Dear Editor
Re: Developing longitudinal qualitative designs: lessons learned and recommendations
for health services research
Manuscript ID: 1077421626669504
Thank you for your letter informing us of your decision and forwarding us the constructive
reviews made by the three reviewers. We have worked further on this paper and we have
addressed all issues raised by the reviewers. We hope the changes made are satisfactory. We
are, of course, happy to make more revisions if necessary. Below we outline how we have
addressed each point raised.
Yours Sincerely
Professor Alex Molassiotis
University of Manchester
Reviewers’ comments
Our response
Reviewer 1:
OVERALL
I read this manuscript with great interest
because I am very interested in
qualitative methods, in learning about
cutting-edge advancements in methods,
and in how qualitative research can be
reported in ways that make it more
relevant to decision makers, including
clinicians, managers and policy makers.
While the content reads well and the
findings are relevant and important to
anyone doing qualitative research, not
only those using longitudinal qualitative
designs, the textual information could
potentially be organized, summarized
and extended to highlight the findings
and expand on the implications. That
would make the paper easier to read,
and more easily “translatable” to practice
by researchers and decision makers.
We have re-organised the paper and we
have followed the reviewer’s
suggestions. We have also under more
headings/subheading to make the flow of
paper easier.
MAJOR COMPULSORY REVISIONS
Methods
Although this is an experiential account,
We have added a short section in p.8
it is not clear upon what it is based.
describing the process of developing this
Obviously it is based on the experiences paper.
of the researchers, but how did they
identify these themes or come to
agreement on which themes to describe
and how. So while the account is of a
qualitative nature, many readers will
judge the relevance or reliability of the
findings based on what they know of how
these recommendations were
assembled. Include a Methods section in
which there is some description of how
themes were identified, documented,
discussed, elaborated, and how
recommendations were generated. There
are formal methods achieving consensus
and generating recommendations. I don’t
think that formal methods are needed
here, but a more precise account of the
thinking and activity that led to the
recommendations is warranted.
Following are more specific suggestions.
Results
The narrative, while well written, is very
extensive and may therefore be
challenging to absorb. While some subtitles are used, I would recommend
additional titles and sub-titles to more
easily guide the reader through this
wealth of information and more clearly
highlight key points so that they are
distinct. For example, under Practical
and ethical issues, many such issues are
discussed, and perhaps many of these
are thought by the authors to be ethical
issues, because only in the last
paragraph for this sub-section is the
concept of practical difficulties
mentioned. How are these conceptually
different from those in subsequent
sections, many of which appear to be
methodological and logistical.
So consider reviewing this information
and elaborating on the use of titles and
subtitles to reflect and distinguish key
themes. You might also further
We have addressed this by amending
headings, removing ‘practical’ from the
‘practical and ethical’ headings that
reflect separately now issues related to
researchers and participants and
amended the order of the text to reflect
this.
distinguish themes as those that affect
researchers or those that affect patients.
A summary table would also be useful.
Consider columns for key themes/issues,
definitions, example from author’s
research, and suggested solutions. In
this way the reader is more easily able to
take away important suggestions.
In my view the recommendations are part
of the results, rather than concluding
remarks. The purpose of the paper is to
provide guidance on how to integrate
multidimensional data that arises from
longitudinal qualitative research. So the
issues and potential solutions discussed
throughout the Results section give rise
to a number of higher-level
recommendations. Many points arose in
the Results that do not appear to be
addressed in the Recommendations so
the Recommendations could be
expanded, and included in the Results
section.
Discussion
Include a more elaborate Discussion
section that first briefly summarizes the
findings, then note limitations in the
methods used to generate the findings
and of the findings themselves. Next
contextualize the findings with respect to
other research in a more general or high
level manner than in the Introduction, for
example, there is much controversy
among qualitative researchers in
qualitative methods, how do these
findings clarify or add to those debates,
and in what way does this research add
to our knowledge about qualitative
methods. Next extend the discussion of
the implications of the findings. For
example, the findings are important
because they provide guidance on a
method that can be used to better
describe what works and does not work
with respect to complex health care
interventions that may be either clinical
care delivery or quality improvements to
the organization and delivery of health
services. Conclude with the existing
We have added a table and this on p.910.
Recommendations have now been
moved to results and expanded.
The Discussion has now been re-written
based on the reviewer’s comments and
at the same time being succinct to avoid
making the Discussion unnecessarily
long.
suggestions for ongoing research. Then
a Conclusions section can offer a brief
summary and next steps.
MINOR ESSENTIAL REVISIONS
Title – lessons learned? Rather than
These have now been all revised in the
learnt?
paper.
Some wording is awkward and perhaps
an anomaly of cutting and pasting? For
example:
Introduction, first paragraph: “…pathway
whether that be to long term survivor…”
Page 5, “Different approaches have been
taken to collection and analysis of data
for example use longitudinal data to…”
Page 6, “…experience over time, for
example, McCann et al [16].” What about
McCann??
Reviewer 2
Thank you for the opportunity to review
this paper. It considers the lessons learnt
from using longitudinal qualitative
methods (LQR) in a health care setting,
and makes recommendations for their
future use. LQR is an emerging
methodology and one being increasingly
employed in health service research, and
so this paper is timely and covers an
important area where more knowledge is
needed.
The paper is well written, and clearly
structured and referenced. The authors
correctly highlight several areas which
are currently problematic, and make use
of reflection upon their own experiences
to form recommendations for addressing
these. It is important to share these
experiences and I believe other
researchers considering using this
approach would find this paper very
useful indeed.
We thank the reviewer for the positive
comments. There are no issues identified
to address related to this review.
Reviewer 3:
Major Compulsory Revisions
I feel that much of the issues commented
on within the paper are general to
qualitative health research and the
We have added more practical examples
from our experience, and this is
throughout the paper.
practical issues discussed are common
problems in research that have already
been addressed elsewhere. Overall,
there are not enough practical examples
using research evidence demonstrated
within the paper. I would like to see
better evidence of how LQR worked for
the authors and what they achieved from
using this methodology. This would add
more strength to their argument.
Data collection
1. Whist many practical issues are
discussed around ethical considerations,
there seems to be a lack of practical
guidance on serial interviews in the data
collection section of the paper; it would
be useful to see a sample of interview
questions or a description of the types of
interview questions that could be asked.
I suggest a table be included in the data
collection section with types of questions
and examples that have been used.
We have now given examples of how the
analysis was done, but we felt adding
exemplary patient quotes and the themes
found in each cancer group would be
repetitive, as these are already
presented in the relevant papers [refs 1825]. Instead, after a summary and broad
examples of analysis, we are referring
the reader to the actual study papers,
plus a new paper of ours were we metasynthesised all qualitative literature on
symptom experiences in cancer patients
and the various themes are outlined
there [ref 39].
Analysis
2. I feel this section needs to include
some evidence of how longitudinal
qualitative data analysis was applied and
what it achieved for the authors. It
would be useful to see practical
examples of how some data were
analysed. It would be useful to include
some extracts of data or summary of
themes and examples of how they were
interpreted.
Paragraph 6
3. It would be useful to include a
This is now in the Discussion and
description of the new of the new insights conclusions more clearly.
that the authors claim to have been
highlighted from their analyses.
Minor Essential Revisions
I have no suggestions here
Discretionary Revisions
Practical and Ethical issues, paragraph 5 We have deleted this section, as
4. It may be worthwhile taking out the last suggested.
seven lines on this paragraph
beginning with We did consider inviting
participants to a presentation……… I feel
this is would be so difficult to put in
practice for ethical reasons and
therefore, is not worth mentioning in this
paper.