Dear Dr. Roth,

Please submit your revised manuscript by Jan 10 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'.
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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,

Jan Christopher Cwik, Ph.D.

Academic Editor

PLOS ONE

Journal Requirements:

1. When submitting your revision, we need you to address these additional requirements.

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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2. We note that the grant information you provided in the ‘Funding Information’ and ‘Financial Disclosure’ sections do not match.

When you resubmit, please ensure that you provide the correct grant numbers for the awards you received for your study in the ‘Funding Information’ section.

3. Thank you for stating the following financial disclosure: [This work was supported within the National Institutes of Health (NIH) Pragmatic Trials Collaboratory through the NIH HEAL Initiative under award number UH3AT010621 administered by the National Center for Complementary and Integrative Health (NCCIH). This work also received logistical and technical support from the PRISM Resource Coordinating Center under award number U24AT010961 from the NIH through the NIH HEAL Initiative. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NCCIH or the NIH or its HEAL initiative].

Please state what role the funders took in the study. If the funders had no role, please state: "The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript."

If this statement is not correct you must amend it as needed.

Please include this amended Role of Funder statement in your cover letter; we will change the online submission form on your behalf.

4. Thank you for stating the following in the Acknowledgments Section of your manuscript: [This work was supported within the National Institutes of Health (NIH) Pragmatic Trials Collaboratory through the NIH HEAL Initiative under award number UH3AT010621 administered by the National Center for Complementary and Integrative Health (NCCIH). This work also received logistical and technical support from the PRISM Resource Coordinating Center under award number U24AT010961 from the NIH through the NIH HEAL Initiative. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NCCIH or the NIH or its HEAL initiative.]

We note that you have provided funding information that is not currently declared in your Funding Statement. However, funding information should not appear in the Acknowledgments section or other areas of your manuscript. We will only publish funding information present in the Funding Statement section of the online submission form.

Please remove any funding-related text from the manuscript and let us know how you would like to update your Funding Statement. Currently, your Funding Statement reads as follows: [This work was supported within the National Institutes of Health (NIH) Pragmatic Trials Collaboratory through the NIH HEAL Initiative under award number UH3AT010621 administered by the National Center for Complementary and Integrative Health (NCCIH). This work also received logistical and technical support from the PRISM Resource Coordinating Center under award number U24AT010961 from the NIH through the NIH HEAL Initiative. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NCCIH or the NIH or its HEAL initiative].

Please include your amended statements within your cover letter; we will change the online submission form on your behalf.

5. 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.

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

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: Partly

Reviewer #2: Yes

Reviewer #3: Partly

Reviewer #4: 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??>

Reviewer #1: Partly

Reviewer #2: Yes

Reviewer #3: Partly

Reviewer #4: Yes

**********

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

Reviewer #1: No

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: 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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: No

Reviewer #4: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

**********

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: Background:

Although the authors acknowledge the need for more research and data on the stakeholder engagement process for integrative medicine (p. 13), it is less clear how this protocol will address this knowledge gap. For example, it is not entirely clear if the use of rapid qualitative methods will yield information that can inform how researchers and study teams adapt or change how stakeholders are involved in the design, implementation, or evaluation of pragmatic clinical trials. A more explicit justification about why the authors anticipate that rapid qualitative methods can provide new insight into stakeholder engagement would be beneficial.

Methodology:

Given the parent study is concluding this calendar year, I have some concerns about the lack of details provided by the authors if they do not get adequate representation from patients and stakeholders in the focus groups and interviews they plan to conduct. The emphasis on snowball sampling may be the most appropriate option in this supplement study. Still, there are potential risks that the authors should acknowledge if they do not reach thematic saturation. Specifically, suppose the focus is to enhance the representation of underrepresented patients in the parent study. In that case, it is unclear how the authors will be able to recruit underrepresented patients for the supplement study.

Furthermore, there is a risk of self-selection bias if the authors can only recruit and enroll non-minority patients in their supplement study to understand better the barriers to participating in the parent study. Similarly, on p. 6, the authors state they will invite participants of the parent study to participate in the supplement study focus groups. Without understanding the perspective of eligible participants who did not consent to the parent study, I have reservations about whether the findings of the supplement study will be able to shed light on the factors impeding patients who are less motivated or less likely to engage in trials or research, in general.

