Dear Dr. Adhikari,

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:

==============================

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We look forward to receiving your revised manuscript.

Kind regards,

Ranjit Kumar Dehury

Academic Editor

PLOS ONE

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Additional Editor Comments (if provided):

Dear authors,

You are advised to work very meticulously on the reviewers comments before reassessment for suitability of publication in the journal.

With regards,

Ranjit

[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?

Reviewer #1: Partly

Reviewer #2: Partly

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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

Reviewer #1: Yes

Reviewer #2: Yes

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

Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: The paper is written about a topic still emerging in current scientific discourse, so it is a valuable addition. However, some areas could be strengthened to ensure it reflects the existing evidence. For instance, the authors would benefit from drawing on existing data about disability and menstrual health in Nepal and other countries in their discussion. I have written detailed comments on each section in the attached document.

Reviewer #2: 1. I suggest instead of “disabled” and “women with physical disability”, the authors should use “differently abled” because "differently abled" reflects a more respectful, inclusive, and optimistic approach to a person with limited mobility, emphasizing their potential and unique capabilities. It aligns with the concept of "person-first language," which focuses on the person rather than their condition. This approach promotes the idea that an individual's identity is not defined by their physical conditions.

2. Why referencing is not done for Braun and Clarke in the references?

3. How 21 in-depth interviews and 1 FGD were determined as the sample?

4. How were the three organizations, namely DARRDO, BWAN, and BYAN, incorporated into the sampling process? Please explain their roles. BWAN and BYAN are associations for visually challenged persons; it is highly likely that your data mostly represent visually challenged persons while not the other types of physically challenged persons.

5. What are those severities and yellow & blue cards mentioned in Table 1? The manuscript does not explain how the type of disability can be understood using those terminologies.

6. Authors should mention how the identities of participants are anonymized. Who can access the data?

7. What are CBOs?

8. The full form of FCHV should come when it is first used in the manuscript, i.e. in the abstract.

9. “One of the participants.” before quotes is grammatically incorrect. Authors may write “One of the participants said” or “According to one of the participants;”

10. The authors confined the study to differently-abled married women, but they failed to capture the experiences that are unique to this group. Their result is general and not focused on the nature of the group studied. They can at least add two themes to the result, discussing the experiences that are unique to differently-abled married women regarding menstruation.

11. In the discussion section, various issues related to differently-abled persons’ challenges that are not found in the results section, such as mental health, diseases, and disorders.

12. In the discussion section, there is no need to write a literature review. You are supposed to substantiate and contradict your findings with the existing literature.

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what does this mean? ). If published, this will include your full peer review and any attached files.

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Reviewer #1: No

Reviewer #2: Yes:  Imteyaz Ahmad

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Attachments

Attachment

Submitted filename: Adhikari 2024 paper review 1.docx

Dear Dr. Adhikari,

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: The authors have to comply before reevaluation

==============================

Please submit your revised manuscript by May 07 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.

• 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,

Ranjit Kumar Dehury

Academic Editor

PLOS ONE

Additional Editor Comments:

The authors have to comply before reevaluation

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

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #1: (No Response)

Reviewer #2: (No Response)

**********

2. Is the manuscript technically sound, and do the data support the conclusions??>

Reviewer #1: Partly

Reviewer #2: Yes

**********

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

Reviewer #1: N/A

Reviewer #2: N/A

**********

4. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy

Reviewer #1: Yes

Reviewer #2: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: Yes

**********

Reviewer #1: Overall

This version is much improved, but it still needs strengthening for publication in an academic journal. In your revisions, use the checklist in Appendix 1 of this paper: https://pmc.ncbi.nlm.nih.gov/articles/PMC2987281/. It is very helpful for ensuring you are including all the relevant information in the paper and under which section it should go. The full paper explains how to present qualitative data for publication.

Abstract

• Methods: include your data analysis approach (eg thematic analysis)

• Result: Avoid using ‘etc’ in academic writing. Some results need more detail. You’re assuming the reader has prior knowledge of the topic, which mightn’t be true. If giving more detail this pushes you over your word count, reduce the number of results. E.g. Line 40 – can you give more details as the reader mightn’t understand the perceived cause and effect. Line 43-44: ‘feeling dependent and vulnerable’. There is a lot to unpack here. Line 48: ‘self-awareness’ or ‘knowledge’?

• Conclusion: don’t use acronyms (line 54). The conclusion should explain the implications of the findings and their relevance. You have included recommendations and these don’t clearly relate to the results.

Introduction

• Include a definition or explanation of ‘self-care’ by building on the WHO framework – eg self care is defined as xxx, which includes self-awareness, self-management… This is a considerable omission because the whole paper hangs on the practice self-care.

