Assessing the role of peer education in improving clinical and patient-reported outcomes in adults with chronic kidney disease: A scoping review protocol

Anna Winterbottom; Jyoti Baharani; Hilary L. Bekker

doi:10.1371/journal.pone.0342126

Peer Review History

Original SubmissionSeptember 24, 2025
13 Nov 2025 Decision Letter - Pasyodun Koralage Buddhika Mahesh, Editor Dear Dr. Winterbottom, 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 Dec 28 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. 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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 If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references.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 If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.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.] 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: Yes Reviewer #3: Yes ****** 3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable??> Reviewer #1: Yes 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: 1.I recommend that the authors include the planned data extraction form as a supplementary appendix. While the manuscript outlines the extraction fields in the text, sharing the actual template would greatly enhance methodological transparency and allow future researchers to replicate or adapt the approach more easily. 2.The research questions could be refined to remove some redundancy and achieve sharper focus. Condensing them into three concise questions, addressing (i) the models and contexts of peer education in CKD, (ii) the outcomes these interventions influence, and (iii) the components and implementation factors that drive effectiveness across different patient groups—would streamline the study aims and better align them with the proposed synthesis strategy. 3.A careful editorial review would further improve the clarity and presentation of the manuscript. Minor grammatical issues (for example, replacing “are their variations” with “are there variations”), consistent use of acronyms, shortening overly long sentences, and standardizing reference and DOI formatting would make the text read more smoothly and professionally. Reviewer #2: Thank you for giving me the opportunity to review this protocol. This is a good study. It's good to use COVIDENCE for this review. Reviewer #3: Assessing the role of peer education in improving clinical and patient-reported outcomes in adults with chronic kidney disease: a scoping review protocol This is an interesting protocol that addresses an important issue in chronic kidney disease care. The idea of using peer education to support decision-making and improve patient outcomes is timely and relevant. The manuscript is generally clear and well-structured, but there are several areas where more detail and clarification would strengthen its contribution. The scope of the review feels somewhat narrow and UK-centric, particularly with the emphasis on the ACE program. It would be helpful to explain how the findings might be generalizable to other healthcare systems or cultural contexts. At present, the global relevance and potential for broader application are not fully clear. While the manuscript distinguishes between peer education, peer support, and peer mentoring, the inclusion of all three in the search strategy could create conceptual ambiguity. A clearer operational definition for each term and an explanation of how overlapping interventions will be handled in synthesis would improve clarity. The methodology is well aligned with JBI and PRISMA-P guidance, but some details need elaboration. For example, the search strategy is described in general terms, yet the rationale for including or excluding certain keywords is not fully explained. How will sensitivity and specificity be balanced to avoid retrieving large volumes of irrelevant studies? The manuscript mentions that quality will be “critically appraised,” but does not specify which tool or criteria will be used. Providing this information would enhance transparency and rigor. Outcome measures are another area that could be strengthened, while heterogeneity is anticipated, a preliminary framework for classifying outcomes (clinical, patient-reported, decision-making quality) would help guide synthesis. The discussion section could do more to situate this review within the broader literature on patient engagement and shared decision-making in CKD. Linking the work to global efforts or similar reviews in other chronic conditions would highlight its relevance and originality. The manuscript mentions variations by ethnicity and socio-economic status but does not explain how these will be analysed or reported. Even if subgroup analysis is not feasible, a plan for descriptive reporting would be valuable. Overall, this is a promising protocol that addresses an important gap. Strengthening the conceptual framework, clarifying methodological details, and emphasizing generalizability and policy implications will significantly improve its scientific merit and practical utility. ****** 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.] 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. Attachments Attachment Submitted filename: PONE-D-25-34226_comments.docx https://doi.org/10.1371/journal.pone.0342126.r001
Revision 1
