Participatory Action Research for Adolescent Sexual and Reproductive Health: A Scoping Review

Round 1

Reviewer 1 Report

The manuscript reports on a scoping review that includes 30 studies on participatory action research for adolescent sexual and reproductive health.

While the topic is relevant for the target journal and the manuscript is readable, there is room for improvement in several respects.

1. Both abstract and results should clearly mention the range of publication years of the included studies.
2. The methods section mentions an OSF pre-registration. However, this pre-registration is very vague and extremely incomplete. It does not cover review questions, databases, search terms, inclusion criteria, exclusion criteria, data charting instrument etc. In my book that is not a solid preregistration. Hence, the IMO misleading claim that the study was pre-registered should be completely dropped.
3. While the chosen target journal is “sexes” and the issue of adolescent sexual and reproductive health is highly gendered, the manuscript does not address sex and gender and does not even address this huge omission as a major limitation. I’d expect such a review in “Sexes” to address sex and gender issues explicitly.
4. “Although the age groups and number of participants and the setting of 258 the studies were identified, there was no significant difference in the extent to 259 which adolescents were involved between the study characteristics” I don’t think that authors can make valid claims about “significant differences” when no tests of significance were run.
5. “This systematic review aims to understand adolescents' participation in 88 PAR for co-designed ASRH interventions, including the barriers and facilita-89 tors, and assess the effectiveness of co-designing on ASRH outcomes.” The review questions should be spelled out more clearly and the results part should be structured accordingly. E.g. “Understanding adolescents’ participation” is too vague does not specify relevant variables.
6. It remains unclear why authors did not consider the quality of the included reviews. Why was the quality of the included reviews not systematically evaluated, e.g. according to AMSTAR 2 framework?
7. “The 301 collective theme of the included studies concluded that for the development 302 of a successful intervention and greater understanding of local perspectives, 303 adolescent involvement should occur at all stages of research in co-designing 304 ASRH interventions.” The authors claim about the “successful interventions” is very surprising as intervention success was neither part of the research question nor the reported data charting. Please clarify. This claim is also contradictory to the claim that “no outcome measures” were reported anyway.
8. The issue of success and outcome measures should be explained in more details. What kinds of outcome measures were authors expecting? Which outcome measures are appropriate for the covered studies?
9. To improve the manuscript, I suggest to add some more detailed examples – I found the level of description in the manuscript very high and abstract.

Author Response

1. Both abstract and results should clearly mention the range of publication years of the included studies.

Author’s reply: Thanks for pointing this out. We have now added this information in lines 23-24 of the abstract and line 140 in the results section  

1. The methods section mentions an OSF pre-registration. However, this pre-registration is very vague and extremely incomplete. It does not cover review questions, databases, search terms, inclusion criteria, exclusion criteria, data charting instrument etc. In my book that is not a solid preregistration. Hence, the IMO misleading claim that the study was pre-registered should be completely dropped.

Author’s reply: I agree, when we were registering the ODF only required those details. However, It is unfair to add those information at this stage and therefore we have removed it from the text.

1. While the chosen target journal is “sexes” and the issue of adolescent sexual and reproductive health is highly gendered, the manuscript does not address sex and gender and does not even address this huge omission as a major limitation. I’d expect such a review in “Sexes” to address sex and gender issues explicitly.

Author’s reply: Thanks. We contacted the journal pre-hand to ask if this title and abstract fit within the scope of the journal and on confirmation, it was submitted to the journal.

1. “Although the age groups and number of participants and the setting of 258 the studies were identified, there was no significant difference in the extent to 259 which adolescents were involved between the study characteristics” I don’t think that authors can make valid claims about “significant differences” when no tests of significance were run.

Author’s reply: Thanks for pointing this out. We have now removed the word “significant” from this sentence in line 262.

1. “This systematic review aims to understand adolescents' participation in 88 PAR for co-designed ASRH interventions, including the barriers and facilita-89 tors, and assess the effectiveness of co-designing on ASRH outcomes.” The review questions should be spelled out more clearly and the results part should be structured accordingly. E.g. “Understanding adolescents’ participation” is too vague does not specify relevant variables.

Author’s reply: We have now corrected this in the Abstract lines 19-21, and in the main text in lines 92-98.

1. It remains unclear why authors did not consider the quality of the included reviews. Why was the quality of the included reviews not systematically evaluated, e.g. according to AMSTAR 2 framework?

Author’s reply: the quality assessment of included studies is usually not required in the scoping review. Plus, AMSTAR details out the quality assessment for systematic reviews and it is not meant to assess the quality of primary studies.

1. “The 301 collective theme of the included studies concluded that for the development 302 of a successful intervention and greater understanding of local perspectives, 303 adolescent involvement should occur at all stages of research in co-designing 304 ASRH interventions.” The authors claim about the “successful interventions” is very surprising as intervention success was neither part of the research question nor the reported data charting. Please clarify. This claim is also contradictory to the claim that “no outcome measures” were reported anyway.

Author’s reply: we have now corrected this in lines 273-278 and 312-318.

1. The issue of success and outcome measures should be explained in more details. What kinds of outcome measures were authors expecting? Which outcome measures are appropriate for the covered studies?

