-->PONE-D-25-69071-->-->Assessing the content validity of the Migrant Health Country Profile Tools in Tunisia: A mixed methods study protocol-->-->PLOS One

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PLOS One

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Reviewers' comments:

Reviewer's Responses to Questions

-->Comments to the Author

1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions?

The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field.-->

Reviewer #1: Yes

Reviewer #2: Yes

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-->2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses?

The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory.-->

Reviewer #1: Yes

Reviewer #2: Partly

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-->3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable?

Descriptions of methods and materials in the protocol should be reported in sufficient detail for another researcher to reproduce all experiments and analyses. The protocol should describe the appropriate controls, sample size calculations, and replication needed to ensure that the data are robust and reproducible.-->

Reviewer #1: Yes

Reviewer #2: No

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: No

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-->6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics.

You may also provide optional suggestions and comments to authors that they might find helpful in planning their study.

(Please upload your review as an attachment if it exceeds 20,000 characters)-->

Reviewer #1: Clarity on the Validation of the MHCP-t: Data Tool: The manuscript's handling of the MHCP-t: Data tool's validation is inconsistent and potentially a conceptual flaw.

The Methods section states that content validity for the Data tool will only be assessed at the "scale level" using the second questionnaire. The Abstract and Objectives imply a full content validity assessment for "all three tools."

The justification that it "inventories sources rather than scalable constructs" (Line 63, 334) is a critical distinction. However, the protocol then proposes to assess its "overall content validity" (Line 335) using questions about relevance and comprehensiveness from Box 1.

Action Required: The authors must more clearly define what "content validity" means for an inventory tool versus an evaluative scale. Is the goal to ensure the list of data sources is comprehensive and relevant, rather than validating a set of scaled items? The distinction between "item-level" and "scale-level" validity for this tool should be explicitly stated and consistently applied throughout the manuscript, particularly in the Abstract, Objectives, and Data Analysis sections. The authors should consider if a different term, such as "utility" or "comprehensiveness," might be more accurate for the Data tool's assessment to avoid conflating it with the psychometric validation of the other two tools.

Feasibility of "Exhaustive Sampling": The manuscript proposes to recruit an "exhaustive sample" of 40-50 participants for each tool (Line 200), totaling 120-150 experts. This is an ambitious target in a specialized field within a single country.

Action Required: The authors should provide more detail on the expert pool in Tunisia. Are there existing registries, networks, or estimates of the total number of individuals who meet the inclusion criteria? Providing this context would strengthen the rationale for the sample size target and demonstrate its feasibility. If 40-50 truly represents the entire universe of eligible experts for each tool, this should be explicitly stated. If not, the term "exhaustive sampling" may be misleading, and a justification for why this number is adequate despite not being exhaustive should be provided.

Burden on Participants: The data collection process is substantial. Participants are asked to: 1) Complete their assigned MHCP-t (which itself is likely lengthy), 2) Complete an item-by-item validation survey for their tool, and 3) Complete a second global validation survey. This represents a significant time commitment.

Action Required: The manuscript would benefit from including an estimated completion time for each of the three MHCP-t tools and the accompanying surveys. This information is crucial for assessing the risk of respondent fatigue and low response rates, a limitation the authors themselves acknowledge. How will the study mitigate this burden beyond providing training? Will participants be compensated or incentivized for their time?

Reviewer #2: The manuscript presents an interesting and potentially valuable proposal for the development of the Migrant Health Country Profile tools (MHCP-t). However, the current submission describes a protocol and proposed validation process rather than findings derived from an implemented study. At present, the manuscript outlines the planned mixed-methods approach, including expert surveys and focus group discussions, but the tools themselves have not yet been tested in practice and no empirical results are available.

Given this, the manuscript is a research proposal or study protocol than as a completed research article. While the methodological design are promising, the contribution to the literature would be significantly strengthened once the proposed surveys and focus group discussions have been conducted and the results analyzed. Empirical evidence demonstrating the tools’ content validity, feasibility, and acceptability would allow readers to better assess the practical usefulness and methodological robustness of the MHCP-t.

I would therefore recommend considering the manuscript for publication after the study has been completed, including the implementation of the surveys with national experts and the focus group discussions. Presenting the resulting data and analysis alongside the methodological framework would provide a more substantial contribution to the field and allow for a clearer evaluation of the proposed tools’ effectiveness and applicability.

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Reviewer #1: Yes: mohamed abdelkarim

Reviewer #2: No

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Assessing the content validity of the Migrant Health Country Profile Tools in Tunisia: A mixed methods study protocol

PONE-D-25-69071R1

Dear Seedat,

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.

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Kind regards,

AKM Alamgir, PhD

Academic Editor

PLOS One

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