Leaving No One Behind: A Photovoice Case Study on Vulnerability and Wellbeing of Children Heading Households in Two Informal Settlements in Nairobi

Round 1

Reviewer 1 Report

Based on an African sample this paper examines from a qualitative perspective the intersections between vulnerabilities of CHHs and the social and environmental factors in Nairobi’s informal settlements though the photovoice research.

  ---Specific comments--- 

1.     Abstract section should be include some sample information. I encourage authors to review this aspect in the Abstract.

2.     Overalll, the Introduction is well written but I have some recommendations. First, I recommend the authors extends the literature review regard to “Well-being as a development concept” because it is sparce. Authors could add some research focused on explore de associations between weel-being and CHHs with current studies and not only referencing White's (2009). Second, I recommend expanding White's (2009) well-being pyramid theory as it seems to be an important theory in the study carried out. I consider that Figure 1 does not need to be included, with the explanation of the text it is sufficient and does not provide new information. I recommend removing it from the manuscript. Third, I believe it is necessary to add value to the manuscript that the authors include a literature review regard to Photovoice research since it is a key point in the study carried out.

3.     The study aim should appear at the end of the Introduction section.

4.     To help the clarity and flow of the manuscript I recommend to do a reorganization of the sections after the Introduction section. So, I recommend include “Participant characteristics” before of “Materials and Methods” and include all sample información in this section (remove it of the method section). It is not clear to me if the authors give the N of the sample. This data should appear in this section. Moreover, create a table would be useful in order to describe the sociodemographic characteristics of the sample.

5.     Results section is correct and well done explain.

6.     The Discussion section should start with the main objective of the study. In general, it would be important for the authors to work on connecting the information on the Discussion with the Introduction, integrating the interpretation of the findings. Referencing should be improved in this section, supporting the results in base on my recommendations for Introduction section. So, please, revise and modify the Discussion section accordingly. Morever, please, include the limitations of the study and strenghts of the manuscript should be explained in more details.

7.     Please, revise according to 7th Edition APA style the entire manuscript. Authors miss doi number. For instance: 

Chloe, I., A. Zahra, S. Bharati and W. Allison (2020). "Use of Photovoice Methods in Research on Informal Caring: A Scoping Review of the Literature." Journal of Human Health Research 1(3): 1-14.

Collins, L., M. Ellis, E. W. Pritchard, C. Jenkins, I. Hoeritzauer, A. Farquhar, O. Laverty, V. Murray and B. D. Nelson (2016). "Child-headed households in Rakai District, Uganda: a mixed-methods study." Paediatr Int Child Health 36(1): 58-63.

Author Response

Overall comment: Based on an African sample this paper examines from a qualitative perspective the intersections between vulnerabilities of CHHs and the social and environmental factors in Nairobi’s informal settlements though the photovoice research.

Review comment 1:Abstract section should include some sample information. I encourage authors to review this aspect in the Abstract.

Response to review comment 1: We have now included the number of CHH participants that were sampled to take part in the photovoice (n=4) and additional in-depth interviews (n=8). (Page 2)

Review comment 2: Overall, the Introduction is well written but I have some recommendations.

1. First, I recommend the authors extends the literature review regard to “Well-being as a development concept” because it is sparce. Authors could add some research focused on explore de associations between weel-being and CHHs with current studies and not only referencing White's (2009).
2. Second, I recommend expanding White's (2009) well-being pyramid theory as it seems to be an important theory in the study carried out. I consider that Figure 1 does not need to be included, with the explanation of the text it is sufficient and does not provide new information. I recommend removing it from the manuscript.
3. Third, I believe it is necessary to add value to the manuscript that the authors include a literature review regard to Photovoice research since it is a key point in the study carried out.

Responses to review comment 2:

1. We have extended the background on well-being as a development concept (page 4, para 2 - page 6, para 1). We have further extended the literature review on CHH to incorporate an overview of how wellbeing is considered in studies of CHH (Pages 6 to 8)
2. We deleted Figure 1 that depicts the White’s (2009) framework and retained the description in the text (Pages 5, para 2)
3. We added additional literature and references on the Photovoice methods and their application (Pages 9, para 2 to page 10, para 1)

Review comment 3: The study aim should appear at the end of the Introduction section.

