Supporting mental well-being of healthcare workers using a mobile app: A mixed-methods feasibility study

Mehmet Yildirim; Timothy Carter; Holly Blake

doi:10.1371/journal.pone.0341055

Peer Review History

Original SubmissionApril 21, 2025
27 Jul 2025 Decision Letter - Najmul Hasan, Editor Dear Dr. Blake, 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 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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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 .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. Is the manuscript technically sound, and do the data support the conclusions? Reviewer #1: Partly Reviewer #2: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #1: Yes Reviewer #2: Yes ****** 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 ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: No Reviewer #2: Yes ****** Reviewer #1: This article aims to assess the feasibility of a self-monitoring mobile app called MYARKEO, to improve mental well-being among healthcare workers and healthcare trainees in the United Kingdom (UK) . First, in the introduction section, authors mentioned "Despite the increasing use of apps for wellbeing, the feasibility, usability and acceptability of such tools has not been investigated with healthcare workers or healthcare trainees. ” This section should be rewritten because the author(s) only need to clearly point out the theoretical basis and the reason of using these theories in this part. Second, the literature review section is deficient in several key areas. It fails to sufficiently address recent scholarly works pertinent to the topic in the following respects: 1. “Chatbot as an emergency exist: Mediated empathy for resilience via human-AI interaction during the COVID-19 pandemic” 2. “Disentangling composite influences of social connectivity and system interactivity on continuance intention in mobile short video applications: The pivotal moderation of user-perceived benefits” 3. “Determining influence of service quality on user identification, belongingness, and satisfaction on mobile social media: Insight from emotional attachment perspective” 4. “How multidimensional benefits determine cumulative satisfaction and eWOM engagement on mobile social media: Reconciling motivation and expectation disconfirmation perspectives” 5.“Struggling or Shifting? Deciphering potential influences of cyberbullying perpetration and communication overload on mobile app switching intention through social cognitive approach” 6. “Determining the influence of depressive mood and self-disclosure on problematic mobile app use and declined educational attainment: Insight from stressor-strain-outcome perspective” 7�“Deciphering dynamic effects of mobile app addiction, privacy concern and cognitive overload on subjective well-being and academic expectancy: The pivotal function of perceived technostress” Third, more details about the method are needed to add in this current article. Language needs polishing; many sentences are not very smooth Fourth, according to the results, some findings were proposed. Combined with related work, the authors should accentuate their contributions in the conclusion section of this paper. Finally, while the paper is well-structured, there are still some issues with the clarity of expression and language, undermining its readability. Thus, the authors should ensure that a revised version of the manuscript is thoroughly proofread. Reviewer #2: Thank you for the opportunity to review your manuscript on MYARKEO. The study explores a timely topic, and the intent behind the intervention is promising. However, the manuscript would benefit from the following improvements: 1. Methodological Considerations Technical Issue Specificity: In Theme 3: Barriers to engagement – Technical Challenges, the mention of “software bugs” is too general. Since the app is central to the study, it would be helpful to describe the types of bugs encountered and their impact. Login issues on Android and the lack of a password reset feature appear to have contributed to attrition. Given that the app was updated during the study, please clarify whether these problems were resolved and why participants were not encouraged to update, as updates typically address such usability concerns. Engagement Calculation: The reported 64.41% engagement rate (514/789 days) lacks detail. Please clarify how this was calculated over the 6-week period, including definitions of engagement and the denominator used. Tracking Frequency: Please specify how often participants used the app each day. This data is often available from app analytics. Encouraging more frequent use may have yielded richer insights, as prior research (e.g., Myin-Germeys et al., 2009) shows the importance of capturing intra-day fluctuations in mental health using Ecological Momentary Assessment (EMA). 