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Dear Editor and Reviewers,
We note with pleasure that your review comments were quite useful in helping us take a closer look and improve our work [
Dear Reviewer P,
Thank you very much for the time you took to critically elaborate on the subject matter and for the compliments. We are grateful to you for indicating to us that this is an innovative paper. We also hold your views of extending our approach to other areas in which similar challenges are faced. Kindly find our answers to your comments below.
1. It would be interesting if there are any other articles that mention this problem and can be added in the manuscript.
Response: We thank the reviewer for this suggestion. We took time to explore a journal database of community eye health [
2. Moreover, the eye care delivery in Cameroon is presented only from the financial aspect. It would be interesting if the authors could add some other demographic or educational and cultural factors that affect the access to health care.
Response: We appreciate your concern. Apart from financial challenges, we also highlighted other factors that limit access to health care, which have now been substantiated. We also added a couple of lines, all of which have been highlighted in yellow.
Dear Reviewer Q,
We are very grateful for the suggestions in improving our paper. We carefully considered and addressed all points as shown below.
1. It is better to choose keywords that are MeSH terms.
Response: We have modified the keywords to address this concern.
2. It is better to integrate all sections before
Response: Done.
3. How did the researchers develop the interview guide?
Response: This has been clarified under
4. The trustworthiness of the results and validity and reliability need to be discussed separately for each research method.
Response: We appreciate this suggestion. We did discuss the above under the subsection
5. More details should be added to the
Response: Done.
6. How many participants took part in the focus groups?
Response: All 29 subjects took part in the focus group discussions as highlighted in the table of participant characteristics. We have also rephrased the first sentence of the
7. The
Response: Thank you for this. We were not able to expand the
8. In the
Response: This has been removed.
9. The
Response: We have gone through the paper again and made corrections where necessary.
10. Strengths and limitations of the study can be reported at the end of the discussion section.
Response: Done.
11. Research implications can be reported before conclusions.
Response: Done.
Dear Reviewer BJ,
Thank you for taking the time to review our paper and for the recommendations. We considered all suggestions in improving the paper further. Kindly find below our responses to your comments.
1. The lengths of both the main text and the abstract are a bit long. We suggest the authors to further condense the paper or move some parts to Multimedia Appendices.
Response: We have removed some text from the
2. Although 29 subjects were interviewed, only 9 of them were direct subjects. We are unsure if this is a sufficient number for such qualitative analysis.
Response: Thank you for raising this concern. In the context of this study, decisions regarding the uptake of cataract surgery to a greater extent are not made by blind patients with cataract themselves but rather by the breadwinner, if not the entire family, and often in consultation with other villagers who have been in similar situations, which sometimes may even extend to seeking advice from traditional healers or spiritualists about the success of the surgery. We wanted a sample that will represent the decision-making mechanism as highlighted under the
There is evidence that data saturation in qualitative studies can be reached with a minimum sample of 13 [
3. The influence of indirect subjects' opinions on the decision of the direct subjects was not particularly discussed.
Response: Thank you again for raising this. Following our explanation in point #2 above, it is a fact that direct patients to a lesser extent decide for themselves what they need. We have highlighted and underscored the fact that the decision-making mechanism in cataract surgery uptake is a social construct [
4. Considering the potentially different weights of direct versus indirect subjects' opinions in the decision, whether the quotes were taken from direct subjects should be shown.
Response: Done.
5. We are no experts of traditional medicine, but is there anything to be noted about these therapies? (Maybe certain therapies were helpful from the patients' perspectives?) We are unsure if these should be taken into consideration when assessing the “Knowledge and awareness” and “reasons of refusal.”
Response: We have now added some text in the
6. The “poor outcome” of prior cataract surgeries was mentioned in the
Response: We have equally added a phrase under the
7. There are still some grammatical mistakes that should be checked and amended.
Response: We have read through and made some corrections.
8. Please make sure to provide the full spellings of all abbreviated words at first use (eg, “MICEI” and “FGDs”).
Response: Done
9. The table did not show the particular demographics of the direct subjects (which may help reveal other socioeconomic factors influencing the decision or limitation of the study).
Response: Done.
10. How is the surgery acceptance or backlog situation for community cataract screening programs conducted in nearby countries with a similar socioeconomic status? While this is not the focus of the study, if there are available data, it would be good to include some general information (this will help justify the study aim and support the overall results).
Response: Thank you for bringing this up. This has now been included in the second-to-last paragraph of the
Dear Editor and Reviewers,
We thank you for pointing out the outstanding concerns which we have now carefully considered and addressed accordingly. We have now integrated our responses in the review comments for both rounds 1 and 2 as recommended by some of the reviewers.
Dear Reviewer Q,
We are thankful for the additional concerns. Kindly find our responses to your concerns below.
1. The author response letter only includes the authors’ responses without mentioning the reviewers' comments. For some comments, they just said “done” and I have no idea what the comments were and what they exactly did. So, a complete response letter needs to be uploaded.
Response: Our understanding in round 1 was that the reviewers had a copy of their comments. Additionally, we uploaded a copy of the response letter bearing the reviewer comments and our responses (as a supplementary file) and made it visible to the reviewers. We equally uploaded a version of the revised manuscript with track changes and made it visible to the reviewers as well. To address your concerns, we have included the responses for round 1 in this letter. We have also uploaded the revised manuscript with track changes.
2. The
Response: We have now integrated the
3. Also, the subsections under the
Response: We have deleted the
Dear Reviewer BJ,
Thank you for taking the time to review our paper and for the recommendations. We considered all suggestions in improving the paper further. Kindly find below our responses to your comments.
1. The authors have addressed most of the comments. While the scientific content is acceptable after the revision, it is still recommended that the authors shortened the article to <6500-7000 words. No further suggestions are enclosed.
Response: We thank the reviewer for raising this concern. While we are not against cutting down the word count, we wish to reiterate that the word count is in line with the journal guidelines [
MM is an independent researcher and can be reached via Alumni Relations, London School of Hygiene & Tropical Medicine.