Dear Dr. Hara,

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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Paridhi Jha, PhD

Academic Editor

PLOS ONE

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This research was funded by JSPS KAKENHI (grant number 22K17434) and TUMUG Support Program from Center for Diversity, Equity, and Inclusion, Tohoku University.

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Additional Editor Comments:

Clarify and strengthen the theoretical framework surrounding work values and their transformation, ensuring that the conceptual basis is well-defined and supported by relevant literature.

Revise the methodology section to enhance transparency and rigor, particularly in the qualitative component. The procedures for data collection, coding, and analysis need to be described in greater detail.

Improve statistical reporting by including effect sizes, confidence intervals, and model diagnostics. This will allow for a more robust interpretation of the findings.

Enhance the integration of qualitative and quantitative findings to justify the use of a mixed-methods approach. Currently, the connection between both strands of data is weak and underdeveloped.

Provide access to anonymized data or offer a more detailed justification for the restrictions imposed. The current data availability statement does not meet PLOS ONE’s transparency standards.

Conduct a thorough language revision to improve clarity, grammar, and readability. While the manuscript is generally intelligible, several sections contain awkward phrasing and typographical errors.

These revisions are essential to ensure the manuscript meets the journal’s standards for methodological rigor, transparency, and clarity.

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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: No

Reviewer #3: Yes

Reviewer #4: Yes

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

Reviewer #1: Yes

Reviewer #2: No

Reviewer #3: Yes

Reviewer #4: 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.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: No

Reviewer #3: No

Reviewer #4: No

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

Reviewer #1: No

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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Reviewer #1: Thank you for the manuscript.

The manuscript is sound and very relevant in workforce development. Here are a few comments/recommendations for you to consider to strengthen the paper for publication.

Here are some of the strengths of the paper.

The use of a retrospective cross-sectional survey is very practical given the difficulty of longitudinal tracking in this population. The paired t-tests and Generalized Estimating Equations (GEE) are suitable for analyzing within-subject changes and identifying associated factors. Your study also employed the use of established scales for work values (Shortened Nurses' Work Values Scale), social support (MSPSS), and workplace support, which enhanced measurement reliability. Again, power analysis using GPower was clearly reported, with a sample size of 199 meeting the requirements for regression analysis with adequate power.

Below are some recommendations for you to address.

1. The title of the manuscript makes it look like it is a mixed-methods paper; however, the execution of the study relies heavily on quantitative methods/analysis. There is very limited or no integration of qualitative methods. Can you explain why this is the case?

There are no clear qualitative research questions or a rationale for a mixed methods approach.

Again, the qualitative analysis is described with no mention of coding procedures and analysis.

I recommend that you substantiate the mixed-methods claim by elaborating the qualitative design (sampling, coding, integration strategy) or reframing the study as a primarily quantitative design with supplemental qualitative insights.

You would have to justify the use of the mixed methods approach.

2. The quantitative findings of the study are significant; however, there is no clear demonstration as to how the qualitative findings reinforce or contrast with the quantitative results. The research topic indicates that the paper is a mixed-method, but there is insufficient qualitative information to back or justify this method.

3. On statistical analysis, the manuscript lacks detail on the correlation structure used in GEE and whether model diagnostics were performed. You would also need to justify the rationale for the effect size selected for the power analysis.

4. Please review the abstract for coherence and consistency with the findings of the paper. You may consider being brief with respect to the methodology and reducing the word count.

5. The discussion could be expanded to consider implications for nursing policy and workforce retention strategies in Japan, especially in light of the aging population and gender equity challenges.

6. Consider including a limitations subsection that explicitly addresses recall bias, generalizability, and the cross-sectional design.

Reviewer #2: Dear Authors,

Thank you for your submission. Your study addresses an important and underexplored topic: the transformation of work values among Japanese nurses before and after pregnancy. However, several critical issues must be addressed to improve the manuscript’s scientific rigor, clarity, and overall contribution. Below are detailed comments and suggestions organized by section:

Abstract

• The abstract is overly dense and includes methodological jargon that may not be accessible to all readers. Consider simplifying and clarifying the structure.

• The phrase “pioneering mixed-methods study” is overstated given the limitations of the design and analysis.

• The conclusion should better reflect the limitations and avoid generalizations not supported by the data.

Introduction

• The literature review is superficial. Key concepts such as “work values” and “value transformation” are not sufficiently defined or contextualized.

• The rationale for focusing on Japanese nurses is clear, but the global relevance of the findings is overstated.

• The introduction would benefit from a clearer articulation of the research questions and hypotheses.

Methods

• The retrospective design is problematic. The authors acknowledge this but do not provide sufficient mitigation strategies.

• The use of G*Power to justify sample size is appropriate, but the choice of effect size (0.15) and power (0.95) should be justified in the context of prior literature.

• The description of the survey instrument lacks detail. How were the questions validated? Were they piloted?

• The qualitative component is inadequately described. What was the coding process? How were themes derived? Was intercoder reliability assessed?