2. Inconsistencies Usability Ratings: The usability section rates ease of use as “excellent,” yet interface satisfaction and usefulness are rated “poor.” This contradiction should be clarified. Participant Feedback vs. Quantitative Ratings: In Theme 1, participants are quoted as praising the app’s design and ease of use, yet this conflicts with the MAUQ ratings. Clarifying this discrepancy would improve interpretive consistency. Dropout and Well-being Scores: The "assessment of mental well-being, depression, stress and anxiety" section mentions that participants who dropped out had higher baseline well-being scores than those who completed the study. This pattern appears to undermine the conclusion that the app supports positive behavior change or improved well-being, and should be discussed. 3. Reporting Clarity Repetition: The phrase “expectation of immediate benefits” is repeated in Theme 3 – Motivational Challenges and could be consolidated. Comparative Claims: The claim that engagement was higher than in similar studies needs supporting references to validate the comparison. The study explores an important area of interest. Addressing the issues above will improve the manuscript’s clarity, methodological transparency, and alignment between data and conclusions. ****** 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: Aishwarya Murali ******** [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. https://doi.org/10.1371/journal.pone.0341055.r001
Revision 1
21 Aug 2025 Author Response Reviewer 1 This article aims to assess the feasibility of a self-monitoring mobile app called MYARKEO, to improve mental well-being among healthcare workers and healthcare trainees in the United Kingdom (UK). First, in the introduction section, authors mentioned "Despite the increasing use of apps for wellbeing, the feasibility, usability and acceptability of such tools has not been investigated with healthcare workers or healthcare trainees.” This section should be rewritten because the author(s) only need to clearly point out the theoretical basis and the reason of using these theories in this part. Response: Many thanks for this comment. We have checked the introduction and revised the flow of the paragraphs. We have added a section into the end of paragraph 3 (line 61) in which we mention mobile app-based mental wellbeing interventions. This improved the flow. Second, the literature review section is deficient in several key areas. It fails to sufficiently address recent scholarly works pertinent to the topic in the following respects: 1. “Chatbot as an emergency exist: Mediated empathy for resilience via human-AI interaction during the COVID-19 pandemic” 2. “Disentangling composite influences of social connectivity and system interactivity on continuance intention in mobile short video applications: The pivotal moderation of user-perceived benefits” 3. “Determining influence of service quality on user identification, belongingness, and satisfaction on mobile social media: Insight from emotional attachment perspective” 4. “How multidimensional benefits determine cumulative satisfaction and eWOM engagement on mobile social media: Reconciling motivation and expectation disconfirmation perspectives” 5.“Struggling or Shifting? Deciphering potential influences of cyberbullying perpetration and communication overload on mobile app switching intention through social cognitive approach” 6. “Determining the influence of depressive mood and self-disclosure on problematic mobile app use and declined educational attainment: Insight from stressor-strain-outcome perspective” 7�“Deciphering dynamic effects of mobile app addiction, privacy concern and cognitive overload on subjective well-being and academic expectancy: The pivotal function of perceived technostress” Response: Thank you for sending details of these 7 studies, all of which have a single author in common. These studies are not directly relevant to our paper. One is about an AI-powered Chatbot, the others relate to a range of issues as mobile social media, cyberbullying, and technostress. We have discussed these papers as a research team and agreed that they are not directly relevant to the topic area of this paper and would detract from its focus. Third, more details about the method are needed to add in this current article. Language needs polishing: many sentences are not very smooth. Response: Thank you for this comment. We have made some minor revisions to sentences throughout the paper (particularly the methods) to improve the flow. We noticed inconsistency in the presentation of well-being (well-being or wellbeing) and this has been corrected throughout. It is not clear what further methodological details are required by this reviewer – we have already included all relevant details for this study. One change we did make is to move the signposting to the interview topic guide (S1 Text) from the results section into the methods. Fourth, according to the results, some findings were proposed. Combined with related work, the authors should accentuate their contributions in the conclusion section of this paper. Response: Thank you for the opportunity to further accentuate our findings. We have endeavoured to do this with a re-draft of