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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?

Reviewer #1: Yes

Reviewer #2: Partly

Reviewer #3: Yes

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

Reviewer #1: N/A

Reviewer #2: Yes

Reviewer #3: Yes

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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

Reviewer #3: Yes

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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Reviewer #1: Introduction:

1. In the second paragraph, the author has used stated 'burdensome and unwanted treatments', I believe this wordings is conflicting and would suggest authors to reword the statement.

Methodology:

1. Under CFIR mapping, two authors reviewed the transcripts. What was the procedure followed in instances of difference of opinion?

2. The author conducted 24 interviews. Why only 24? Is there a reasoning behind sample size fixed at 24 host participants?

3. Were there any non English audio files? If yes, how were they translated and back translated before transcribing?

4. Any particular reason why both analyst didn't code similar number of transcripts?

Results:

1. Throughout the methodology, the authors have stated 24 host participants. However, under host characteristics section, the manuscripts reads as 26. Kindly clarify.

2. Same in table 1.

Reviewer #2: The manuscript presents a valuable and timely effort to evaluate a model of community-engaged research in advance care planning (ACP) using the Consolidated Framework for Implementation Research (CFIR). The integration of CFIR into this context is conceptually sound and offers a novel application of implementation science to community-based health initiatives. However, several points merit clarification or further elaboration.

Firstly, the rationale for selecting CFIR over other frameworks (such as RE-AIM or the Theoretical Domains Framework) needs to be more explicitly stated. While CFIR is comprehensive, its application to community-engaged research—especially in culturally sensitive domains like ACP—requires adaptation and justification, particularly for constructs that may not fully resonate with community dynamics.

The manuscript could benefit from a more detailed discussion on how CFIR constructs were operationalized during data collection and analysis. For example, were interview guides or coding frameworks co-developed with community partners? Such steps would support the authenticity of community engagement and demonstrate methodological rigor. Additionally, the process for ensuring inter-coder reliability when mapping qualitative data to CFIR constructs is unclear. More transparency here would bolster confidence in the study’s analytical rigor.

In terms of findings, the manuscript thoughtfully identifies relevant CFIR domains such as “Inner Setting” and “Characteristics of Individuals,” but it is less clear how these domains interacted or evolved over time within the implementation process. A visual depiction or matrix linking specific constructs to key findings would enhance clarity and utility for readers and future researchers.

The manuscript also briefly touches on adaptability and sustainability—two crucial components of implementation success—but does not delve deeply into how these were influenced by the broader socio-political context or varying community characteristics. Exploring these nuances could offer richer insight into transferability, especially across underserved or diverse populations.

A strength of the manuscript is its integration of community voices throughout the evaluation process. However, it would be helpful to understand whether community stakeholders were involved in selecting or interpreting CFIR constructs, and how their perspectives were integrated into the final framework application. This would further demonstrate the authenticity of the “community-engaged” approach.

From an ethics and publication standpoint, there are no immediate concerns regarding dual publication or research misconduct. However, the authors should clarify if this model has been described in any prior evaluations or pilot studies. If so, appropriate cross-referencing or citation should be provided to ensure transparency and avoid redundancy.

Overall, this manuscript makes a meaningful contribution to the intersection of implementation science and community-engaged research. With greater clarity in the methodological application of CFIR, enhanced attention to context, and deeper integration of stakeholder perspectives, the study could serve as a strong model for others aiming to implement and evaluate ACP initiatives in diverse community settings.

Reviewer #3: Thank you for the opportunity to review this important and timely study. I have a few minor revisions and clarifications to recommend:

Qualitative Analysis Methods:

In the methods section, under Qualitative Analysis, please include the company name and country of origin after mentioning MAXQDA (v. 24). For example: MAXQDA (v. 24; VERBI GmbH, Berlin, Germany).

Data Consistency:

Please ensure consistency between the narrative text and Table 1 by updating the following:

In the main text, revise “Black communities (39%)” to “Black communities (38.5%)” to match Table 1.

Revise the regional distribution text to reflect one decimal place, consistent with Table 1 formatting:

“Hosts from a total of 18 states were included in the sample from across the Northeast (19.2%), Midwest (15.4%), South (42.3%), and West (23.1%).”

Table 1 Corrections:

Update the “Urban Black” entry from 38.4% to 38.5%.

Revise “West” from 23.2% to 23.1%.

Figure 1 Quality:

The image quality of Figure 1 is currently suboptimal. Please consider uploading a higher-resolution version to improve clarity for readers.

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

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Reviewer #1: Yes: Miyola Cia FernandesMiyola Cia Fernandes

Reviewer #2: Yes: SUBIA EKRAMSUBIA EKRAM

Reviewer #3: Yes: Ala ElhelaliAla Elhelali

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Using the Consolidated Framework for Implementation Research to evaluate a model of community-engaged research in advance care planning

PONE-D-25-11461R1

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