Statistical Analysis

• The use of paired t-tests is simplistic and does not account for potential confounders.

• The application of Generalized Estimating Equations (GEE) is appropriate but poorly explained. What correlation structure was used? Were model diagnostics performed?

• The results section lacks effect sizes and confidence intervals, which are essential for interpreting the magnitude and precision of findings.

• There is no discussion of missing data or how it was handled.

Results

• The presentation of results is fragmented. Tables are referenced but not included in the review document.

• The finding that only prestige work values decreased significantly is interesting but not explored in depth.

• The GEE results are presented without sufficient interpretation. What do these associations mean in practical terms?

Qualitative Analysis

• The qualitative findings are superficial. There is no evidence of methodological rigor (e.g., thematic saturation, triangulation).

• Quotes from participants are not included, which limits the reader’s ability to assess the validity of the interpretations.

• The integration of qualitative and quantitative findings is weak. Consider using a joint display or narrative synthesis.

Discussion

• The discussion overstates the implications of the findings. The limitations of the design and analysis should be more prominently acknowledged.

• The authors should avoid normative statements such as “Understanding these shifts is crucial…” unless supported by evidence.

• The discussion lacks engagement with broader literature on gender, work-life balance, and nursing retention.

Ethics and Data Availability

• The ethics statement is thorough and appropriate.

• However, the data availability is insufficient. PLOS ONE requires full data transparency. The authors must provide anonymized datasets or justify restrictions more clearly.

Language and Style

• The manuscript is generally intelligible but contains awkward phrasing and grammatical inconsistencies. A professional language edit is recommended.

• Examples: “not very import” (likely a typo), “prestige work values showed a significant decrease in the mean” (awkward phrasing).

Recommendations for Improvement

1. Clarify and strengthen the theoretical framework around work values and their transformation.

2. Revise the methodology section to provide greater transparency and rigor, especially for the qualitative component.

3. Improve statistical reporting by including effect sizes, confidence intervals, and model diagnostics.

4. Enhance the integration of qualitative and quantitative findings to justify the mixed-methods approach.

5. Provide access to anonymized data or a detailed justification for restrictions.

6. Conduct a thorough language revision to improve clarity and readability.

Reviewer #3: ABSTRACT

• In the abstract, the results section speaks only to the quantitative findings. Briefly mention at least one key qualitative insight from the results.

BACKGROUND

• Line 64- The sentence starting at line 64 is virtually a repetition of the sentence starting at line 49. Consider combining the two paragraphs or improving their flow.

METHODS

• Line 180- keep the same referencing style

• Lines 195 to 197- How qualitative data was collected is not clear. Authors should indicate the data collection method used, whether by face-to-face interview or focus group discussion. Which tool was used to collect the data? Was it by audio recording or text?

• The qualitative aspect of data collection lacks rigor. It does not address questions such as “what type of data analysis was used? Was it content or thematic analysis?”, “Who did the coding?”, “How was the coding done?” and “Whether any software was used in managing the data?” among others. Authors should rectify this.

• Line 90- The Authors mentioned Retrospective recall bias as part of the limitations. Authors should go beyond citing Thigpen and Hipp to indicate in the methods section, steps taken to mitigate this, to improve the validity of the study approach.

• Line 98- In Japan, preschool covers a wide age range; therefore, specifying the age range of their first child will be more precise.

• Variables were well listed; however, to improve readability, I suggest the authors use a table either in the manuscript or on a different sheet as a supplementary document to capture the variables listed.

RESULTS

• Line 275- insert the necessary figures or remove the phrase.

DISCUSSION

• Either by Omission or misunderstanding on my part, I did not find an explanation from the qualitative data suggesting why there is a drop in prestige. Authors should indicate if this was just a feeling of the participants or otherwise.

Reviewer #4: This manuscript addresses an important and underexplored topic. However, some revisions are needed to improve clarity, structure, and analytical depth.

Study Design and Recall Bias: The use of a retrospective cross-sectional design is acknowledged, but here recall bias remains a concern. Authors should further justify the reliability of recalling pre-pregnancy work values and discuss how this may have influenced results.

Methodological Detail: Please clarify the correlation structure assumed in the GEE model

Sample Representation: The sampling process is not fully explained. How samples were selected and how was the web survey done?

Ethics Section: Clarify whether consent was implied or explicitly obtained through digital checkboxes.

Qualitative Analysis: The qualitative analysis section needs clearer explanation of the coding process (e.g., number of coders, inter-rater agreement, any use of software).

The inclusion of participant IDs in Table 5 is appreciated. If feasible, consider adding a brief note in the methods to explain that these IDs

Integration of Mixed Methods: The mixed-methods design would be stronger with explicit integration—how do the qualitative findings confirm, complement, or contradict quantitative results?

Data Availability: PLOS ONE requires publicly available data. Data availability statement is incomplete and non-compliant with PLOS ONE policy.

Discussion: Expand on implications for hospital policy and management beyond Japan.