text in the conclusion section. Finally, while the paper is well-structured, there are still some issues with the clarity of expression and language, undermining its readability. Thus, the authors should ensure that a revised version of the manuscript is thoroughly proofread. Response: Thank you for this comment. We have re-read the manuscript and made minor revisions to the language used throughout. Reviewer 2: 1. Methodological Considerations Technical Issue Specificity: In Theme 3: Barriers to engagement – Technical Challenges, the mention of “software bugs” is too general. Since the app is central to the study, it would be helpful to describe the types of bugs encountered and their impact. Login issues on Android and the lack of a password reset feature appear to have contributed to attrition. Given that the app was updated during the study, please clarify whether these problems were resolved and why participants were not encouraged to update, as updates typically address such usability concerns. Response:Many thanks for these helpful comments. In Theme 3, “unresponsive questions, delayed saving of data, and daily scores not loading” are the minor bugs. The next sentence (line 391) was revised, those bugs (occurred a few times) were gone after restarting the app. These bugs may also occur based on the phone quality. There is one major technical issue with Android phones which is mentioned in line 231. This issue occurred during the recruitment period. We contacted the app developer, but unfortunately the issue could not be resolved. Since we had already reached our target number of participants, recruitment stopped. Engagement Calculation: The reported 64.41% engagement rate (514/789 days) lacks detail. Please clarify how this was calculated over the 6-week period, including definitions of engagement and the denominator used. Response: Mobile engagement means frequency of mobile app use, which is someone entering the app and answering the daily questions. We had 19 participants in the intervention group. It was expected all participants would use the app every day, total of 42 days. So, 19x42= 798 which is the total days. However, some participants used the app every day, but some only used it for a few days. When somebody used the app, the app saved the day and their daily score. Based on these records, we calculated the total actual use which was 514. Then, we divided 514/798 =64.4% that is the daily engagement rate. In the method section line 186-189, a sentence was added to describe how the engagement rate was calculated. While re-checking the numbers, we noticed that there was a mistake relating to the total number. It is 798 but was mistakenly reported as 789. This has been corrected and all other numbers have been checked and are correct. Tracking Frequency: Please specify how often participants used the app each day. This data is often available from app analytics. Encouraging more frequent use may have yielded richer insights, as prior research (e.g., Myin-Germeys et al., 2009) shows the importance of capturing intra-day fluctuations in mental health using Ecological Momentary Assessment (EMA). Response: Many thanks for this suggestion. However, since participant were encouraged to use the app once per day for daily monitoring, we did not observe more than one use in a day and would not expect to in this particular study. 2. Inconsistencies Usability Ratings: The usability section rates ease of use as “excellent,” yet interface satisfaction and usefulness are rated “poor.” This contradiction should be clarified. Participant Feedback vs. Quantitative Ratings: In Theme 1, participants are quoted as praising the app’s design and ease of use, yet this conflicts with the MAUQ ratings. Clarifying this discrepancy would improve interpretive consistency. Response: Thank you for this comment. This MAUQ included 18 questions, which were divided into three groups: ease of use (the first five questions), interface and satisfaction (the following seven questions), and usefulness (the last six questions). Participants expressed different views on these three groups. The findings from the MAUQ are consistent with the qualitative findings. In the themes, the participants like the ease of use of the app. However, they indicate some cons about interface and satisfaction such as “masculine interface” (in Theme 4, design improvements) and perceived lack of usefulness (in Theme 1, Impacts on mental wellbeing). The MAUQ total score reflects these differences in views as its “good” in between “excellent” and “poor”. Dropout and Well-being Scores: The "assessment of mental well-being, depression, stress and anxiety" section mentions that participants who dropped out had higher baseline well-being scores than those who completed the study. This pattern appears to undermine the conclusion that the app supports positive behavior change or improved well-being, and should be discussed. Response: Many thanks for this thoughtful comment. However, high well-being score is better mental wellbeing based on the interpretation of the scoring of WEMWBS. In the intervention group, post-intervention mental well-being score is slightly lower than baseline mental-wellbeing score. It is also lower than the control group scores. So, this may mean that the app may not show significant improvement in the well-being scores. We have reflected on this in the discussion (line 446-459), although, as we have now added to the text, it is not the intention of a feasibility study to examine / determine effectiveness of an intervention. Small sample size, and higher well-being scores in drop-outs may impact on these differences. 