Relatedly, the protocol paper lacks sufficient detail to explain how the study team will assess the impact or effectiveness of the stakeholder engagement process. Although qualitative data is necessary to understand the factors inhibiting or enabling patient enrollment, I believe the authors can explain more precisely how they will measure the impact of their community-based participatory research activities.

From a methodological perspective (p. 6), it would be insightful if the authors provided an appendix of the approved interview and focus group guides. How will these guides be modified to accommodate the usual care and intervention groups? Also, on p. 6, what is a policy influencer? Can the authors provide an example of one?

Page 7: What is the justification for including local insurers in the recruitment, retention, integration, and dissemination of MBSR? Please expand.

Also, why will “most interviews” occur virtually? Will the ones conducted in person be audio-recorded, too?

Minor comment: The 3-hour training session with the CAB members sounds interesting. Do the authors anticipate that this type of training would be beneficial to implement more broadly if they anticipate scaling this trial to other sites? Are the authors measuring CAB members’ participation in and satisfaction with this training?

Page 8: The CAB includes various representatives, but I believe an essential group is missing from the protocol: research associates and coordinators of the parent study. Given their central role in the recruitment and retention processes for clinical trials and knowledge of why patients decline to participate, I was hoping the authors could shed light on the decision not to include these roles in their supplement study. Are these types of roles not involved in the parent study?

Finally, how will the authors consolidate the recommendations from the stakeholders and patients to understand what recommendations are most appropriate and actionable? Using a grid that lists each discussion point (p. 10) is a starting point, but how will the CAB members, in conjunction with the study team, identify common recommendations across the three sites that are appropriate (i.e., context-specific) for all study locations? Perhaps the authors may want to consider having participants and study team members rank the recommendations according to the study site so that the recommendations selected for implementation could be specific to each site.

Study status and timeline:

Concerning the current study status and timeline (p. 11), it would be helpful if the authors could expand briefly on the status of their supplement study. Understanding this is a protocol paper; I was still left wanting to know more about the current data collection status of the supplement study. How many focus groups have been completed since the supplement study began in September 2021? How many interviews have been conducted at this point in the supplement study? Has there been any improvement in recruitment for the parent study because of this stakeholder engagement process?

Reviewer #2: O manuscrito inteligível, fornece uma justificativa válida para o estudo proposto, com questões de pesquisa claramente identificadas e justificadas. Metodologia viável. Descreve os métodos em detalhes suficientes

Reviewer #3: Outstanding study and well done. This paper has a potential to be accepted, but some important points have to be clarified or fixed before we can proceed and a positive action can be taken. Given these shortcomings the manuscript requires major revisions. I have some suggestions for each aspect of the manuscript. We here summarize these points:

Abstract:

Please focus the introduction in the abstract on the current study and your aims. The introduction is lengthy, and the last two lines are unnecessary and vague. In the methodology should be summarized, emphasizing the sample of this study and the methods of data collection.

The conclusion provides a clear and structured response to the main question or Purpose of the current research. Please conclude in relation to the overall Purpose or main question of the study and avoid generalizations.

Introduction:

In the introduction section authors should begin with a general context, narrowing to the specific focus of the manuscript. Include answer five main question: why your research is important, what is already known about the topic, the “gap” or what is not yet known about the topic, why it is important to learn the new information that your research adds, and the specific research aim(s) that your manuscript addresses. Your research aim should address the gap you identified. Be sure to add enough background information to enable readers to understand your study. Please clearly demonstrate the research problem of the present study from both a tactical (theoretical necessity) and a content (practical necessity) perspective.

In the introduction, more attention should be given to background information, research problem, research objective(s) and research question, making them tangible and understandable for the reader.

Methodology:

There is very little info on the development of this protocol (details, implementation, fidelity). The explanations are general; please address the details of the design and feasibility of the protocol.

