Perceived Consequences of COVID-19 Restrictive Visitation Policy on Family Members at Rural Hospitals in Vhembe District: A Qualitative Study

Round 1

Reviewer 1 Report

This manuscript presents some very interesting data on "visitors not allowed" circulars during COVID-19.

Please describe specifically what kind of means of communication existed in areas where smartphones and other devices were not available. I think that it will be a more understandable description if you show the effects and limitations of the communication method collectively.

Author Response

Thanks for the valuable comments

Author Response File: Author Response.pdf

Reviewer 2 Report

Thank you for this work.  I believe it is important, particularly because many efforts like this lacked support or even prohibited by healthcare organization.  I thought the paper was straightforward and clear.  I kept wondering if it would be helpful or appropriate to characterize these visitation measures as iatrogenic harm in the Ivan Illich sense? 

Author Response

Thanks for the comments

Author Response File: Author Response.pdf

Reviewer 3 Report

Dear Editor,

Thank you for the opportunity to review the article “Perceived consequences of COVID-19 restrictive visitation policy on family members in rural hospitals of Vhembe district: A qualitative study” whose aim was to explore family members' experiences regarding the implementation of a restricted visitation policy when a family member is admitted with COVID-19 at public hospitals in the Vhembe district.

The article is relevant, needing to clarify some items:

In the methodology it states that the analysis is done by creating categories, subcategories. However, throughout the work, only 3 themes are presented.

In the presentation of the registration units, with the citations of the participants, I suggest coding the participants so as not to get confused with the references.

In the introduction, I suggest reflecting in 1 or 2 paragraphs on the studies carried out on this topic at an international level.

Explain in the methodology why only 12 interviews were carried out.

I suggest not presenting the frequencies by percentages, but the N.

Add to the discussion about the implications of this study about its specific implication for nursing and the approach to the family.

Review the results and discussion according to the presentation of categories and subcategories.

Author Response

Thanks for the comments

Author Response File: Author Response.pdf

Reviewer 4 Report

Thank you for the opportunity to revise the manuscript entitled “PERCEIVED CONSEQUENCES OF COVID-19 RESTRICTIVE VISITATION POLICY ON FAMILY MEMBERS IN RURAL HOSPITALS OF VHEMBE DISTRICT: A QUALITATIVE STUDY”.

Overall, it’s an interesting manuscript; however, there are some major and minor issues that the authors should address before considering it for publication. Here are my comments.

General comments:

Looking at the references it seems like the argument has already been explored a lot, why the authors decided not to cite any other study about the impact of family members absence for inpatients during Covid-19 pandemic in the introduction?

Regarding this point, the authors should introduce these articles in the Introduction section. 

You must adhere to the EQUATOR Network Guidelines (e.g., COREQ tool) and declare it in the methods section. 

Specific comments:

Introduction

In lines 52-53-54 and 60-61 are the authors already stating some results? If not, they should consider writing a reference.

In lines 70-71 the authors should declare why they assumed such concepts.

Introduction seems to be too long and redundant. Please, delete some concepts and introduce the state of art regarding the similar articles already published and cited in the discussion section. 

In the Introduction I expected to read a literature review regarding the topic, and then the rationale of your study: why a novel qualitative data analysis is necessary? 

Material and methods:

I think this section is incomplete.

The authors state that six district hospitals in Vhembe participated in the study: did they have all the same policies about Covid-19 visitation restrictions? Please, better describe the setting of the study. 

Why the authors have used a non-probability, purposive sampling? Please, justify your decision and put a methodological reference. 

Also, justify the method approach with unstructured in-depth interviews with the family members. Add a reference regarding this issue. I suggest the authors clarify also the sentence in lines 93-94. In which way the authors encouraged the participants? 

Why did the authors ask questions focused on means of communication? It is not part of the declared objective of the study.

Did the authors use a software to conduct the data analysis? If no, please better describe the coding tree process, i.e., codes, categories and themes. And add a methodological reference in order to justify your approach. 

Presentation of results:

I think that lines 106-107 should be part of the introduction.

From line 108 to line 114 there is a whole description of the methods used to conduct the study, therefore the authors should relocate this part. Also I think that it would be interesting to state what does it mean “significant other” (108) and what does it mean that the participants visited the admitted family member (108-109).

The piece of information in lines 177-178 is part of the results or is it a reference?

Results should include at least two tables. Table 1 should be the 'sample characteristics", Table 2 should be the 'coding tree process', by adding an example from the 'quotes' for each code. 

Discussion:

In the discussion the authors add some information which has not been previously stated in the introduction. As an example, why did the authors start talking about healthcare providers point of view? (line 187) The discussion usually refers both to the introduction and to the results.

