather than only speaking of agreeing upon on meetings (subjective approach).

3. The recommendations fall into conclusion section, not discussion section. Also, conclusion does not take any references.

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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: Yes:  Hailemariam Mamo Hassen(PhD)

Reviewer #2: No

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[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.

Mental health related stigma in a primary care setting in Karnataka, rural India: service user and carer perspectives

PONE-D-24-43039R2

Dear Dr. Gronholm,

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.

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Kind regards,

Eleni Petkari

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: