• A 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,-->-->Udoka Okpalauwaekwe, MD, MPH, PhD-->-->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

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https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf

2. We noted in your submission details that a portion of your manuscript may have been presented or published elsewhere.

[The protocol has been submitted for registration with OSF.]

Please clarify whether this publication was peer-reviewed and formally published. If this work was previously peer-reviewed and published, in the cover letter please provide the reason that this work does not constitute dual publication and should be included in the current manuscript.

3. When completing the data availability statement of the submission form, you indicated that you will make your data available on acceptance. We strongly recommend all authors decide on a data sharing plan before acceptance, as the process can be lengthy and hold up publication timelines. Please note that, though access restrictions are acceptable now, your entire data will need to be made freely accessible if your manuscript is accepted for publication. This policy applies to all data except where public deposition would breach compliance with the protocol approved by your research ethics board. If you are unable to adhere to our open data policy, please kindly revise your statement to explain your reasoning and we will seek the editor's input on an exemption. Please be assured that, once you have provided your new statement, the assessment of your exemption will not hold up the peer review process.

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: Yes-->-->________________________________________-->-->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-->-->________________________________________-->-->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: Yes-->-->________________________________________-->-->4. Have the authors described where all data underlying the findings will be made available when the study is complete?-->--> -->-->The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception, at the time of publication. 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-->-->________________________________________-->-->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-->-->________________________________________-->-->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: Reviewer comments PONE-->-->It was a pleasure reviewing your protocol which addresses an important gap in implementation and scale-up science by proposing a systematic approach to naming, describing, and comparing structural models used to spread and scale digital health initiatives.-->-->Overall, the methods are thorough and well aligned with JBI and PRISMA-ScR methodology. The topic is also timely given the global push toward virtual care and digital health scale-ups post-COVID-19. The writing is clear and organized.-->--> -->-->However, several aspects require clarification to strengthen reproducibility, transparency, and rigor, particularly around conceptual definitions, positionality of the research team, and the plan for managing anticipated subjectivity in derived naming of models. See comments below:-->-->1) How will extractors decide whether a description in a paper constitutes a structural model vs. a scale-up framework or mechanism? And What minimum criteria qualify something as a “model”? I ask because you state that structural models are distinct from process models and theories, yet the distinction remains conceptually fuzzy.-->-->2) You mention that because many studies lack explicit model names , names will be derived by reviewers. Don’t you think this introduces interpretative bias? Why not add explanation on how disagreements will be handled (e.g., consensus threshold, third reviewer and state whether authors will record rationales for naming decisions (to enable reproducibility).-->-->3) I feel your equity Implementation analysis plan is underdeveloped. You fail to indicate whether communities or people with lived experience were involved in shaping extraction criteria, and whether cultural or structural determinants (e.g., Indigenous sovereignty, rurality, broadband inequity) will be captured.-->-->4) You state that the search strategy is already fully completed and title/abstract screening has begun. I wonder if you checked the Plos One requirements for protocols which states that protocols should typically be posted before significant screening occurs. Thoughts?-->-->5) Will searches will be limited by geography-->-->6) Will only English-language grey literature will be included (main text limits publications by English only; grey lit unclear)-->-->7) Your PCC table criteria could acknowledge emerging tech not yet in health systems (e.g., AI imaging triage)-->-->8) Your use of duplicate reviewer screening is appropriate, but protocol should specify if Cohen’s statistic or percent agreement will be reported-->-->9) Provide justification for your data availability statement.-->-->10) Add citation to PRISMA-ScR checklist in main text rather than supplementary only.-->-->________________________________________-->-->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?

Structural models for spreading and scaling digital health initiatives: A scoping review protocol

PONE-D-25-58053R1

Dear Dr. Laur,

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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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,

Udoka Okpalauwaekwe, MD, MPH, PhD

Academic Editor

PLOS One

Additional Editor Comments (optional):

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?

Reviewer #1: Yes

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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??>

Reviewer #1: Yes

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

Reviewer #1: 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??>

The PLOS Data policy

Reviewer #1: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: Yes

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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.

Reviewer #1: The authors sufficiently addressed my comments and I have no further comments at this time. Wish you the best

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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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