Author’s reply: Added those to the objective section in lines 65-97

Reviewer 2 Report

The article "Participatory Action Research for Adolescent Sexual and 2 Reproductive Health: a scoping review" addresses an important issue and it can help to develop better SRH interventions.

However, I would like the authors to address the following major issues:

1. I don't agree with the conclusion "The collective theme of the included studies concluded that for the development of a successful intervention and greater understanding of local perspectives, adolescent involvement should occur at all stages of research in co-designing ASRH interventions." This conclusion does not seem logical to me. According to your article, only one study involved adolescents in the observation and not a single study involved youth in reflecting on the results. How can one deduce from this that young people should be involved in ALL phases when this obviously does not happen in practice? How can we know that this is actually helpful if it is not tried? I have the impression that this recommendation (?) is not evidence-based. If the interventions are successful even if the young people are not involved in the last two phases, why involve them?
2. Table 1 is generic and not necessary to understand the article
3. Please revise Table 2: It contains too much information and too many abbreviations that were not explained. Column "study design" is not very helpful because it contains vague terms and is a mix of study designs (e.g. randomized controlled trials) and research approaches (e.g. PAR). I illustrate further problems of the table in the PDF.
4. Please revise Table 3: The table contains far too much information, which is also presented in an unclear manner. In addition, the information does not match the text. The text states that in no study were young people involved in the reflection. Why then does the table "engagement of adoloescents in PAR process in included studies" contain the column "Reflection"?I illustrate further problems of the table in the PDF.

For minor issues, please check the PDF.

Comments for author File: Comments.pdf

Author Response

1. I don't agree with the conclusion "The collective theme of the included studies concluded that for the development of a successful intervention and greater understanding of local perspectives, adolescent involvement should occur at all stages of research in co-designing ASRH interventions." This conclusion does not seem logical to me. According to your article, only one study involved adolescents in the observation and not a single study involved youth in reflecting on the results. How can one deduce from this that young people should be involved in ALL phases when this obviously does not happen in practice? How can we know that this is actually helpful if it is not tried? I have the impression that this recommendation (?) is not evidence-based. If the interventions are successful even if the young people are not involved in the last two phases, why involve them?

Author’s reply: we have now corrected this in lines 273-278 and 312-318.

1. Table 1 is generic and not necessary to understand the article

Author’s reply: Table 1 is the requirement if you follow the PRISMA checklist  

1. Please revise Table 2: It contains too much information and too many abbreviations that were not explained. Column "study design" is not very helpful because it contains vague terms and is a mix of study designs (e.g. randomized controlled trials) and research approaches (e.g. PAR). I illustrate further problems of the table in the PDF.

Author’s reply: We have now corrected the information that has been asked for. Also, replied to all the comments marked in the PDf and mentioned them below as well.  

1. Please revise Table 3: The table contains far too much information, which is also presented in an unclear manner. In addition, the information does not match the text. The text states that in no study were young people involved in the reflection. Why then does the table "engagement of adoloescents in PAR process in included studies" contain the column "Reflection"?I illustrate further problems of the table in the PDF.

Author’s reply: As per both the reviewer’s, we feel this is too detailed and unnecessary at times, so we have removed it.

For minor issues, please check the PDF.

Author’s reply to reviewer’s comments on PDF

• Line 32: corrected the spelling of Reproductive
• Line 43-44: We have actually removed it since it was misleading as per the suggestion
• Line 71: we have corrected and added the comparison group
• Line 78-80: we agree, this is generic with any other health issues. We have therefore added this line
• Line 94: Table 1 is necessary as per PRISMA checklist.
• Line 97: No, we didn’t limit search to English papers only. We searched for all languages.
• Line 105-106: agree, we have now added this information in the abstract as well.
• Line 209: removed it.
• Line 265-267: Thanks for pointing this out. We have now revised the conclusion.
• Line 290-91: yes, we looked for studies in other languages as well.
• Line 301-305: yes, agree, we have now revised the conclusion based on the suggestion.
• Table 1: Table 1 is necessary as this reflects that PRIMSA guidance were followed.
• Table 2: study designs are corrected.
• Table 3 concise. We have removed as suggested that this is not required.

Round 2

Reviewer 1 Report

While some of my concerns were addressed, the authors did not address sufficiently my concern that the manuscript completely ignores sex and gender issues. 

Author Response

1. While some of my concerns were addressed, the authors did not address sufficiently my concern that the manuscript completely ignores sex and gender issues.

Author’s reply: Thanks. We have now mentioned in lines 104-107.  

Reviewer 2 Report

Dear authors,

thank you very much for the updated version of the article. Important questions from the first round of reviews have now been clarified. The few questions I still have can be found in the attached PDF.

Comments for author File: Comments.pdf

Author Response

1. Dear authors, thank you very much for the updated version of the article. Important questions from the first round of reviews have now been clarified. The few questions I still have can be found in the attached PDF.

Author’s reply: Thanks. We have addressed the specific comments in the PDF below.

Comments from the PDF.

2. Line 20: Thanks for your comment. I understand what you mean and we have now addressed the comment where required such as in line 79.
3. Line 77: We have now added the full form of LMICs
4. Line 87-89: this is in connection to comment from line 20 and we have addressed this now.
5. Line 104: Thanks. Okay we have now marked it as Supplementary table 1.
6. Line 166: corrected and mentioned the full form in line 79 already.