References: DOI links should be active and complete.

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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.). 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: No

Reviewer #2: Yes: RICHARDSON AUGUSTO ROSENDO DA SILVARICHARDSON AUGUSTO ROSENDO DA SILVARICHARDSON AUGUSTO ROSENDO DA SILVARICHARDSON AUGUSTO ROSENDO DA SILVA

Reviewer #3: Yes: Clement Asoya AsebigaClement Asoya AsebigaClement Asoya AsebigaClement Asoya Asebiga

Reviewer #4: No

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Dear Dr. Hara,

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 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.. 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.. 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.. 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). 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 . 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 . 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 . 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,

Xiangdan Piao

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.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #1: All comments have been addressed

Reviewer #3: All comments have been addressed

Reviewer #4: All comments have been addressed

**********

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

Reviewer #1: Yes

Reviewer #3: Yes

Reviewer #4: Yes

**********

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

Reviewer #1: Yes

Reviewer #3: Yes

Reviewer #4: 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.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 #3: Yes

Reviewer #4: Yes

**********

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

Reviewer #1: Yes

Reviewer #3: Yes

Reviewer #4: Yes

**********

Reviewer #1: Congratulations on making significant improvements to the manuscript and responding to all reviewer and editor comments. This has made the manuscript very strong, and it now has a clearer theoretical grounding of work values and value transformation. There is equally a much improved qualitative analysis section. the results section and the discussion section are well written and coherent.

However, here are a few suggestions

1. in your abstract, as your keyword, you use the word/phrase "nursing stuff." It is not clear if that is what you really want to write. The actual word should be "nursing staff." What do you think? Please clarify and correct.

2. Your transitions from paragraph to paragraph also appear to be abrupt. Please double-check and ensure that there is a flow between the paragraphs and that they transition smoothly.

3. In the qualitative analysis, it will be appropriate to put the supporting statements in quotation marks (i.e., "...") and italicize them, alongside the participant code or pseudonym.

4. some small language copyediting of the entire manuscript will do.

Thank you

Reviewer #3: REVIEW COMMENTS

The authors have addressed almost all the comments raised previously. however, the authors need to address a few minor issues in relation to their ethical consideration and methodology.

ETHICAL CONSIDERATION

1. LINE 147; The last sentence states that the study does not include minors. That was very clear; however, the authors could briefly state why minors are not included to avoid queries (e.g., "As all participants were required to be nurses and parents, no minors were eligible for inclusion.").

ANALYSIS METHOD

1. I suggest the authors consider revising the heading "Analysis method" to "Data Analysis" as a top-level subsection. This sounds more standard.

2. In the qualitative part, the authors mention that "validity was assessed by two other researchers." That was perfect; however, I suggest they use the standard qualitative term "trustworthiness" or "rigor" in their description and specify the process. This strengthens the claim.

3. The author's description ("inductively grouped... abstract subcategories and categories…") is essentially ‘inductive thematic analysis.’ I therefore suggest that the authors be clear and use the term inductive thematic analysis. This term adds methodological recognition to their work.

Reviewer #4: The manuscript now largely meets the required standards. Only minor wording refinements are needed to avoid unintended longitudinal implications, along with a brief clarification on the direction of recall bias. No major methodological issues remain.

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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.). 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.

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 For information about this choice, including consent withdrawal, please see our For information about this choice, including consent withdrawal, please see our For information about this choice, including consent withdrawal, please see our Privacy Policy..-->

Reviewer #1: No

Reviewer #3: Yes: Clement Asoya AsebigaClement Asoya AsebigaClement Asoya AsebigaClement Asoya Asebiga

Reviewer #4: Yes: Amisha S AminAmisha S AminAmisha S AminAmisha S Amin

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Attachments

Attachment

Submitted filename: review comments new.pdf

An exploratory analysis of changes in work values among nurses before and after pregnancy

PONE-D-25-37669R2

Dear Dr. Hara,

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,

Xiangdan Piao

Academic Editor

PLOS One

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #1: All comments have been addressed

Reviewer #3: All comments have been addressed

Reviewer #4: All comments have been addressed

**********

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

Reviewer #1: Yes

Reviewer #3: Yes

Reviewer #4: Yes

**********

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

Reviewer #1: Yes

Reviewer #3: Yes

Reviewer #4: 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.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 #3: Yes

Reviewer #4: Yes

**********

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

Reviewer #1: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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Reviewer #1: (No Response)

Reviewer #3: authors responded all issues raised

Reviewer #4: The manuscript is now technically a sound piece of scientific research with data that supports the conclusions. All comments addressed by authors

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Reviewer #1: No

Reviewer #3: Yes: Clememt Asoya AsebigaClememt Asoya AsebigaClememt Asoya AsebigaClememt Asoya Asebiga

Reviewer #4: Yes: Amisha S AminAmisha S AminAmisha S AminAmisha S Amin

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Attachments

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Submitted filename: REVIEWERS COMMENTS.pdf