3. Reporting Clarity Repetition: The phrase “expectation of immediate benefits” is repeated in Theme 3 – Motivational Challenges and could be consolidated. Comparative Claims: The claim that engagement was higher than in similar studies needs supporting references to validate the comparison. Response: Yes, thank you for noticing this. The repetition has now been removed. We appreciated the suggestion to cite references for our comparison with other studies relating to engagement. We have already cited two articles in which the sample is a healthcare population. Knill K, Warren B, Melnyk B, Thrane SE. Burnout and well-being: Evaluating perceptions in bone marrow transplantation nurses using a mindfulness application. Clin J Oncol Nurs. 2021;25: 547–554. doi:10.1188/21.CJON.547-554 Orosa-Duarte Á, Mediavilla R, Muñoz-Sanjose A, Palao Á, Garde J, López-Herrero V, et al. Mindfulness-based mobile app reduces anxiety and increases self-compassion in healthcare students: A randomised controlled trial. Med Teach. 2021;43: 686–693. doi:10.1080/0142159X.2021.1887835 To further address your suggestion, we have now added a recent meta-analysis of persuasive design, engagement, and efficacy in 92 RCTs of mental health apps to support our argument that our engagement rate is higher than overall daily app use. Valentine L, Hinton JDX, Bajaj K, Boyd L, O’Sullivan S, Sorenson RP, et al. A meta-analysis of persuasive design, engagement, and efficacy in 92 RCTs of mental health apps. NPJ Digit Med. 2025;8: 229. doi:10.1038/s41746-025-01567-5 The study explores an important area of interest. Addressing the issues above will improve the manuscript’s clarity, methodological transparency, and alignment between data and conclusions. Response: Many thanks for your supportive comments which we believe have improved the manuscript quality. Tracking Frequency: Please specify how often participants used the app each day. This data is often available from app analytics. Encouraging more frequent use may have yielded richer insights, as prior research (e.g., Myin-Germeys et al., 2009) shows the importance of capturing intra-day fluctuations in mental health using Ecological Momentary Assessment (EMA). Many thanks for these helpful comments. In Theme 3, “unresponsive questions, delayed saving of data, and daily scores not loading” are the minor bugs. The next sentence (line 391) was revised, those bugs (occurred a few times) were gone after restarting the app. These bugs may also occur based on the phone quality. There is one major technical issue with Android phones which is mentioned in line 231. This issue occurred during the recruitment period. We contacted the app developer, but unfortunately the issue could not be resolved. Since we had already reached our target number of participants, recruitment stopped. Mobile engagement means frequency of mobile app use, which is someone entering the app and answering the daily questions. We had 19 participants in the intervention group. It was expected all participants would use the app every day, total of 42 days. So, 19x42= 798 which is the total days. However, some participants used the app every day, but some only used it for a few days. When somebody used the app, the app saved the day and their daily score. Based on these records, we calculated the total actual use which was 514. Then, we divided 514/798 =64.4% that is the daily engagement rate. In the method section line 186-189, a sentence was added to describe how the engagement rate was calculated. While re-checking the numbers, we noticed that there was a mistake relating to the total number. It is 798 but was mistakenly reported as 789. This has been corrected and all other numbers have been checked and are correct. Many thanks for this suggestion. However, since participant were encourage to use the app once per day for daily monitoring, we did not observe more than one use in a day and would not expect to in this particular study. 