-->PONE-D-25-24968-->-->Integrating Online Peer Support Group and Goal Setting to Promote Behavioural Changes in Midlife Women with Type 2 Diabetes: A feasibility study of the Women’s Wellness with Type 2 Diabetes Programme-->-->PLOS ONE

Dear Dr. bozkurt,

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.

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We look forward to receiving your revised manuscript.

Kind regards,

Shairyzah Ahmad Hisham, PhD.

Academic Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

-->Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. -->

Reviewer #1: Yes

Reviewer #2: Partly

Reviewer #3: Yes

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

Reviewer #1: Yes

Reviewer #2: I Don't Know

Reviewer #3: Yes

**********

-->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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PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.-->

Reviewer #1: Yes

Reviewer #2: No

Reviewer #3: Yes

**********

-->5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)-->

Reviewer #1: This research teams recruited 34 women aged between 45-65 with T2D for a single arm study to evaluate the feasibility of implementing online peer support group to promote behavioral changes. The results demonstrated its feasibility and acceptability.

1. Abstract. What’s WWDP? It would be better to attach your abbreviation when you spell them out for the first time before you use abbreviation in the text.

2. It might be informative to know whether there are other chronic diseases among the participants.

3. Line 160. Should be “from 1 to 10”

4. Paired t-test and Wilcoxon signed-rank test was implemented. It would be helpful to specify which variables were tested with which methods with normality assessment justification.

5. Please clarify how the missing data were handled in the analysis

6. Self-report data were used. It would be helpful to discuss potential biases and their impact on the findings.

7. A scoring method was implemented, e.g., GAS. It would be helpful to explain how these scores were aggregated or what they represent

8. Please clarify how pre-specified thresholds were determined.

9. As this is a feasibility study, it would be a great help to report or discuss how the resulting information serves as the resource for the future study, e.g., sample size planning.

Reviewer #2: Dear authors,

While I believe the study was well-conducted, I feel that the manuscript's reporting needs significant enhancement to improve clarity. Please refer to the attached document for my comments and suggestions.

Thank you.

Reviewer #3: Dear authors,

This study was conducted with the aim to evaluate the feasibility of a revised Women’s Wellness with Diabetes Program alongside peer support group and goal setting for midlife women to inform the design

of a future RCT. This is crucial in addressing issues concerning the T2DM status among midlife women in the near future. From the abstract, there was lack of explanation on the integration of peer support group into the program. There should also be a brief explanation on the goal setting for midlife women. For example "goal settings were made based on the personal goal evaluation form and the goal assessment scale (GAS). Participants were encouraged to set SMART short term goals throughout the intervention".

Overall, the introduction part was well-written with very good flow of issues discussed leading to the rationale of the study. There could be more details included under methods and discussion on the following:

1) Interventions provided: The information on delivery of the content was only obtained when referring to the supplementary document. It should be briefly described under methods i.e. how long does it take for the participants to answer the baseline questions, by whom were the materials delivered and prepared, the flow of delivery by day etc.

2) Statistical software or programs used - SPSS? Jamovi? not indicated in the manuscript

3) The interpretation of the discussion were not elaborated and sufficiently evidenced e.g. (Line 345) The sentence on limitations in achieving meaningful outcomes in physical activity was not explained and was left hanging. Important measures included in this clinical trial were BMI, HbA1c, glucose control. These measures are heavily associated with physical activity. An elaboration as to why it was not measured may provide justification on the design of the study.

Apart from that, line 329 stated that program fatigue, participant motivation or external influences may have reduced peer group engagement. Please include more explanation and evidences on this. The elaboration again will help to justify 'peer group engagement' as one of the intervention in improving T2DM among midlife women.

4) In supplementary document 2: Were the 215 posts came from participants only? It is understood that the facebook group is a private group. However, i am not sure whether the comments from the administrative personnel were included in the statistical analyses. There should also be some elaboration as to popular days and popular times for the comments to take place. This will help to strategize on when and how to approach participants appropriately.

5) There is also a concern on traceability of the engagement of participants with the T2DM programme e-book. Was this documented during the study period? If not, perhaps this could be explained as part of the study limitation. Documentation on this is definitely important as it will affect the study outcomes.

Although the intervention implemented was innovative and contextually relevant, the findings should be interpreted with caution. The study's reliance on subjective measurement and self-recorded measurement weakens the reliability of its conclusion. This was mentioned in the last paragraph of the discussion whereby it was stated that "all the data collected in the study-was self reported" which have compromised the reliability and validity of the findings. Improving study method by collecting anthropometric measurements and clinical outcomes during arranged follow-ups to ensure transparency and reliability of data may be suggested. Overall, the study was worth exploring.

**********

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Reviewer #1: No

Reviewer #2: Yes: ZAINOL AKBAR ZAINAL

Reviewer #3: Yes: Aina Yazrin Ali Nasiruddin

**********

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Attachments

Attachment

Submitted filename: PONE-D-25-24968 - Reviewer Comments.pdf

-->PONE-D-25-24968R1-->-->The Women’s Wellness with Type 2 Diabetes Programme: Feasibility of an Online Peer Support and Goal-Setting Intervention for Midlife Women-->-->PLOS One

Dear Dr. bozkurt,

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 24 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.