12 Dec 2025 Author Response Dear Sir/Madam, RE: Assessing the role of peer education in improving clinical and patient-reported outcomes in adults with chronic kidney disease: a scoping review protocol Thank you for reviewing our manuscript favourably, we are delighted for the opportunity to address the committee and reviewer’s comments. Each point is addressed in turn below: Reviewer Comments Reviewer #1: 1. I recommend that the authors include the planned data extraction form as a supplementary appendix. While the manuscript outlines the extraction fields in the text, sharing the actual template would greatly enhance methodological transparency and allow future researchers to replicate or adapt the approach more easily. Thank you for this useful comment, we included this table in the appendix . 2.The research questions could be refined to remove some redundancy and achieve sharper focus. Condensing them into three concise questions, addressing (i) the models and contexts of peer education in CKD, (ii) the outcomes these interventions influence, and (iii) the components and implementation factors that drive effectiveness across different patient groups—would streamline the study aims and better align them with the proposed synthesis strategy. Thank you, we have made minor alterations to the research questions but were concerned that too much refinement would lose some of the specificity of the aims. 3. A careful editorial review would further improve the clarity and presentation of the manuscript. Minor grammatical issues (for example, replacing “are their variations” with “are there variations”), consistent use of acronyms, shortening overly long sentences, and standardizing reference and DOI formatting would make the text read more smoothly and professionally. Thank you for bringing this to our attention, we have conducted a generalised review of spellings, grammar and sentence length and improved the manuscript throughout. Reviewer #2: Thank you for giving me the opportunity to review this protocol. This is a good study. It's good to use COVIDENCE for this review. Thank you for the positive feedback Reviewer #3: This is an interesting protocol that addresses an important issue in chronic kidney disease care. The idea of using peer education to support decision-making and improve patient outcomes is timely and relevant. The manuscript is generally clear and well-structured, but there are several areas where more detail and clarification would strengthen its contribution. The scope of the review feels somewhat narrow and UK-centric, particularly with the emphasis on the ACE program. It would be helpful to explain how the findings might be generalizable to other healthcare systems or cultural contexts. At present, the global relevance and potential for broader application are not fully clear. Thank you for this helpful comment. We have made reference to and described the potential implications of our findings to other healthcare systems and cultural contexts in our introduction and discussion sections, and added in a recent publication (Elliot et al., 2025) ‘highlighting the growing interest in peer-based approaches globally’ While the manuscript distinguishes between peer education, peer support, and peer mentoring, the inclusion of all three in the search strategy could create conceptual ambiguity. A clearer operational definition for each term and an explanation of how overlapping interventions will be handled in synthesis would improve clarity. To address this point we have added the following sentence: ‘To ensure conceptual clarity, our review will focus primarily on peer education interventions (structured, curriculum-based teaching), but will include studies of peer support or peer mentoring where these contain educational components that align with our operational definition. During synthesis, we will clearly distinguish between intervention types and report findings accordingly to minimize conceptual ambiguity.’ We have also included Table 1, which outlines the different attributes of peer education and peer support. Peer mentoring is included as an attribute of peer support rather than separate intervention as we believe this accurately reflects it’s approach. The methodology is well aligned with JBI and PRISMA-P guidance, but some details need elaboration. For example, the search strategy is described in general terms, yet the rationale for including or excluding certain keywords is not fully explained. How will sensitivity and specificity be balanced to avoid retrieving large volumes of irrelevant studies? We have addressed this point with inclusion of the following sentence: ‘Through iterative refinement with an information specialist, we balanced sensitivity (ensuring comprehensive capture of relevant studies) against specificity (minimizing irrelevant retrievals) by using focused kidney-related terms combined with broader peer-related terms, without overly restrictive context modifiers.’ The manuscript mentions that quality will be “critically appraised,” but does not specify which tool or criteria will be used. Providing this information would enhance transparency and rigor. We have named the appraisal tool that we will include: ‘Two reviewers will independently extract all of the information and critically appraise the study quality using the Mixed Methods Appraisal Tool (MMAT) for studies with diverse designs (qualitative, quantitative, and mixed methods) and the Joanna Briggs Institute (JBI) critical appraisal checklists for specific study types (e.g., RCTs, cohort studies). These tools assess methodological quality, risk of bias, and reporting transparency.’ Outcome measures are another area that could be strengthened, while heterogeneity is anticipated, a preliminary framework for classifying outcomes (clinical, patient-reported, decision-making quality) would help guide synthesis. Further details about outcome measures and how these will be classified have been added to two sections of the methodology: ‘Outcome measures are another area that could be strengthened, while heterogeneity is anticipated, a preliminary framework for classifying outcomes (clinical, patient-reported, decision-making quality) would help guide synthesis.’ The discussion section could do more to situate this review within the broader literature on patient engagement and shared decision-making in CKD. Linking the work to global efforts or similar reviews in other chronic conditions would highlight its relevance and originality. The manuscript mentions variations by ethnicity and socio-economic status but does not explain how these will be analysed or reported. Even if subgroup analysis is not feasible, a plan for descriptive reporting would be valuable. Further detail on how the review sits within the broader literature has ben provided: ‘By situating our findings within the broader literature on patient engagement and shared decision-making in CKD and other chronic conditions, we will identify common principles and context-specific factors that influence implementation and effectiveness. This evidence-base is necessary when identifying the elements needed to implement a complex intervention such as peer education within services to meet multiple decision maker's expectation of effective engagement and will inform policy development for peer education programs internationally. The findings will have implications beyond the UK context. By examining peer education interventions across diverse healthcare systems, the review will identify transferable principles and highlight contextual factors (such as healthcare infrastructure, cultural norms, and resource availability) that may influence implementation. This will support adaptation of peer education models to different settings globally, while recognizing that implementation strategies may need tailoring to local contexts.’ We have also provided further detail of how ethnicity and socio-economic status will be analysed and reported: ‘Models of peer education will be summarised and assessed in terms of a) their impact on patient and clinical outcomes reported within the studies, organized by outcome categories (clinical outcomes such as treatment uptake, adherence, and hospitalization rates; patient-reported outcomes including knowledge, self-efficacy, quality of life, and satisfaction; and decision-making quality measures) and b) the identification of the core components of peer education, c) an exploration of variations in the experience of peer education by patient characteristics and need. Where data permit, we will descriptively report findings stratified by patient characteristics including ethnicity, socio-economic status, age, gender, and disease stage to identify potential differential effects or implementation considerations.’ Overall, this is a promising protocol that addresses an important gap. Strengthening the conceptual framework, clarifying methodological details, and emphasizing generalizability and policy implications will significantly improve its scientific merit and practical utility. We are very grateful for this feedback and the opportunity to strengthen the manuscript, thank you. Yours sincerely, Anna Winterbottom (on behalf of the co-authors) https://doi.org/10.1371/journal.pone.0342126.r002
18 Jan 2026 Decision Letter - Pasyodun Koralage Buddhika Mahesh, Editor Assessing the role of peer education in improving clinical and patient-reported outcomes in adults with chronic kidney disease: a scoping review protocol PONE-D-25-34226R1 Dear Dr. Winterbottom, 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. 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Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions? Reviewer #1: 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 #3: Yes ****** 3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable??> Reviewer #1: 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 #3: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: 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: 1. The authors have responded carefully and constructively to the previous reviewer feedback, and the revised version is noticeably improved in terms of conceptual clarity, methodological transparency, and scope. The addition of the data extraction form, the clearer definitions of peer education and related concepts, and the expanded discussion of generalisability and equity substantially strengthen the protocol. 2. The distinction between peer education, peer support, and peer mentoring is now clearly articulated and justified, and the inclusion of Table 1 is particularly helpful in preventing conceptual ambiguity. This has strengthened the theoretical coherence of the review and will make it easier for readers to understand what is and is not included in the scope. 3. The review objectives are appropriate for a scoping review and cover relevant dimensions of literature. There is still some conceptual overlap between the objectives relating to “models,” “core components,” and “mechanisms of impact,” and the authors may wish to slightly refine or cross-reference these aims to reduce redundancy, although this is a relatively minor issue. 4. The methodological approach is rigorous and well aligned with current standards for scoping reviews, including the use of JBI guidance and PRISMA-ScR reporting. The search strategy is comprehensive, well justified, and appropriately balances sensitivity and specificity, and the inclusion of grey literature further strengthens the completeness of the review. 5. The use of established quality appraisal tools (MMAT and JBI checklists) is appreciated and enhances the transparency and credibility of the review process, even within the flexible framework of a scoping review. 6. The proposed classification of outcomes into clinical, patient-reported, and decision-making domains is sensible and will support meaningful synthesis across heterogeneous study designs and outcome measures. 7. The planned attention to variation by ethnicity, socio-economic status, age, gender, and disease stage is an important strength of the protocol and reflects current priorities around equity, inclusion, and implementation relevance in healthcare research. 8. The discussion has been improved by situating the review within the broader literature on patient engagement and shared decision-making, and by highlighting the potential relevance of the findings beyond the UK context. This strengthens the manuscript’s contribution and international relevance. 9. A small number of minor editorial and grammatical issues remain (for example, occasional singular/plural inconsistencies and punctuation), and a final careful proofread would further improve clarity and presentation. 10. The note that data extraction has already commenced is potentially worth clarifying in relation to protocol registration and reporting norms, although this is unlikely to undermine the validity of the work. Reviewer #3: The authors have addressed all the comments provided during the review process and are satisfied with the corrections. ****** 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 #3: No ******** https://doi.org/10.1371/journal.pone.0342126.r003
Formally Accepted
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