It is recommended to evaluate the psychometric characteristics of the designed protocol in this study based on the principles of developing therapeutic interventions according to the American Psychological Association’s guidelines for assessing treatment protocols in three areas: the process of developing guidelines, Treatment Efficacy, and Clinical Utility.

The first criterion in the process of developing guidelines pertains to the members of the intervention development working group. What areas of expertise did the working group for the designed protocol include?

As the second criterion, the ethical evaluation of the developed program was conducted by whom?

The evaluation of treatment protocols by the American Psychological Association in the section on the therapeutic effectiveness of the intervention includes five criteria. The first criterion pertains to the theoretical foundations of the designed intervention. The second criterion is based on scientific clinical observations and the consensus of experts regarding the intervention topic. The third criterion addresses the effectiveness of the intervention in terms of the desirability of outcomes both exclusively and in comparison, to other related interventions. The fourth criterion in the area of treatment effectiveness relates to the alignment between the treatment and the patient. In the fifth criterion, provide the necessary documentation to specify the outcomes of the intervention and present supporting evidence.

what did the sessions involve, who delivered the sessions, who was present during the session, what format were the sessions delivered in (face-to-face, website, workbooks?), where were the sessions delivered (clinic, home?) A table with the topics of each session is not enough.

Results:

How were the psychometric characteristics of the current protocol examined? How many members were in the focus group, and what specialties did they have? How was the content of the interviews coded? What software was used for coding? Please provide the necessary explanations on these matters.

Qualitative research software should be used for coding interviews

Discussions:

in the discussion should beginning with interpretation of your results and moving to general implications. begins with a restatement of the main findings, which can usually be accomplished with a few carefully-crafted sentences. Next, interpret the meaning or explain the significance of your results, lifting the reader’s gaze from the study’s specific findings to more general applications. Then, compare these study findings with other research. Are these findings in agreement or disagreement with those from other studies? Does this study impart additional nuance to well-accepted theories? Situate your findings within the broader context of scientific literature, then explain the pathways or mechanisms that might give rise to, or explain, the results. Keep in mind that every study has strengths and limitations. Candidly reporting yours helps readers to correctly interpret your research findings. The next element of the discussion is a summary of the potential impacts and applications of the research. Should these results be used to optimally design an intervention? Does the work have implications for clinical protocols or public policy? These considerations will help the reader to further grasp the possible impacts of the presented work. Finally, the discussion should conclude with specific suggestions for future work. Here, you have an opportunity to illuminate specific gaps in the literature that compel further study. Avoid the phrase “future research is necessary” because the recommendation is too general to be helpful to readers. Instead, provide substantive and specific recommendations for future studies.

Conclusions:

Please provide a clear, objective, and tangible response to the overall research question and the feasibility of the current protocol for the target population.

References:

Please use more recent and high-quality references.

The text of the article needs to be simplified and made more fluid for better communication with the reader. Therefore, it is suggested that the authors simplify, trim, and summarize some of the long and unnecessary sentences to keep the reader’s mind aligned with the flow of the study’s progression.

Reviewer #4: This is an excellent piece of writing title “A Protocol for Using Rapid Qualitative Techniques to Incorporate Multi-Level Stakeholder Feedback in a Pragmatic Clinical Trial of Mindfulness for Chronic Low Back Pain”. However, there are few things which need clarification of the methods to diagnose low back pain. What tools would be used to rule out the diagnosis? Whether it would be a categorical or dimensional classification?

As the intervention would be given as part of tele health intervention, authors need to give details that how the retention would be managed. Further, authors need to explain the critical incidents during the intervention phase, how you would address the issues, and any escalation plan in hand to address the distress of patients experienced during the intervention.

Authors have mentioned that Individuals such as “clinic staff (front desk/registration, nurses, nurse practitioners, medical assistants, clinic managers, medical directors), healthcare system professionals (medical staff directors, providers, nursing staff directors, clinic and health system administrators), and payors (insurance representatives) will be providing their expert opinions in one-on-one interviews with trained study personnel”. Further they will undergo verbal informed consent, any reason for not taking written informed consent, give some reasons for this.