Please include the following items when submitting your revised manuscript:-->

• 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 you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

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,

Aqeel M Alenazi

Academic Editor

PLOS One

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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.

Additional Editor Comments:

Dear authors, please respond to the reviewers comments in order to make a decision for your manuscript

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Reviewers' comments:

Reviewer's Responses to Questions

-->Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.-->

Reviewer #1: All comments have been addressed

Reviewer #2: (No Response)

Reviewer #3: (No Response)

**********

-->2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. -->

Reviewer #1: (No Response)

Reviewer #2: Yes

Reviewer #3: Yes

**********

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

Reviewer #1: (No Response)

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 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: (No Response)

Reviewer #2: Yes

Reviewer #3: Yes

**********

-->5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.-->

Reviewer #1: (No Response)

Reviewer #2: Yes

Reviewer #3: Yes

**********

-->6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)-->

Reviewer #1: (No Response)

Reviewer #2: Dear author,

Thank you for considering my previous suggestions and comments for improvement of the manuscript. I have gone through the revised manuscript and I would like to confirm that most of the previous suggestions have been addressed accordingly. There are, however, a few more minor parts of the manuscript that need further revision. Please kindly refer to the attached document for your reference.

Reviewer #3: Dear Authors,

Overall the manuscript was well written. However, there are a few clarification required to further improve the manuscript.

Under the 'Materials and methods: Study Setting and recruitment' subheading, the duration of disease (from the point of diagnosis) was not included as part of the inclusion criteria. From my point of view, the duration of disease will greatly affect the outcomes of study. If it is included in the DDS, it would be great if this can be clearly outlined in the paragraph.

As for the sample size, could you please detail out the recommendations by reference no 23 and 24 in order to reduce the level of uncertainty in determining the sample size.

Referring to table 2, the ethnicity of the sample population was not based on universal categories e.g., chinese should be under Asian. White Turkish is also not a universal ethnic group classification. The classification under others can further be detailed out in methods.

In table 2, you may want to arrange the 'self-reported diabetes treatment' according to treatment step up therapy. Example, 1st group should be diet and exercise followed by OHA and then OHA and insulin and so on so forth. With this we can screen through the sample population according to severity of disease. I would also like to clarify, all diabetic patients should be on diet, exercise and lifestyle modification. Perhaps you could consider reclassifying the samples. However, i am aware that this will affect some parts of your discussion and data presentation.

Similarly in table 2, the reported diabetes complications are not the universal diabetes complications as per stated in the guidelines i.e. macrovascular and microvascular complications including diabetic retinopathy, nephropathy etc. The listed diabetes complications are more of comorbidities. Kindly revise.

Based on the above comments, there may be changes to the discussion part. Therefore i rest my further comments on the discussion part. All in all, this study offers beneficial outcomes in the management of diabetes among midlife women. Further studies should be conducted to cover a bigger sample population for better generalisability of the data.

**********

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: Yes: Aina Yazrin Ali Nasiruddin

**********

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Attachments

Attachment

Submitted filename: PONE-D-25-24968 R1 - Reviewer Comments.pdf

-->PONE-D-25-24968R2-->-->The Women’s Wellness with Type 2 Diabetes Programme: Feasibility of an Online Peer Support and Goal-Setting Intervention for Midlife Women-->-->PLOS One

Dear Dr. bozkurt,

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.

==============================

ACADEMIC EDITOR: Please, revise according to reviewer's comments and double check on the percentages and numbers across the manuscript.

==============================

Please submit your revised manuscript by Mar 06 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.

Please include the following items when submitting your revised manuscript:-->

• A 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 you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

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,

Aqeel M Alenazi

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.

Additional Editor Comments:

Please, revise according to reviewer's comments and double check on the percentages and numbers across the manuscript.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

-->Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.-->

Reviewer #2: All comments have been addressed

**********

-->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

**********

-->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 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

**********

-->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

**********

-->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: Dear authors,

Thank you for addressing my previous suggestions. For this 2nd revision, I have suggested a few more minor amendments to be made in the Results section.

Thank you.

**********

-->7. PLOS authors have the option to publish the peer review history of their article (what does this mean? ). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy .-->

Reviewer #2: No

**********

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Attachments

Attachment

Submitted filename: PONE-D-25-24968 R2 - Reviewer Comments.pdf

The Women’s Wellness with Type 2 Diabetes Programme: Feasibility of an Online Peer Support and Goal-Setting Intervention for Midlife Women

PONE-D-25-24968R3

Dear Dr. bozkurt,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Aqeel M Alenazi

Academic Editor

PLOS One

Additional Editor Comments (optional):

You addressed all the comments appropriately.

Reviewers' comments:

Reviewer's Responses to Questions

-->Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.-->

Reviewer #1: All comments have been addressed

**********

-->2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. -->

Reviewer #1: (No Response)

**********

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

Reviewer #1: (No Response)

**********

-->4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.-->

Reviewer #1: (No Response)

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-->5. Is the manuscript presented in an intelligible fashion and written in standard English?

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Reviewer #1: (No Response)

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Reviewer #1: (No Response)

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Reviewer #1: No

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