Developing Risk Assessment Items of Treatment Interruption Among Vietnamese Patients with Tuberculosis in Japanese DOTS—A Quantitative and Qualitative Survey Using the Delphi Method

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Thank you for the opportunity to review your manuscript titled Developing risk assessment items of treatment interruption among Vietnamese patients with tuberculosis in Japanese DOTS – Quantitative and qualitative survey using the Delphi method. It's an interesting research that try to develop treatment interruption risk assessment items that can be utilized in DOTS to help Vietnamese patients to complete TB treatment in Japan. I have some comments for the authors:

Methods. What software did you use to send the survey?

The loss of subjects throughout the conduct of a Delphi is frequent. Can you indicate the time that you allowed the subjects to respond to the survey? Did you use any reminders? Specify your answers in the manuscript.

Author Response

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Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

the study addresses tuberculosis in immigrantes and may heal the public service in Japan deal with the problem os interruption of treatment with news intervetions, but it studies a small population. Moving forward with a larger study could bring better results

Author Response

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Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

Title:

Developing risk assessment items of treatment interruption among Vietnamese patients with tuberculosis in Japanese DOTS – Quantitative and qualitative survey using the Delphi method

Details of the Paper:

This paper explores the development of a risk assessment tool or procedure for treatment interruptions among Vietnamese tuberculosis (TB) patients in Japan. Using the Delphi method, the authors had communications with public health nurses and healthcare workers experienced in Directly Observed Treatment Short-Course (DOTS) for Vietnamese patients. The study identified various factors affecting treatment continuation, including cultural, social, and medical characteristics of Vietnamese patients. The paper's findings are intended to aid healthcare professionals in tailoring DOTS plans to the unique challenges faced by Vietnamese TB patients.

The paper contributes to TB care for immigrant populations in Japan by using a specific case to Vietnamese patients (i.e a growing population of foreign TB cases in the country). While DOTS has been widely studied globally, this research provides a risk assessment tool tailored as a concern for immigrant group, combining cultural, linguistic, and social factors. The work of the authors lies in addressing the specific challenges faced by this foreign population in the context of a Japanese healthcare system.

Strengths:

a.     The study addresses a growing concern in Japan, where foreign-born TB patients, particularly Vietnamese, are on the rise.

b.    The paper’s methodology (Delphi method) is well-suited for consolidating expert opinions in fields with limited empirical data.

c.     The authors recognize the importance of not only medical factors but also socio-cultural and economic elements that may lead to treatment interruptions.

Limitations:

a.    Small Sample Size: The study involves only 15 participants, which limits the generalizability of the results. While these were experts, a larger and more diverse sample size would yield more robust conclusions.

b.      Geographical Scope: The study focuses only on health centres in areas with significant Vietnamese populations. It would be beneficial to the body of knowledge to investigate how risk factors vary in other parts of Japan, particularly rural areas.

c.      Lack of Quantitative Validation: Although the Delphi method is used to generate consensus, there is no mention of quantitative validation of the proposed risk assessment tool beyond expert opinions. Validation through real-world testing of the tool on Vietnamese TB patients is necessary. Can other methods be used to compare results to draw scientific conclusions?

d.      General Applicability: While the authors suggest that the tool could be used for Vietnamese patients in other countries, the socio-economic conditions of immigrants differ widely across nations, limiting the applicability of this tool.

suggested questions for the authors to be answered:

a. Could you clarify how the agreement among Delphi participants is determined or assumed (e.g., why was a content validity index of 0.78 chosen)?

b. Possibly, did you consider including quantitative data from actual Vietnamese patients who have interrupted treatment? Would such data strengthen the findings and add to the body of knowledge?

c. How do you plan to address potential challenges in implementing the proposed tool in health centres within the rural areas with fewer Vietnamese patients?

d. And lastly, the result obtained, can it be used to compare the outcome to other studies conducted?

Suggestions for Improvement:

a. Increasing the number of participants and including a more geographically diverse set of health centers could make the findings more representative.

b. For example, collecting data from actual Vietnamese TB patients, particularly those who have experienced treatment interruptions, would provide more robust validation.

c. Consider comparative studies on different immigrant groups to identify if unique risk factors apply to each nationality.

 Recommendation:

Minor revisions needed.

(The paper should be accepted provided the authors work on the limitations highlighted. And if possible, incorporating quantitative data or proposing future work to validate the tool would significantly strengthen the study.)

Comments on the Quality of English Language

Minor improvements

Author Response

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Author Response File: Author Response.pdf

Reviewer 4 Report

Comments and Suggestions for Authors

Dear Editor and Authors,

Thank you for the opportunity to review the article titled "Developing Risk Assessment Items for Treatment Interruption Among Vietnamese Patients with Tuberculosis in Japanese DOTS – A Quantitative and Qualitative Survey Using the Delphi Method."

The study’s results are intriguing, the manuscript is well-written, and the content is detailed and easy to follow.

However, I would like to seek clarification on a few points. The study aims to evaluate risk assessment items for Vietnamese TB patients in Japan, and the sample consists of nurses with experience in caring for these patients. My question is whether these nurses have sufficient knowledge or understanding of Vietnamese culture and characteristics to ensure that the findings accurately represent the Vietnamese population. Additionally, were the developed risk assessment items validated by Vietnamese experts, or was feedback solely based on Vietnamese patients?

Finally, while the study mentions the use of both quantitative and qualitative survey methods, the qualitative findings were not clearly presented.

Thank you,

Author Response

Please see the attachment.

Author Response File: Author Response.pdf