**********

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:  Ana Carina Henriques Teodósio Moisão

Reviewer #3: No

Reviewer #4: Yes:  Salman Shahzad

**********

[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.

Attachments

Attachment

Submitted filename: A Protocol for Using Rapid Qualitative Techniques.docx

PLOS ONE

Dear Dr. Roth,

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 Jun 01 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 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,

Jan Christopher Cwik, Ph.D.

Academic Editor

PLOS ONE

Journal Requirements:

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:

Thank you for submitting your revised manuscript. I have now received feedback from the reviewers on your revisions. Two of the reviewers have noted some minor aspects, which I would like you to consider adjusting in a further revision.

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

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

Reviewer #2: Yes

Reviewer #3: 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??>

Reviewer #1: Yes

Reviewer #2: Partly

Reviewer #3: Yes

**********

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

Reviewer #1: No

Reviewer #2: Yes

Reviewer #3: 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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

**********

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: Thank you for responding to the reviewers' comments. However, some unresolved issues remain. I cannot locate Appendix B in the revision. What new references about rapid qualitative methods were added to the revised manuscript? If policy influencer and advocacy groups are used synonymously throughout the paper, it would be beneficial to use only one of those terms.

Reviewer #2: I agree with the reviewer #1 :Although the authors acknowledge the need for more research and data on the stakeholder engagement process for integrative medicine, it is less clear how this protocol will address this knowledge gap.

Given the parent study is concluding this calendar year, I have some concerns about the lack of details provided by the authors if they do not get adequate representation from patients and stakeholders in the focus groups and interviews they plan to conduct. The emphasis on snowball sampling may be the most appropriate option in this supplement study. Still, there are potential risks that the authors should acknowledge if they do not reach thematic saturation. Specifically, suppose the focus is to enhance the representation of underrepresented patients in the parent study. In that case, it is unclear how the authors will be able to recruit underrepresented patients for the supplement study.

Reviewer #3: Given that the authors have thoroughly addressed all requested comments and effectively resolved the raised concerns, and that the manuscript now meets the requisite criteria for publication, I find no specific issues to highlight. Therefore, I conclude that the paper aligns well with the journal’s established standards for quality and rigor.

**********

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: No

Reviewer #3: No

**********

[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

Dear Dr. Roth,

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 Sep 19 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,

Jan Christopher Cwik, Prof. Dr. Dr.

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,

As you can see from the attached feedback, one reviewer has requested some revisions. I would therefore like to ask you to adapt these in a further revision process of your manuscript.

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

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

Reviewer #2: 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??>

Reviewer #1: Yes

Reviewer #2: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: 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

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

**********

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: I do not have any additional comments to provide to the authors. Thank you for providing the interview guides.

Reviewer #2: It is unclear how the authors will be able to recruit underrepresented patients for

the supplement study.

Here are potential risks that the authors should acknowledge if they do not reach thematic saturation

**********

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:  Ana Carina Henriques Teodósio Moisão

**********

[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

A Protocol for Using Rapid Qualitative Techniques to Incorporate Multi-Level Stakeholder Feedback in a Pragmatic Clinical Trial of Mindfulness for Chronic Low Back Pain

PONE-D-23-30839R3

Dear Dr. Roth,

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.

An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager®  and clicking the ‘Update My Information' link at the top of the page. For questions related to billing, please contact billing support .

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,

Jan Christopher Cwik, Prof. Dr. Dr.

Academic Editor

PLOS ONE

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 #2: 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 #2: Yes

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

Reviewer #2: 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 #2: Yes

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

Reviewer #2: 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 #2: A questão de pesquisa delineada aborda um problema ou tópico académico válido e contribuiu para a base de conhecimento na área.

Descreve os métodos com detalhes suficientes para evitar flexibilidade não divulgada no procedimento experimental ou na linha de análise, incluindo condições neutras em relação ao resultado suficientes para testar as hipóteses propostas e uma análise de poder estatístico.

Descrição de métodos e materiais suficientes

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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 #2: Yes:  Ana Carina Henriques Teodósio Moisão

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