Response to review comment 3: We edited the introduction and moved the objective of the study to the end of the introduction section (Page 8)

Review comment 4: To help the clarity and flow of the manuscript I recommend doing a reorganization of the sections after the Introduction section. So, I recommend include “Participant characteristics” before of “Materials and Methods” and include all sample información in this section (remove it of the method section). It is not clear to me if the authors give the N of the sample. This data should appear in this section. Moreover, create a table would be useful in order to describe the sociodemographic characteristics of the sample

Response to review comment 4: We have added a new section within Materials and Methods (page10) to clarify the study population and their key characteristics including the total N of the sample. In our understanding, this information is part of the ‘material and methods’ in the structure prescribed by the journal and it should also follow our account of the overall study design, which justifies our approach. We have therefore included this within rather than preceding this section, but we hope that we have achieved the increased clarity which we believe is the aim of this recommendation.

Review comment 5: The Discussion section should start with the main objective of the study. In general, it would be important for the authors to work on connecting the information on the Discussion with the Introduction, integrating the interpretation of the findings. Referencing should be improved in this section, supporting the results in based on my recommendations for the Introduction section. So, please, revise and modify the Discussion section accordingly. Moreover, please, include the limitations of the study and the strengths of the manuscript should be explained in more detail.

Response to review comment 5: We have revised the discussion. This section now starts with the main objective of the study, and a discussion of the key results and limitations of the study (page 32, para 1).

We have also increased coherence between the discussion and introduction sections, including linking specific points in the discussion to the expanded literature review in the introduction (pages 32 to 35).

Review comment 6: Please, revise according to 7th Edition APA style the entire manuscript. Authors miss doi number. For instance: 

1. Chloe, I., A. Zahra, S. Bharati and W. Allison (2020). "Use of Photovoice Methods in Research on Informal Caring: A Scoping Review of the Literature." Journal of Human Health Research 1(3): 1-14.
2. Collins, L., M. Ellis, E. W. Pritchard, C. Jenkins, I. Hoeritzauer, A. Farquhar, O. Laverty, V. Murray and B. D. Nelson (2016). "Child-headed households in Rakai District, Uganda: a mixed-methods study." Paediatr Int Child Health 36(1): 58-63.

Response to review comment 6: We updated the reference file to MDPI format in line with the Author guidelines. The dois are now up to date as recommended and where available

Reviewer 2 Report

Excellent article in general and in any specific part. It has a great value in relation with human rigths of children and the fact that you give visibility to a social problem and well-being way of living.

The general approach to the object of the article is nor surprising but quite necessary because of the invisibility of the way that some children are living not only in some African countries. The flexibility using the research method, collecting the information and the use of tolls is also very interesting and quite adapted to the needs of the population you are going to work with. Sometimes researchers consider "human beings" as an artificial laboratory. The human approach explains the global article. Qualitative research is also absolutely necessary to know deeply the origin of the problems they are living, familiar problems and so on. The concept of well.being and caring are useful and explained as a process. Maybe they need only to explain a little better the concept of vulnerability. Why? THe children are not guilty of the vulnerability, they are suffering it.

Author Response

Thank you very much for your feedback. It was very helpful in improving the quality of this manuscript. Please see our response below:

Review comment 1: The general approach to the object of the article is not surprising but quite necessary because of the invisibility of the way that some children are living not only in some African countries. The flexibility using the research method, collecting the information and the use of tolls is also very interesting and quite adapted to the needs of the population you are going to work with. Sometimes researchers consider "human beings" as an artificial laboratory. The human approach explains the global article. Qualitative research is also absolutely necessary to know deeply the origin of the problems they are living, familiar problems and so on. The concept of well-being and caring are useful and explained as a process. Maybe they need only to explain a little better the concept of vulnerability. Why? The children are not guilty of the vulnerability, they are suffering it.

Response to review comment 1: We have added more literature to explain the concept of vulnerability, focusing on CHH in both the introduction section (Page 6, para 2 to page 8, para 2) and the Discussion section (pages 32 to 35)