-->PONE-D-24-22172-->-->Intercultural understandings: The experiences of doctors in Lesotho during the COVID-19 pandemic-->-->PLOS ONE

Dear Dr. Holdsworth,

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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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

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

Reviewer #1: N/A

Reviewer #2: N/A

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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: No

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: No

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-->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: Thank you for the opportunity to review this paper, which presents an interpretive phenomenological analysis of the experiences of doctors working in Lesotho during the COVID-19 pandemic.

Context and need for research well-established, though the comparable LMIC studies are all quantitative surveys, so further justification for why the authors used a qualitative methodology, and an IPA one at that, for this piece of work which is purported to be contributing to that body of literature.

Methodology: well described, and IPA well applied. Table outlining demographic features of participants by pseudonym (pseudonym, rough age, gender, perhaps medical specialty) would enrich the contextualisation of participant voices in the findings. Reflexive statement is a great addition, particularly the critical reflection on the differing logics around coping, stigma, mental wellbeing etc and how these were actively acknowledged and worked with through the research process. One small comment, possibly reviewer ignorance: interviews were conducted in English, not Sesotho, would English be the operational language of their professional work, but Sesotho be what they speak (and think in) on a personal, family and identity level? It may have also been the best common language between researcher and participants, but what is lost in the ability to sense-make (on either side) by choosing one or the other? How does the process and articulation of sensemaking (core to IPA) differ if the rendering of meaning is happening in a language that might be one of several known, is it easier/different to “make sense” in a mother-tongue? Or in the language of Western models of health/wellbeing? That’s not to say interviewing in English is a weakness of the work, but some thoughts reflecting on this and potential implications in terms of phenomenology would be insightful.

Results/Findings: Powerful, good clear themes identified, good use of participant voice and clear interpretation of sense-making.

Discussion: Some interesting critical thought here, particularly around how cultural norms in Basotho culture might shape some of the findings. This I would like to see the authors go deeper on, as not only might it form a core part of the deeper hermeneutic of sensemaking for many of the participants, but is the key “unique selling point” of this paper in a literature on doctors’ COVID experiences that is already quite saturated. Likewise the faith of doctors, and their reference to faith in their storytelling, is touched on but bears deeper discussion, particularly around the “vocational” nature of medicine as a “calling”. Gender is not mentioned, but the authors might also give some thought as to how gendered experiences were sense-made, particularly in light of medical culture (which is highly masculinised) vs the feminised pandemic burden of care, perhaps also vs traditional cultural ideas about gendered roles.

Implications and limitations well founded: excellent critical thought on limitations.

Additional comments:

Line 45: “Whilst another study” ; Line 66: “A figure higher than” – in each case, the indicated sentence should run on from the previous sentence with a comma, not be the start of a new sentence

Line 64: this population figure is almost 10 years old; consider a more up-to-date source.

Line 95: Provide an explanation for what Basotho means as the general readership of this journal cannot take this knowledge for granted.

Reference 15: missing detail of authors

Reference 34: confirm whether the text “TARGET ARTICLE” should appear

Reviewer #2: Dear Author

Thank for submitting this article for consideration. Below are my comments:

1. Abstract: This is written well and describes the contents of the article.

2. Ethics Statement: This is granted by the Ministry of Health REC and not the National REC. Not all industries seek ethical approval from this body.

3. Title: The element of 'intercultural understandings' is not well outlined in the article. What elements of the Basotho culture affected or contributed to the experiences of the doctors during the pandemic and/or vice versa?

4. Introduction: The word 'introductions is missing before line 37. There are several articles that I recommend on Covid-19 in Lesotho to further your knowledge on the matter. See the following links:

https://doi.org/10.11648/j.wjph.20240902.22

https://wlv.openrepository.com/handle/2436/625528

https://www.scirp.org/journal/paperinformation?paperid=115129

https://napier-repository.worktribe.com/output/3176278/caring-of-covid-19-clients-by-nurses-and-midwives-in-lesotho-feedback-of-a-pre-and-post-workshop-questionnaire

5. Method: Which sampling method guided the recruitment of study participants? What guided the selection of 7 participants? In how many districts were they working?

