Healthcare Providers’ Perceptions and Experiences of Training to Respond to Violence against Women: Results from a Qualitative Study
Round 1
Reviewer 1 Report
The study embodies a struggle between social and medical dimensions on violence against women and muscle the urge to work under an interdisciplinary form, that permits to address all the victims whose entrance in public system is through healthcare (e.g., in or out-patient services]. Therefore, this study shows major relevance, especially within its geographic context.
Overall, the manuscript is clear, fluidly written with minor adjustments to be required:
1. It is suggested to remove “A total of 220 providers of different cadres were trained by master trainers across three hospitals in eight batches of approximately 30 HCPs.” [173], as it is presented in the after topic.
2. What were the criteria for the IDI [21] and FGD [5] participants? And why 21 and 5?
2.1. It is mentioned that two of five participants of the FGD didn´t arrive on time. Was FG delayed or rescheduled? If so, with the same 5 participants?
3. It is suggested that the facilities names should not be presented, instead presented facilities and its characteristics (e.g., tertiary facilities);
3.1. Since it is acknowledged the importance of training HCP in primary needs facility, why were the participants selected from tertiary facilities?
4. In l442 LIVES citation is required;
5. In point 3.3.2.2., what undermined the use of the term “champions” in 3.3.2.2.? Isn´t it too informal?
6. Some of the quotes have both italic and quotation marks. We suggest (only) the use of italic in all quotes and uniformized it.
7. Minor punctuation review is required;
8. SPO acronym is not presented and some
Author Response
Dear reviewer, 1st February, 2023
We would like to thank you for your useful comments. It was indeed a learning experience for us to work on the feedback and revise our paper. We have made the changes in track change mode and have also indicated our responses in the form of a table in attachment.
Thank you.
Sincerely,
Sanjida Arora (Corresponding Author
Author Response File: 
Author Response.pdf
Reviewer 2 Report
The paper presents a qualitative inquiry that was embedded in a larger intervention study. The paper presents results from interviews and focus group discussions with HCP in two Indian hospitals who received training to improve their skills in adressing violence against women in their consultation. Thank you for giving me the opportunity to read and review this highly relevant paper. To me, the paper reads like the authors put a lot of work into conducting the overall interventional study with scientific rigor and considerations, but this could be carved out a little better in the presentation of the paper.
As a general comment, I recomment to rework the paper in order to focus your main arguments better and to avoid redundancies.
Furthermore, I have some more detailed suggestions:
Introduction
As you have addressed the HCPs attitudes and positions in the health care system as part of the intervention, it would also be helpful to put this more in the foreground in the introduction: patriarchy & gender discrimination as well as the intersections of gender, class, race and other dimensions lead to a structural context in which survivors of VAW are often not believed or face a backlash instead of support when they speak out. At best, HCP can be a strong support line, but at worst, HCP can reproduce these experiences. I'm missing the latter aspect in the introduction, but see it in the design of the intervention.
Methods
Given the fact that you have a considerable high number of interviews, I was a bit surprised to read that data saturation was not assessed explicitly. Please add a little more context to this decision and/or refer to authors who have criticized the concept of data saturation and/or use other measures such as the question of data quality and information power.
Please provide more information about the FGD: Were all participants part of the same team? Were professions as well as age and position in the formal hierchy also mixed in the FGD? This might have an impact on participants' ability to speak openly and thus on data quality.
I recommend either attaching the interview guide or to at least include the main topics/questions of the interview guide to give readers a better orientation.
Line 237f.: I recommend moving this to the beginning of the results section. Also, to my understanding the frequency of occurence is not a relevant feature in a phenomenological approach, so it might be worth reconsidering if this should be the basis for the structure of the results section.
Please add some information how you ensured the quality of the analytic process and enhanced trustworthiness of the analysis. Did you add definitions to the codebook to clearly distinguish codes from each other? Did both coders code all data? How did you proceed when coders had different understanding of codes and data sections?
Table 3: I have difficulties understanding the hierarchy of themes in table 3. Does every theme have only one subtheme? If so, why adding subthemes as an extra?
When I read the results section, it became clear, that the theme "Acceptability and feasibility" is also filled with content. Thus, I recommend adding these aspects also to the table.
Results
See comment to table 3 - further codes/subheadings are missing. Overall the structure of the headings and subheadings is a bit confusing. I recommend reworking the structure of headings/subheadings and to add the missing dimensions in table 3.
The ratio between descriptive/analytic text and quotes is well-balanced.
Discussion
You only address the sample/setting of the study in the limitations. I recommend that you also address some methodological questions (e.g. the points I mentioned in regards to the methods section).
I recommend that you bring your findings a little more in coversation with the literature. E.g. in line 671, you refer to literature without mentioning any. As you are addressing a highly relevant global public health issue in a local context, literature would also help to strengthen the relevance of your findings and creating ressonance with others.
Also, I read your findings as a tension between the positive impacts of the intervention (more knowledge, confidence, willingness to develop communicative strategies) and the structural limits such as a lack of resources and support structures for women. This might also lead to distress in HCPs and could create a barrier in the long run (why open the subject when it is clear that nothing will change due to a lack of support?). Given the relevance of the topic as a public health issue and a backlash fueled by the COVID-19 pandemic, I would recommend that you improve the explicity and sharpeness of your discussion.
Author Response
Dear reviewer, 1st February, 2023
We would like to thank you for your useful comments. It was indeed a learning experience for us to work on the feedback and revise our paper. We have made the changes in track change mode and have also indicated our responses in the form of a table in attachment.
Thank you.
Sincerely,
Sanjida Arora (Corresponding Author
Author Response File: Author Response.pdf
Round 2
Reviewer 2 Report
Dear authors,
thank you for considering my remarks. In my opinion, the paper has gained quality in the presenation of your study. Thus, the immense effort that you seem to have made to undertake the intervention and the study become much clearer.
I am still a but confused by the fact that some themes don't have sub-themes, while others have sub-themes and sub-themes within sub-themes. I assume, that this mirrors the relevance of the themes to your research questions. Nevertheless, the layout makes it a bit difficult to follow the results while reading. Maybe reconsider the layout to make it a bit more accessible, e.g. have the themes in bold letters, the subthemes in bold and italics and the sub-themes of sub-themes in italics?
Also, I recommend a last language check.
I wish you all the best for the publication process!
Author Response
Dear reviewer,
We would like to thank you once again for reviewing the revised manuscript. As per your suggestion, we have made the layout changes for better reading of the results section. We have also done a thorough language check at our end.
Thank you
Sincerely,
Sanjida Arora (Corresponding Author)