• Line 94: I’m not sure the disability cards ‘ensure’ inclusive development. Best use less definitive language, such as ‘To facilitate inclusive devt, the govt….’

• Line 108: needs a full stop and reference for the health issues

• When describing the situation in Nepal, can you include some data on Karnali so it builds the case for you doing your study there?

• Line 112-115. Without a definition of ‘self-care’ this sentence doesn’t make sense

• Line 116-118 – needs a reference

• Line 116-122: include your research objectives. You reference objectives in line 132 and you must include them explicity

Methods and materials

• Line 127 – reference Braun and Clarke and give a brief explanation of this approach

• Line 128 - Include information about Karnali province

• Participants and sampling:

o Include your definition of ‘physical disability.’ How did you determine this in your study (e.g. self-reported or from medical lists)?

o Line 130-133: ‘better explain their experiences according to the study’s objective’ introduces researcher bias as you could have excluded relevant participants. How did you attempt to manage that? How can you justify this approach?

o Why was ‘married women’ important?

o It would be helpful if you specifically state what your inclusion/exclusion criteria is

• Include a separate section on ethical considerations. You need to put a lot more information in about the ethical procedures you followed. This would include the informed consent process, which ethical board you sought and received ethical clearance from, where you conducted the interviews etc etc. Some of this is covered under ‘data collection and procedures’. You can look at published qualitative papers related to disability to see what should be included and the level of detail

• Reference the supporting documents were relevant (eg topic guides)

Results

• Line 199-202 and Table 2 should go under methods

• You use terms like ‘moderate’, ‘severe’ disability and severity of disability (line 262-263), but you have not explained what you mean by this and the criteria you used to define moderate in the methods. This introduces researcher bias. Either delete the reference to this throughout the results or explain the criterion in your methods.

• Line 226-227 – change to ‘their unborn children’ as that is what the participant is referring to, not living children

• Line 242 – define menstrual underwear. What are these, are they bought, are the reusable? Line 252 – you refer to menstrual panties, period panty. Use one term consistently throughout. In your introduction, include menstrual underwear as a product used in Nepal

• Line 245 – cloths, not clothes

• Line 281-285 – full stops are missing. Ensure you closely proof read your manuscript before submission

• In academic writing you always need to define terms used. Eg you refer to ‘proper disposal’; that must be explained as ‘proper’ can be subjective. Always use references when giving definitions. This doc might be helpful: https://www.unicef.org/documents/guidance-menstrual-health-and-hygiene

• Line 310: give an example to make this sentence clear

• Line 410: ‘some of the young’ – define the age range as you are only interviewing adults

Discussion

• Include a discussion on the transferability of research findings to other settings

• Line 515. Have a separate section on the study’s strengths and limitations

• Reflect on the influence of the researcher[s] on data, including a consideration of how the researcher(s) may have introduced bias to the results is included

Reviewer #2: 1. Abstract: Undefined acronym: FCHV

2. Results: The status of physical disability is mentioned with all the quotes, and age can also be mentioned for a better understanding of the background of the participants.

**********

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

Reviewer #2: Yes:  Imteyaz Ahmad

**********

[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.

Dear Dr. Adhikari,

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 Aug 28 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.

• 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 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,

Seifadin Ahmed Shallo, MPH

Academic Editor

PLOS ONE

Journal Requirements:

1. 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. 

2. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments:

Dear authors,

I appreciate your efforts in addressing then comments given you so far. Yet, the following issues also need to be addressed. 

1. How did you analyze your data (Data analysis method/software vs manual )

2. Is it monthly or life time history you took. The women may use sanitary pad sometimes and rag clothes on another time. The recent one she may used can affect your finding? (ups and downs in life )

3. Which type of physical disabilities did you consider in the study and why????

4. Why only married women? Since all women who started menstruations can be parts of the study.

5. Why only 1 FGD? What was your justification and how did you able to determine the idea saturation with single FGD????

6. Its better to indicate what severe, moderate, and mild disability mean in method section and what is your reference to classify them in such category??

7. If severity matters, did you consider including them from different severity status??

8. The way dta collected was bit confusing? Make it clear.

9. You have cited similar information with different source line…145 and 225. (refe 28 vs 31)

10. Did you use the deductive or inductive approach while you generate the “Themes’’? and why?

11. Is your finding different from what is common among general population? Especially in terms of menstrual hygiene materials utilized, awareness level, and in terms of pain relieving approaches?

12. The recommendation should also some thing inline with your finding and applicable (should be to bring tangible change if applied) 

[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.

Understanding the menstrual health self-care practices and experiences among women with physical disabilities in rural Nepal: A qualitative study 

PONE-D-24-31534R3

Dear Dr. Adhikari,

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,

Seifadin Ahmed Shallo, MPH

Academic Editor

PLOS ONE