2. Inconsistencies Usability Ratings: The usability section rates ease of use as “excellent,” yet interface satisfaction and usefulness are rated “poor.” This contradiction should be clarified. Participant Feedback vs. Quantitative Ratings: In Theme 1, participants are quoted as praising the app’s design and ease of use, yet this conflicts with the MAUQ ratings. Clarifying this discrepancy would improve interpretive consistency. Dropout and Well-being Scores: The "assessment of mental well-being, depression, stress and anxiety" section mentions that participants who dropped out had higher baseline well-being scores than those who completed the study. This pattern appears to undermine the conclusion that the app supports positive behavior change or improved well-being, and should be discussed. Thank you for this comment. This MAUQ included 18 questions, which were divided into three groups: ease of use (the first five questions), interface and satisfaction (the following seven questions), and usefulness (the last six questions). Participants expressed different views on these three groups. The findings from the MAUQ are consistent with the qualitative findings. In the themes, the participants like the ease of use of the app. However, they indicate some cons about interface and satisfaction such as “masculine interface” (in Theme 4, design improvements) and perceived lack of usefulness (in Theme 1, Impacts on mental wellbeing). The MAUQ total score reflects these differences in views as its “good” in between “excellent” and “poor”. Many thanks for this thoughtful comment. However, high well-being score is better mental wellbeing based on the interpretation of the scoring of WEMWBS. In the intervention group, post-intervention mental well-being score is slightly lower than baseline mental-wellbeing score. It is also lower than the control group scores. So, this may mean that the app may not show significant improvement in the well-being scores. We have reflected on this in the discussion (line 446-459), although, as we have now added to the text, it is not the intention of a feasibility study to examine / determine effectiveness of an intervention. Small sample size, and higher well-being scores in drop-outs may impact on these differences. 3. Reporting Clarity Repetition: The phrase “expectation of immediate benefits” is repeated in Theme 3 – Motivational Challenges and could be consolidated. Comparative Claims: The claim that engagement was higher than in similar studies needs supporting references to validate the comparison. The study explores an important area of interest. Addressing the issues above will improve th Attachments Attachment Submitted filename: Response to reviewers.docx https://doi.org/10.1371/journal.pone.0341055.r002
17 Nov 2025 Decision Letter - Najmul Hasan, Editor Dear Dr. Blake, 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. I’m glad to hear from the reviewer that the paper has improved! Could you please specify the minor issues you’d like me to address? If you can list them by the relevant parts, I’ll fix everything right away. Please submit your revised manuscript by Jan 01 2026 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, Najmul Hasan, PhD 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. 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. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author Reviewer #2: All comments have been addressed Reviewer #3: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions??> Reviewer #2: Yes Reviewer #3: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #2: Yes Reviewer #3: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #2: Yes Reviewer #3: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #2: Yes Reviewer #3: Yes ****** Reviewer #2: Thank you for addressing the comments and providing details. The manuscript shows improvement with stronger evidence and explanations. However, a few points still need clarification: Line 231 – Android Bug: Please specify the exact “major Android bug” mentioned. It’s unclear what issue this refers to and how it affected the study. It is important to understand the technical difficulties as the app is the primary tool. App Update: Clarify whether the app update during the study resolved the usability problems and why participants were not encouraged to update, since updates often fix such issues (especially the major Android bug mentioned above). Overall, the paper is well improved and close to readiness once these clarifications are addressed. Reviewer #3: The manuscript is conceptually strong and methodologically appropriate for a feasibility study, but requires clarifications in methods, moderating of claims, and more precise framing of results. ****** 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 #2: No Reviewer #3: Yes: Asma Khaleel Abdallah ******** [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.] To ensure your figures meet our technical requirements, please review our figure guidelines: https://journals.plos.org/plosone/s/figures You may also use PLOS’s free figure tool, NAAS, to help you prepare publication quality figures: https://journals.plos.org/plosone/s/figures#loc-tools-for-figure-preparation. NAAS will assess whether your figures meet our technical requirements by comparing each figure against our figure specifications. https://doi.org/10.1371/journal.pone.0341055.r003
Revision 2
