PONE-D-25-26146Care needs of patients with chronic wounds for implementing a virtual care program: A qualitative studyPLOS ONE

Dear Dr. Lotfi,

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PLOS ONE

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This work was supported by the Research Deputy of Tabriz University of Medical Sciences.

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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: Yes

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

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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: Yes

Reviewer #2: Yes

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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: Yes this manuscript is technically sound. I am a bit confused about the way FGD were conducted. Yes, data underlying this manuscript were fully available. The manuscript is written in standard English. I have some underlying comments to the authors.

1. Abstract: Please add the number of FGDs and IDIs in the abstract on pages 31-32.

2. The Introduction is well written.

3. Line 100-102, please move ethical consideration to a separate paragraph at the end of the methodology section.

4. Settings and participants: Please add purposive sampling method was used for participant selection on line 109.

5. Page 6, line 115, is a repetition regarding informed consent. Please remove.

6. Page 7, I am not convinced how the FGDs were reported. Please follow the COREQ checklist to report your study. Please check. The original 2007 paper by Tong, Sainsbury, and Craig mentions that COREQ is a 32-item checklist for interviews and focus groups in qualitative health research.

7. Please move the interview guide page 8, lines 149-158, to the annex.

8. Page 8, line 165 is a repetition, please remove.

9. Page 9, line 171, please report the mean duration of the interviews.

10. Page 9, move lines 172-179 to the annex.

Reviewer #2: I would like to thank for the opportunity to review this manuscript. The topic is timely and highly relevant, as the management of chronic wounds represents a growing global health challenge, both in terms of patient quality of life and healthcare system costs. Exploring how virtual care programs can be tailored to meet patient needs is of particular importance, especially in contexts where access to specialized wound care is limited. More broadly, digitalization has become a common and shared strategy across public health programmes to address priority health needs and reduce the distance between communities and healthcare providers. By investigating the perspectives of both patients and wound therapists, this study provides valuable insights that can inform the design of patient-centered digital/tele-health interventions.

Please find here below my comments to your work.

Abstract

• Clearly state the study design (e.g., “descriptive qualitative study using conventional content analysis”).

• Specify data collection methods (focus groups and semi-structured interviews).

• The abstract conclusions are somewhat general. They should align more closely with the specific findings.

Introduction

• Provide a stronger rationale for using a qualitative approach and explain why content analysis was chosen.

• Clarify the conceptual/theoretical background that supports the research (paradigm, perspective, or framework).

• Ensure references are updated (include the most recent literature on chronic wounds and virtual care, beyond 2020).

Methods

• Study design: The rationale for choosing descriptive qualitative design is not given. State why this was the most appropriate.

• Researcher reflexivity: Information on the interviewers (credentials, training, gender, role, possible biases) is missing.

• Participant selection: Purposeful sampling is mentioned but not explained in detail; provide justification for the sample size (eg. why authors feel is sufficient before saturation). Please also report on refusals/dropouts (response rate).

• Inclusion/exclusion criteria: Listed, but it is unclear whether these were adapted from previous studies or developed specifically for this study. Please specify.

• Data collection procedures:

1. Clarify why FGDs were partly online (WhatsApp) and partly in person—justify the mixed approach.

2. State whether the interview guide was piloted or validated.

3. Report if transcripts were returned to participants for verification (member checking).

4. Provide details on how consistency was ensured when translating or transcribing interviews.

• Trustworthiness: The manuscript mentions credibility, dependability, confirmability, and transferability following Guba and Lincoln’s criteria, but the description is too general. Please expand with concrete examples:

1. Credibility: clarify whether member checking involved only transcript review or also validation of themes and indicate how many participants were engaged in this process.

2. Dependability: specify whether an audit trail was maintained and how the research process was documented for external review.

3. Confirmability: detail the role of the two qualitative experts (e.g., whether they reviewed raw data, coding tree, or final themes).

4. Transferability: explain which participant characteristics were prioritized to ensure diverse perspectives and how these support applicability of findings to other contexts.

• Ethical aspects: Ethics approval is reported, but it is unclear how informed consent was obtained for participants with possible literacy limitations. Clarify how confidentiality and voluntary participation were guaranteed.

Analysis / Results

• Analysis process:

1. Describe the coding process in more detail (how many coders, how disagreements were resolved, whether a coding tree was developed).

2. Clarify whether thematic saturation was achieved and how this was determined.

3. Strengthen the description of measures to ensure trustworthiness (triangulation, audit trails, member checking).

• Presentation of results:

1. Participant quotations are included but identifiers are inconsistent (e.g., “participant 5,” “patient No. 2”). Standardize.

2. Demographic table is cluttered; age is missing in participants patients. Please simplify presentation of participant characteristics.

3. Ensure the link between raw data (quotes) and themes is explicitly demonstrated.

• Influence of participant characteristics: Table 1 shows variation among the seven patient participants in terms of education and wound duration. The manuscript does not explain whether and how these differences influenced responses (e.g., patients with longer wound duration or higher education level may express different needs). Clarify whether patterns were observed across subgroups, or state explicitly if no differences emerged.

Discussion and Conclusions

• Some conclusions are broader than what the data justify (e.g., strong policy recommendations from a small sample). Tone down overgeneralizations.

• Clarify how findings align with or differ from prior literature and highlight the unique contribution of this study.

• Limitations: already listed but expand on the impact of (1) small patient sample, (2) use of WhatsApp FGDs, and (3) potential biases due to researcher role.

• Sample size: The patient sample (n=7) is relatively small. Authors should discuss the implications of this limited number, particularly regarding generalizability/transferability of findings and the potential underrepresentation of certain perspectives.

• Consequences of sample size: Recommend highlighting the need for further investigation with larger and more diverse patient populations to validate and expand upon the findings.

• Implications: discussion should distinguish between what findings directly support and what remains speculative.

• Suggestions for future research are appropriate but could be more specific (e.g., testing the identified needs in implementation trials).

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Reviewer #1: Yes: Sayeeda Tarannum

Reviewer #2: No

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Submitted filename: Comments from Reviewer.pdf

Care needs of patients with chronic wounds for implementing a virtual care program: A qualitative study

PONE-D-25-26146R1

Dear Dr. Lotfi,

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,

Erfan Ghadirzadeh, MD

Academic Editor

PLOS One

Additional Editor Comments (optional):

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

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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

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

Reviewer #1: N/A

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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

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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

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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: (No Response)

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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: Sayeeda Tarannum

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