Multi-stakeholder perspectives on reproductive and adolescent healthcare schemes in tribal regions of India: A qualitative study

Rohit Raj; Jarina Begum; Syed Irfan Ali; Manasee Panda

doi:10.1371/journal.pone.0343794

Peer Review History

Original SubmissionAugust 20, 2025
13 Jan 2026 Decision Letter - Yogesh Jain, Editor Dear Dr. Begum, 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. ============================== Kindly address the comments provided by reviewer 2. ============================== Please submit your revised manuscript by Feb 27 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 letter that responds to each point raised by the academic editor and reviewer(s). 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If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.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 1. Is the manuscript technically sound, and do the data support the conclusions? Reviewer #1: Yes 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: Yes Reviewer #2: No ****** Reviewer #1: The study is a well planned qualitative study addressing a crucial region specific lacuna. The leading questions and interviews have given answers to the questions raised .The study results can be noted and followed up by the stakeholders for addressing the lacuna Reviewer #2: Regarding the contribution of the study, the added value compared to previous studies in Indian populations is not clearly seen. It is suggested to include 1 or 2 paragraphs on which specific gap this study fills. This is in order for the reader to understand why the results matter for policies and programs. Regarding the design, the analytical approach is not specified. It is suggested to state “qualitative descriptive design”, or “interpretive descriptive approach”, or “case study design”, or whatever was actually done. The use of a standard reference such as COREQ as a checklist should be added, and it should also be mentioned who designed the interview guides and how the pilot was carried out. Regarding saturation, the process should be detailed, clarifying whether saturation was sought by group or in a general/global way. This is important to provide credibility to the study. Regarding the depth of the interviews, a duration of 10 to 15 minutes is reported. It is suggested to be more modest and use “semi-structured interviews” unless the guides were very focused and field notes were collected. Otherwise, this should be included as a limitation. Regarding the qualitative analysis procedure, it is not specified whether it was inductive, deductive, or mixed, nor the number of coders. Regarding the discussion, it should be developed using relevant conceptual frameworks such as the health system, accessibility, etc. The same findings are repeated many times but with little theoretical depth. In the ethics section, there are elements written in the future tense; the description should be unified in the past tense ****** what does this mean? ). 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Revision 1
15 Jan 2026 Author Response Reviewer #1: The study is a well-planned qualitative study addressing a crucial region-specific lacuna. The leading questions and interviews have given answers to the questions raised. The study results can be noted and followed up by the stakeholders for addressing the lacunae. Answer: We sincerely thank Reviewer 1 for their positive and encouraging feedback, and we appreciate the recognition of the study’s methodological rigor, region-specific relevance, and potential utility for stakeholders in addressing identified lacunae. Reviewer #2: 1. Regarding the contribution of the study, the added value compared to previous studies in Indian populations is not clearly seen. It is suggested to include 1 or 2 paragraphs on which specific gap this study fills. This is in order for the reader to understand why the results matter for policies and programs. • We thank the reviewer for this important suggestion. To clearly articulate the study’s added value, we have revised the Introduction sections by adding two dedicated paragraphs that explicitly highlight the specific gap addressed by this study. 2. Regarding the design, the analytical approach is not specified. It is suggested to state “qualitative descriptive design”, or “interpretive descriptive approach”, or “case study design”, or whatever was actually done. The use of a standard reference such as COREQ as a checklist should be added, and it should also be mentioned who designed the interview guides and how the pilot was carried out. • We thank the reviewer for this constructive suggestion. We have now clearly specified the study as a qualitative descriptive design in the Materials and Methods section to enhance methodological clarity. • Additionally, we have stated that the study reporting follows the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist, which has been added to the Methods section and included as a supplementary file. • We have also clarified that the semi-structured interview guides were self-developed by the research team, informed by existing literature and study objectives, and that these guides were pilot tested among ten stakeholders to assess clarity, relevance, and cultural appropriateness before final data collection. 3. Regarding saturation, the process should be detailed, clarifying whether saturation was sought by group or in a general/global way. This is important to provide credibility to the study. • We thank the reviewer for highlighting this important methodological aspect. We have now elaborated on the data saturation process in the Methods section, clarifying that saturation was assessed using a group-wise approach across stakeholder categories, as well as overall thematic saturation. Interviews were continued within each stakeholder group until no new codes or themes emerged, and cross-group comparisons were used to confirm saturation at the overall study level. These revisions have been incorporated to enhance transparency and methodological rigor. 4. Regarding the depth of the interviews, a duration of 10 to 15 minutes is reported. It is suggested to be more modest and use “semi-structured interviews” unless the guides were very focused and field notes were collected. Otherwise, this should be included as a limitation. • We thank the reviewer for this important clarification. The study employed in-depth interviews using a focused interview guide; however, we acknowledge that the interview duration was relatively short (10–15 minutes) due to contextual field constraints. Many participants, particularly from tribal communities, provided brief or one-word responses, and several healthcare workers reported time constraints related to service delivery responsibilities, which limited prolonged engagement. We have now explicitly acknowledged this as a study limitation in the manuscript to ensure transparency and appropriate interpretation of the depth of findings. 5. Regarding the qualitative analysis procedure, it is not specified whether it was inductive, deductive, or mixed, nor the number of coders. • We thank the reviewer for this important methodological clarification. We have now specified that the thematic analysis followed a mixed inductive-deductive approach. Initial coding was conducted inductively from the data, while deductive elements were guided by predefined health system domains relevant to reproductive and adolescent health schemes for category section. We have also clarified that multiple coders were involved in the analysis, with independent coding followed by team discussions to resolve discrepancies and refine the codebook. These details have been added to the Data analysis section to enhance transparency and rigor. 6. Regarding the discussion, it should be developed using relevant conceptual frameworks such as the health system, accessibility, etc. The same findings are repeated many times but with little theoretical depth. • We have updated the discussion under the sub headings based on WHO building blocks of health system. To add the evidence we have tried to incorporate more depth with references to the discussion part. 7. In the ethics section, there are elements written in the future tense; the description should be unified in the past tense. • Corrected. Attachments Attachment Submitted filename: Reviewers response.docx https://doi.org/10.1371/journal.pone.0343794.r002
11 Feb 2026 Decision Letter - Yogesh Jain, Editor Multi-stakeholder perspectives on reproductive and adolescent healthcare schemes in tribal regions of India: A qualitative study. PONE-D-25-44960R1 Dear Dr. Begum, 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, Yogesh Kumar Jain, PhD Academic Editor PLOS One Additional Editor Comments (optional): 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: I have reviewed the R1 version of the manuscript and can confirm that it addresses all previously noted observations, responding to each point appropriately and comprehensively. I would also like to highlight that the manuscript demonstrates additional improvements, particularly in the restructured discussion using relevant conceptual frameworks and in the clearer explanation of the analytical approach, which substantially strengthens both methodological rigor and overall coherence. ****** 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 ******** https://doi.org/10.1371/journal.pone.0343794.r003
Formally Accepted
Acceptance Letter - Yogesh Jain, Editor PONE-D-25-44960R1 PLOS One Dear Dr. Begum, 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. Yogesh Kumar Jain Academic Editor PLOS One https://doi.org/10.1371/journal.pone.0343794.r004

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