PONE-D-19-19733

Establishing need and population priorities to improve the health of homeless and vulnerably housed women, youth, and men: a Delphi consensus study

PLOS ONE

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PLOS ONE

Additional Editor Comments (if provided):

The Reviewers appreciated the study, though, both noted that the manuscript requires careful revision of the writing, especially in terms of clarity and fluency. I therefore suggest the Author to proceed with the reviewers' suggestions and, if necessary, to use a professional English language proofreading service.

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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: Yes

Reviewer #2: I Don't Know

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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: Yes

Reviewer #2: No

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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

Reviewer #2: Yes

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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: The Delphi technique is a tried-and-tested way for groups to build a consensus. Yet to date the method has seldom been used in homelessness. The value for Delphi panels in the context of evidence-use is that they can create an agreed view between researcher, professional and patient on what might work best, not a top-down ‘we know what research is best for you’ approach.

I was therefore delighted to see the technique used in this context to develop new policy and practice guidelines. The National Institute for Health and Care Excellence (NICE) in the UK uses Citizen Councils. While these are not strictly Delphi panels, they have a similar ethos: creating advice and guidelines that reflect a real-world consensus, not just rigidly following the scientific evidence from the lab.

The authors of the article took great care to ensure the inclusion of a diverse national group of people with lived homelessness experience. This is no small feat given the transient nature of the population.

Perhaps a little reframing in the introduction could have made it even clearer that the purpose of the work was to create rigorous and relevant guidelines to improve the care of people experiencing homelessness in Canada, building on a series of excellent systematic reviews. Applying this methodology will ensure the guidelines are as useful as possible in real life.

It is very positive that the authors are committed to continuing engagement efforts with an ever wider range of participants. Indeed, the fact that mental health and addiction care was identified as the most important issue among respondents suggests this will be important to highlight even further the structural causes of homelessness.

Reviewer #2: I have been asked to review "Establishing need and population priorities to improve the health of homeless and vulnerably housed women, youth, and men: a Delphi consensus study" for potential publication in PLoS One. This manuscript provides useful prioritization information in an important area of public health. I offer the following comments in order as they appear in the manuscript for the authors to consider:

- Abstract: Methods is difficult to follow grammatically. Could it be revised to "Initial needs were drafted from a literature review. To ensure accuracy and relevancy, we recruited 84 practitioners and 76 people with lived homelessness experience to participate in a 3-step Delphi consensus survey identifying and rating health and social priorities for homeless populations."

- Abstract: Methods would benefit from one line summarizing the criteria used to identifying individual needs and sub-populations as "high priority" or "most important".

- Abstract Findings would benefit from explicitly identifying the number of needs and sub-populations identified as "high priority".

- Introduction Lines 56-59: Could the authors also provide the life-expectancy figures for men and women who are not chronically homeless?

- Introduction Lines 59-61 make an unexpected jump to first-person language and discussion of the systematic reviews/Delphi conducted by this team. It reads as very out of place to me and could be removed, or at least moved elsewhere (e.g., to an appropriate place in the last paragraph of the introduction).

- Methods Lines 102-104 are difficult to follow grammatically.

- The Methods section would be easier to follow if sub-headers were used throughout. Per most reporting guidelines for empirical research, I recommend separate subsections for (1) participants (eligibility criteria and recruitment strategy), (2) data collection instruments (questionnaire items), (3) procedures (drafting of items, piloting, and running the process), and (4) analysis (how the authors analyzed the data from the Delphi). At the moment, the information in the methods section presents this information that seems "out of order" to me. For example, the authors discuss the Delphi survey, then they note the rankings were finalized during a meeting subsequent to the survey, and then they go back to information about conducting the Delphi survey (i.e., Survey Monkey or paper).

- The Methods section should include information on how many needs and populations were on the "initial list of needs and populations" (Line 122) and whether needs/populations were added or dropped in subsequent rounds.

- The Methods section should provide more information on the actual ranking task: were all needs and populations listed on one page? Did participants do a Q-sort task? Did they pick their top 10 (and then rank within it)? Please describe to the degree needed for the reader to replicate the ranking task. To this end, copies of the Delphi protocol and the survey for each round should be provided as an online supplement or included in an online repository (e.g., the Open Science Framework).

- In conjunction with more information on the ranking task, the Methods section also should provide more specific information on the analytic procedure used to analyze the ranking data for each round. For example, were rankings averaged across participants and then sorted? Please describe to the degree needed for the reader to replicate the analytic procedure.

- Methods Lines 140-141: The authors need to provide more details about the following: "We finalized rankings at a team meeting of experts working in the field of evidence-based homeless health." Who were the experts? How many were there at the meeting, and how were they chosen? When and for how long did the meeting take place? What information from the Delphi did they use at the meeting, and what was the specific procedure and analysis process for "finalizing" the rankings?

- Results Line 155: Figure 1 should include the response percentages as well as the N's.

- Results Lines 160-161 states "all age groups were included in the survey", though this is an artifact of the age categories created by the authors. The "<30" group particularly strikes me as one that should be split into more groups, given the growing public health concern about youth homelessness (including the statistics provided by the authors on youth homelessness).  

- Results Lines 177-186: These findings are difficult to interpret without the methodological context asked for above (i.e., the actual ranking task and the analytic procedure). The authors should provide more detail on how many items were considered in each round and provide a table with the actual ranking data on these items, including which and the number of items that do (and do not) meet their criteria for "most important" or "high priority". It is also not clear why only the needs are listed in a table: could similar information be provided for the sub-populations as well?

- Results Lines 187-189 are not results but rather are methods (see Lines 140-141). The authors here should report how many items came to this group, and the results of their discussions (e.g., how many items made the final list) according to the methodological details asked for above about the meeting.

- Discussion Line 193: I do not see a "Table 3" anywhere in the manuscript file.

- Discussion Lines 253-255: Please provide citations to support this claim.

- Discussion Lines 273-275: The authors refer to "the guideline development process", but have not provided the reader with any details about this. What guideline is being developed? Who is developing it? Who is involved? Who will use it once done?

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Reviewer #1: Yes: Ligia Teixeira

Reviewer #2: Yes: Sean Grant

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Establishing need and population priorities to improve the health of homeless and vulnerably housed women, youth, and men: a Delphi consensus study

PONE-D-19-19733R1

Dear Dr. Pottie,

We are pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it complies with all outstanding technical requirements.

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With kind regards,

Stefano Federici, Ph.D.

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 #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 #2: Yes

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

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 #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 #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 #2: (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 #2: Yes: Sean Grant