Peer Review History

Original SubmissionFebruary 4, 2026
Decision Letter - Miquel Vall-llosera Camps, Editor

-->PONE-D-26-03860-->-->Gatekeepers or barriers? Exploring traditional medicine practitioners’ understanding of breast cancer in Ghana-->-->PLOS One-->-->

Dear Dr. BOAMAH MENSAH,

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We look forward to receiving your revised manuscript.

Kind regards,

Miquel Vall-llosera Camps

Senior Staff 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

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

Reviewer #1: N/A

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-->3. Have the authors made all data underlying the findings in their manuscript fully available?

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Reviewer #1: Yes

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-->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

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-->5. Review Comments to the Author

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Reviewer #1: This is a great paper focusing on an under-reported topic.

There are a few places in the manuscript that refer to themes 'emerging' (method - line 122, line 151; results - line 208, 238). Please rephrase as themes do not emerge (see https://journals.sagepub.com/doi/10.1177/14733250241277355 ).

Please also avoid quantitative language (e.g. 'validated' on line 155).

In the results I was hoping for further information on what happens after recognition/suspicion of cancer or if/how beliefs about aetiology affect management. Indeed the discussed notes that beliefs might delay timely diagnosis. But at present there is no evidence of this presented in the results. Was there any data on this? If not available this should be recognised as a limitation.

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-->6. 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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Reviewer #1: Yes:  Suzanne Scott

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Revision 1

Journal requirements: 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming.

Author's Response: Thank you for this directive. We have formatted the manuscript according to PLOS ONE's style requirements, including those for file naming.

Reviewer # 1

1. 1. This is a great paper focusing on an under-reported topic.

There are a few places in the manuscript that refer to themes 'emerging' (method - line 122, line 151; results - line 208, 238). Please rephrase, as themes do not emerge (see https://journals.sagepub.com/doi/10.1177/14733250241277355 ).

Author's Response: Thank you for this helpful comment and for directing us to the recent editorial by Morriss on the use of Braun and Clarke’s thematic analysis. We agree that our previous wording could have implied that themes passively “emerged” from the data rather than being actively developed through researcher engagement and interpretation. We have therefore revised the manuscript to avoid this language throughout. Specifically, we replaced phrases such as “themes emerged” and “themes to emerge inductively” with wording such as “our analysis generated,” “we developed,” and “themes were developed through iterative engagement with the transcripts.” We also revised the sampling and data analysis sections to avoid the phrase “no new themes emerged” and instead describe the dataset's adequacy and depth. Please refer to "Abstract," line 42, and “Data Analysis," lines 145 to 161.

2. Please also avoid quantitative language (e.g., 'validated' on line 155).

Author's Response: Thank you for this important observation. We have reviewed the manuscript and revised language that could be read as overly quantitative, including the term “validated.” For example, we replaced “interpretations were validated through team debriefings” with “interpretations were strengthened through team debriefings" and revised “participant validation” to “member checking.” We also replaced “consensus was reached” with language describing discussion of differing interpretations and refinement of the analytic account. Please see "Trustworthiness," lines 162 to 171 of the revised manuscript.

3. In the results I was hoping for further information on what happens after recognition/suspicion of cancer or if/how beliefs about aetiology affect management. Indeed, the notes discuss that beliefs might delay timely diagnosis. But at present there is no evidence of this presented in the results. Was there any data on this? If not available, this should be recognized as a limitation.

Author's Response: Thank you for this helpful comment. We agree that the previous Results section did not sufficiently describe what happened after TMPs recognized or suspected breast cancer, nor how beliefs about etiology may shape management. We have revised Theme #4 in the Results section to include an additional analytic paragraph on “management responses after recognition or suspicion." This paragraph shows that some TMPs’ spiritual or social explanations were linked to advice about spiritual or relational repair, while bodily explanations were linked to treating perceived underlying causes such as reproductive or infectious problems. We have also included examples showing that some TMPs relied on biomedical confirmation through scans or hospital reports. Please refer to lines 336 to 356 of the revised manuscript.

However, we also recognize that the interviews did not systematically trace full patient pathways after TMP consultation. We have, therefore, added this as a limitation (lines 448 to 455) and revised the Discussion to avoid implying direct evidence that TMP beliefs caused diagnostic delay. Instead, we now present this as a possible mechanism that requires further study. Please refer to lines 380 to 391 of the revised manuscript.

Attachments
Attachment
Submitted filename: RESPONSE TO REVIWERS.pdf
Decision Letter - Sawsan Al-Rawi, Editor

Gatekeepers or barriers? Exploring traditional medicine practitioners’ understanding of breast cancer in Ghana

PONE-D-26-03860R1

Dear Dr. BOAMAH MENSAH,

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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If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Sawsan S Al-Rawi

Guest 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

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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

**********

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

Reviewer #1: 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

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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

**********

-->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)

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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.

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:  Suzanne Scott

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Formally Accepted
Acceptance Letter - Sawsan Al-Rawi, Editor

PONE-D-26-03860R1

PLOS One

Dear Dr. Boamah Mensah,

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS One. Congratulations! Your manuscript is now being handed over to our production team.

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PLOS ONE Editorial Office Staff

on behalf of

Mrs. Sawsan S Al-Rawi

Guest Editor

PLOS One

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