17 Nov 2025 Author Response 17 November 2025 Dear Editor, Thank you for the opportunity to revise and resubmit our article: [PONE-D-25-19125R1] - [EMID:cbd3df42c2f44951]. A point-by-point response is provided below. We look forward to hearing from you in due course. Kind regards, Prof. Holly Blake (corresponding author). Comments Revisions Reviewer 2 All comments have been addressed Thank you for confirming that all comments have been addressed to satisfaction. Reviewer has confirmed YES to: The manuscript is technically sound, and the data support the conclusions. Statistical analysis been performed appropriately and rigorously. All data underlying the findings in the manuscript are fully available. The manuscript presented in an intelligible fashion and written in standard English. The manuscript shows improvement with stronger evidence and explanations. However, a few points still need clarification: Line 231 – Android Bug: Please specify the exact “major Android bug” mentioned. It’s unclear what issue this refers to and how it affected the study. It is important to understand the technical difficulties as the app is the primary tool. App Update: Clarify whether the app update during the study resolved the usability problems and why participants were not encouraged to update, since updates often fix such issues (especially the major Android bug mentioned above). Overall, the paper is well improved and close to readiness once these clarifications are addressed. Thank you for this positive feedback. In response to the two comments: The major Android bug, referenced on line 231, was a persistent authentication error. Even though new Android users entered correct credentials, they received "invalid password or email" error resulting no access to the app. This issue was not seen in IOS users. Regarding the app update, the developer informed us that due to financial constraints resulting from the COVID-19 pandemic, they were unable to develop or release a patch to resolve this specific major bug and other minor bugs. Therefore, no update was available to offer participants. However, minor bugs faced by a few participants were gone after restarting the app. We have faced this issue after recruiting 49 participants which was a sufficient number for a feasibility study (e.g. Totton et. al., 2023). Therefore, since we reached the sufficient participant number for our study, and were unable to resolve this major issue, we did not recruit any further participants to the study. The relevant section has been revised in the manuscript. Reviewer 3 All comments have been addressed Thank you for confirming that all comments have been addressed to satisfaction. Reviewer has confirmed YES to: The manuscript is technically sound, and the data support the conclusions. Statistical analysis been performed appropriately and rigorously. All data underlying the findings in the manuscript are fully available. The manuscript presented in an intelligible fashion and written in standard English. The manuscript is conceptually strong and methodologically appropriate for a feasibility study, but requires clarifications in methods, moderating of claims, and more precise framing of results. The review has confirmed that: 1. All comments have been addressed (in the revised version previously submitted). 2. The manuscript is conceptually strong. 3. The methodology is appropriate for a feasibility study. The reviewer has now made an additional comment that this manuscript “requires clarifications in methods, moderating of claims, and more precise framing of results” but has not given any indication as to what should change. We have already been very precise in our reporting of methods and results, which is guided by the Consolidated Standards of Reporting Trials (CONSORT) for pilot and feasibility studies, the Checklist for Reporting Qualitative Studies (COREQ-32), and mobile health (mHealth) evidence reporting and assessment (mERA) checklist. Therefore, we do not believe there is anything further to clarify in the methods, except for addressing the two specific comments about the App, made by Reviewer 2. We have not overstated our claims, and believe the interpretation is appropriate in line with reporting guidelines for feasibility studies (Consolidated Standards of Reporting Trials (CONSORT) for pilot and feasibility studies). We conclude that “Our study is the first to examine the feasibility and detailed daily usage of a well-being monitoring mobile app for mental well-being promotion among healthcare workers and trainees. This study demonstrates the feasibility of a mental well-being monitoring mobile app for healthcare workers and trainees, with positive findings related to the acceptability of randomised controlled trial design methodology including recruitment, randomisation, intervention delivery, questionnaire implementation, and participant retention”. Using cautious language, we indicate that “Although a feasibility study does not aim to examine effectiveness of the intervention…” and “the effectiveness of such interventions needs to be a tested in a large-scale randomised trial”. However, we have re-drafted the whole study strengths and limitations section, and sections of the results, discussion and conclusion to ensure maximum clarity. Note that this reviewer has confirmed that “all comments have been addressed”, “The manuscript is technically sound, and the data support the conclusions”, “Statistical analysis been performed appropriately and rigorously”, “All data underlying the findings in the manuscript are fully available” and “The manuscript presented in an intelligible fashion and written in standard English”. https://doi.org/10.1371/journal.pone.0341055.r004