The study design should follow the qualitative inquiry. Cross-sectional designs are quantitative in nature. What guided the development of the interview guide? How was it tested for reliability? Which ethical considrations were applied throughout the study?

IPA was used to analyse the data. Explain how this procedure was followed.

The epistemiological approach and reflexive statement should align with the study type chosen. It is actually difficult to follow on the study type and design as you have used terms and concepts from different types.

6. Results: Table 1 should show the themes and subthemes developed. Remove information identifying participants and use codes instead. For more on this read the Belmont pronciples or UK GDPR. This should also be addressed throughout the results section after the excerpts. Again, the element of 'intercultural underpinnings is not reflected in this section.

Avoid writing in first person or describing the authors in the report. There should a section on author details where their information can be added.

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Reviewer #1: Yes:  Jennifer Creese

Reviewer #2: No

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-->PONE-D-24-22172R1-->-->The experiences of doctors in Lesotho during the COVID-19 pandemic: A qualitative study-->-->PLOS ONE

Dear Dr. Holdsworth,-->--> -->-->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 revise participant identifiers to protect confidentiality.

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

Please submit your revised manuscript by Aug 24 2025 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,

Rosemary Frey

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.

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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: All comments have been addressed

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-->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: Partly

**********

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

Reviewer #1: N/A

Reviewer #2: N/A

**********

-->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

Reviewer #2: No

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-->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: Yes

Reviewer #2: Yes

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-->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: Thank you to the authors for engaging genuinely and reflectively with comments provided. Congratulations on a really rich and interesting addition to the literature on clinical professional identity, experiences and wellbeing which brings a novel perspective to the body of knowledge on COVID-19 impacts.

Reviewer #2: Dear Authors

Thank you for submitting your manuscript for review. Most of my previous concerns have been addressed.

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-->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.

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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:  Jennifer Creese

Reviewer #2: No

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[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.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.-->

The experiences of doctors in Lesotho during the COVID-19 pandemic: A qualitative study

PONE-D-24-22172R2

Dear Dr. Holdsworth,

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,

Rosemary Frey

Academic Editor

PLOS One

Additional Editor Comments (optional):

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 #3: (No Response)

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-->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 #3: Yes

**********

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

Reviewer #1: N/A

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: Yes

Reviewer #3: No

**********

-->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: 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: Thank you for making the additional revisions to this submission, which provide a more safe and ethical account of participants now.

Reviewer #3: Name of the Reviewer: Prof Maseabata Ramathebane

Study title: The experiences of doctors in Lesotho during the COVID-19 pandemic: A qualitative study

I find this study very important for Lesotho and other LMIC countries. It highlights the experiences of doctors working in a resource-limited environment. The study employs a robust qualitative methodology. It gives confidence that the results will reliably answer the research question. The study is culture sensitive, but if conducted in Sesotho, it could have yielded more accurate results. However, because the participants were doctors, English was good enough. The results highlight experiences that left a lasting mark on their professional journey, whereby there was a thin line between a doctor and a person who was torn between helping patients and exposing themselves to a killer disease, fearing having the disease and infecting family members. Lack of support that led to isolation. The research highlights the important aspect of the government's lack of support, including limited access to PPE and risk allowances.

The study could have had a greater impact if it had drawn on research from Sub-Saharan Africa to compare experiences in similar settings. But the study carefully weighed all these and took steps to address the matter, as it should reflect culture, by including a local person from Lesotho who understands Basotho culture.

All in all, the study is very well written and deserves publication to make it more accessible for future pandemic response in LMICs.

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-->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.

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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: No

Reviewer #3: Yes:  Maseabata Ramathebane

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