-->PONE-D-26-01917-->-->The acceptability of a community-based telehealth care model for moderate-to-severe hypertension in rural communities in Kenya and Uganda-->-->PLOS One

Dear Dr. Johnson-Peretz,

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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Zahra Hoodbhoy

Academic Editor

PLOS One

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“The study was supported by grants from the National Institutes of Health (U01-AI150510 Multiple-PI award to DVH, MLP, MRK; K23HL162578 to MDH). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.”

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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: Yes

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-->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 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

**********

-->4. 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: Yes

Reviewer #2: 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: The study evaluates “acceptability,” but does not explicitly anchor findings in a formal implementation science framework such as:

• Theoretical Framework of Acceptability (TFA)

• CFIR (Consolidated Framework for Implementation Research)

• RE-AIM

• DSD (Differentiated Service Delivery) frameworks

The current framing is descriptive rather than conceptual.

Suggestion:

Add a short conceptual paragraph clarifying:

• How “acceptability” is defined (affective attitude? perceived effectiveness? trust? burden?)

• Whether analysis was mapped to any implementation construct

• How findings inform implementation science beyond this context

This would significantly increase scientific depth and generalizability.

Also clarify

How participants were selected (maximum variation? based on BP control? adherence?)

• Whether data saturation was achieved

• Whether sampling differed by country, sex, or outcome

• Whether non-adherent or dissatisfied participants were deliberately included

Also, Expand mechanistic interpretation:

Link themes (trust, triadic communication, CHW embeddedness) to outcome improvement pathways.

Also, Some repetition in discussion (trust theme).

• Some quotes are long and could be shortened.

• Clarify whether medication stock-outs were eliminated in both arms.

• Clarify if clinicians were Ministry staff or study staff.

• Consider adding a figure illustrating the telehealth workflow.

Reviewer #2: 1. The qualitative part of the methods has been written well covering the plan of analysis too

2. A flow diagram of the study is missing that further delineates intervention and control groups. This will help the audience to dissect the overall flow of the study

3. A little expansion on the methods of the overall study is needed here in the qualitative aspect of the project as well. I know this has been provided in quantitative part seperately, just to make it more understandable for the readers.

4. The authors in the limitations haven't mentioned about contamination bias, since the control group participants might receive the intervention and vice-versa, kindly shed some light on this aspect as well.

5. How about the lost to follow-up data?

6. How about the duration of the intervention?, methodological details are missing.

**********

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Reviewer #1: Yes:  Shazia mohsin

Reviewer #2: Yes:  Adeel Khoja

**********

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-->PONE-D-26-01917R1-->-->Patient perceptions and preferences during a community-based telehealth care model for moderate-to-severe hypertension in rural communities in Kenya and Uganda-->-->PLOS One

Dear Dr. Johnson-Peretz,

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 Jun 18 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.

As the corresponding author, your ORCID iD is verified in the submission system and will appear in the published article. PLOS supports the use of ORCID, and we encourage all coauthors to register for an ORCID iD and use it as well. Please encourage your coauthors to verify their ORCID iD within the submission system before final acceptance, as unverified ORCID iDs will not appear in the published article. Only  the individual author can complete the verification step; PLOS staff cannot  verify ORCID iDs on behalf of authors.

We look forward to receiving your revised manuscript.

Kind regards,

Zahra Hoodbhoy

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.

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: 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: Yes

Reviewer #2: Yes

**********

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

Reviewer #1: Yes

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 #1: Yes

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 #1: No

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 #1: This is a well-designed qualitative study embedded within a randomized framework that addresses an important gap in understanding the acceptability of community-based telehealth models in low-resource settings. The work is strengthened by the inclusion of multiple stakeholder perspectives, including patients, community health workers, and clinicians, and by the richness of narrative data supporting the findings. However, the manuscript would benefit from clearer conceptual framing and stronger analytical positioning. At present, the findings are largely descriptive; elevating them through an explicit theoretical lens such as patient-centred care, trust in healthcare delivery, or differentiated service delivery models would significantly strengthen the scientific contribution. Trust appears to be a recurring and central theme across participant narratives, yet it is not explicitly articulated as the primary mechanism underpinning telehealth acceptability; this should be highlighted more clearly and consistently throughout the discussion. The results section, while detailed, is overly long and repetitive, and would benefit from restructuring into a smaller number of coherent themes such as access and convenience, trust and relationships, perceived quality of care, the role of community health workers, and the limitations of telehealth. In addition, the comparison between control and intervention groups should be made more analytically explicit, as this contrast provides critical insight into how direct experience modifies perceptions of care quality and trust. The discussion should move beyond narrative summary to clearly state the implications of the findings, particularly linking the qualitative insights to the improved clinical outcomes reported in the parent trial, and emphasizing how reduced structural barriers and enhanced trust likely contributed to better adherence and blood pressure control. Methodologically, further clarity is needed regarding sampling sufficiency, analytical approach, and researcher reflexivity to align with qualitative research standards. The paper also underutilizes important insights related to gender and economic roles, particularly the impact of clinic attendance on work and productivity, which could be framed as a key social determinant influencing care preferences. Finally, the policy and practice implications should be more explicitly articulated, particularly the importance of hybrid care models, sustained clinician involvement, and structured training and supervision of community health workers. With these refinements, the manuscript has the potential to make a strong contribution to the literature on telehealth implementation in resource-limited settings.

Reviewer #2: All the comments from the previous version of the manuscript have been addressed, I would like to congratulate the authors for a wonderful job. This is one of the keys areas to provide access to hypertensive patients in rural and under-served communities of an LMIC setting.

**********

-->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 #1: Yes:  Shazia Mohsin

Reviewer #2: Yes:  Dr Adeel Khoja

**********

[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.

-->

Patient perceptions and preferences during a community-based telehealth care model for moderate-to-severe hypertension in rural communities in Kenya and Uganda

PONE-D-26-01917R2

Dear Dr. Johnson-Peretz,

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,

Zahra Hoodbhoy

Academic Editor

PLOS One