16 Dec 2025 Decision Letter - Najmul Hasan, Editor Dear Dr. Blake, 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 Jan 30 2026 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, Najmul Hasan, PhD 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. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author Reviewer #2: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions??> Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #2: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #2: Yes ****** Reviewer #2: All comments have been addressed in the latest submission. The Android problem specifically is also added. ****** 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 #2: 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.] To ensure your figures meet our technical requirements, please review our figure guidelines: https://journals.plos.org/plosone/s/figures You may also use PLOS’s free figure tool, NAAS, to help you prepare publication quality figures: https://journals.plos.org/plosone/s/figures#loc-tools-for-figure-preparation. NAAS will assess whether your figures meet our technical requirements by comparing each figure against our figure specifications. https://doi.org/10.1371/journal.pone.0341055.r005
Revision 3
22 Dec 2025 Author Response 17 December 2025 Dear Editor and Reviewers, PONE-D-25-19125R2 Supporting mental well-being of healthcare workers using a mobile app: a mixed-methods feasibility study We have received a request for minor revisions to the above paper. However, there do not seem to be any revisions to address. We have responded to the points made below which confirm this. Consequently, no changes have been made to the documents submitted last time. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter We have no changes to make, the information already included is correct, although we have included it again in our cover letter. 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 #2: All comments have been addressed Thank you for this positive comment. 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 #2: Yes Thank you for confirming our manuscript is technically sound. 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #2: Yes Thank you confirming the statistical analysis has been performed appropriately and rigorously. 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 #2: Yes Thank you for confirming our data are fully available in a research data management repository. 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 #2: Yes Thank you for confirming that our manuscript is written in an intelligible fashion and standard English. 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 #2: All comments have been addressed in the latest submission. The Android problem specifically is also added. Thank you for confirming that all comments were addressed in the previous submission. To ensure your figures meet our technical requirements, please review our figure guidelines: https://journals.plos.org/plosone/s/figures We have checked and our figures already do meet technical requirements. Attachments Attachment Submitted filename: Response_to_reviewers_auresp_3.docx https://doi.org/10.1371/journal.pone.0341055.r006
2 Jan 2026 Decision Letter - Najmul Hasan, Editor Supporting mental well-being of healthcare workers using a mobile app: a mixed-methods feasibility study PONE-D-25-19125R3 Dear Dr. Blake, 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, Najmul Hasan, PhD Academic Editor PLOS One Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0341055.r007
Formally Accepted
Acceptance Letter - Najmul Hasan, Editor PONE-D-25-19125R3 PLOS One Dear Dr. Blake, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS One. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset You will receive further instructions from the production team, including instructions on how to review your proof when it is ready. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few days to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. 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. You will receive an invoice from PLOS for your publication fee after your manuscript has reached the completed accept phase. If you receive an email requesting payment before acceptance or for any other service, this may be a phishing scheme. Learn how to identify phishing emails and protect your accounts at https://explore.plos.org/phishing. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Najmul Hasan Academic Editor PLOS One https://doi.org/10.1371/journal.pone.0341055.r008

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