Limitation of the study:

Limitation of the study should be updated after the review work. 

Conclusions:

In the conclusions the authors summarize a piece of information that is not stated before in the findings (line 234).

References

Also, I think it is necessary to update the references using a uniform style.

Please, add some up-to-date references regarding visiting restrictions and COVID-19. Some papers have been published also from Nursing Reports.

 

Author Response

Thanks for the comments

Author Response File: Author Response.pdf

Round 2

Reviewer 4 Report

Thank you for the opportunity to review the revised manuscript entitled "Perceived consequences of COVID-19 restrictive visitation policy on family members in rural hospitals of Vhembe district: A qualitative study".

The authors did not review the manuscript by the rules of the peer review. 

The authors did not solve both the major and the minor issues that I pointed out. No substantial changes have been made in the body of the manuscript.

The authors should not reply to the general and specific comments by inserting the answers of the COREQ guide questions in the checklist, but should revise and integrate the manuscript, as well as the references.

Moreover the responses made by the authors are very difficult to understand.

At this stage, my opinion regarding this manuscript has not been changed. 

Author Response

1. Provide sufficient background and provide all relevant references

   Additional information is provided and highlighted

2. Are all cited references relevant to research?

All references have been checked and revised

All references appearing in the in-text have been listed in the reference list

Reference technique has also been updated. 

3. Are the methods adequately described

The research methods were clearly described and expanded

4. Are the results clearly presented

Results have been clearly edited and rephrased

5. Are the conclusions supported by results?

Conclusions have been rephrased in line with the results and has been highlited

 

 

Round 3

Reviewer 4 Report

Thank you for the opportunity to revise this manuscript that has been improved. At least this time the authors have tried to answer the issues from the reviewers in the proper manner.

But the authors fail to provide strong description of their analysis process based on available qualitative data.

Setting is not clearly stated (e.g., it's got a population of xxx people).

The authors declared the alignment to COREQ guidelines. However, important steps from the guidelines are still missing, especially in the data analysis’s process. Here some point from COREQ statement:

1) Personal characteristics of the interviewer have not been declared. Which author/s conducted the interview or focus group? What were the researcher’s credentials? E.g. PhD, RN. What was their occupation at the time of the study? Was the researcher male or female? What experience or training did the researcher have? And so on.

2) What are the important characteristics of the sample? You have reported only the ages. It is not clear how the sampling was carried out and why there were recruited 18 people (finally 12).

3) It seems that the saturation of the data has been imposed by the sample, “Data was collected until data saturation was reached with twelve family members”.

4) Description of the coding tree is (again) missing. Curious that there are three subthemes and three themes. Usually the sub-themes are more than the themes. The data analysis process is not clear. Neither is it clear how the codes (?), sub-themes and themes derived from the data. Who and how performed this process?

Author Response

Response to reviewers’ comments for-2301119

Title: Perceived consequences of COVID-19 restrictive visitation pol-icy on family members in rural hospitals of Vhembe district: A qualitative study

Reviewers’ comments	Authors’ responses
The authors fail to provide strong description of their analysis process based on available qualitative data.	Data analysis is described on line 128-132
Setting is not clearly stated (e.g., it's got a population of xxx people)	The setting has been written in detail line 84-92
Software used	Software was not used
The authors declared the alignment to COREQ guidelines. However, important steps from the guidelines are still missing, especially in the data analysis’s process. Here some point from COREQ statement:	Data analysis has been re-written to indicate the application of COREQ line 128-132
Did participants provide feedback on the findings?	This has been stated under trustworthiness as member checks on line 138
Personal characteristics of the interviewer have not been declared. Which author/s conducted the interview or focus group? What were the researcher’s credentials? E.g. PhD, RN. What was their occupation at the time of the study? Was the researcher male or female? What experience or training did the researcher have? And so on.	Personal characteristics of the interviewers is declared on line 114-115.
What are the important characteristics of the sample?	Important characteristics of the sample is presented on Table 1, line 146
You have reported only the ages. It is not clear how the sampling was carried out and why there were recruited 18 people (finally 12).	Sampling has been clarified in detail on line 100-106
3) It seems that the saturation of the data has been imposed by the sample, “Data was collected until data saturation was reached with twelve family members”.	It has been clarified that saturation was reached when no new information was coming out. This is explained on line 105-107
Description of the coding tree is (again) missing. Curious that there are three subthemes and three themes. Usually the sub-themes are more than the themes. The data analysis process is not clear. Neither is it clear how the codes (?), sub-themes and themes derived from the data. Who and how performed this process?	Presentation of themes and sub-themes is presented on table 2 line 154 The process is described under data analysis on line 128-132.