Experiences and Acceptability of a Weight Loss Intervention for Diabetes (Diabetes Remission Clinical Trial—DiRECT) in Aotearoa New Zealand: A Qualitative Study within a Pilot Randomised Controlled Trial

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Campbell et al. provides valuable insights into the acceptability and experiences of the DiRECT weight loss intervention in Aotearoa New Zealand. The study is overall well written, some minor suggestions for improvement.

 

COREQ checklist might be a good approach to ensure rigor of the qualitative approach

While the study acknowledges cultural differences, more emphasis on how cultural sensitivity was incorporated into the design and conduct of the study may strengthen the methodology. how the researchers' understanding of Māori and Pacific cultures influenced the study design and analysis?

Although data saturation was not actively sought, it might be good to discuss how a large sample size (40 interviews) ensured a comprehensive unpacking of the participants' experiences

Authors can elaborate on transparency regarding the thematic analysis process, for instance, provide examples of how themes were developed and reviewed.

Please include interview guide as a supplementary material

Flow chart may fit better in the results. Results well drafted, no comments.

Partial meal replacement might also be an option for diabetes remission, which might be applicable in primary care setting in AU and NZ. this can be integrated in discussion.

limitations should be covered eg consider how the single-dietitian approach might limit generalisability or how cultural diversity within the participant group was addressed.

Author Response

Thank you very much for taking the time to review our manuscript. Please see the attachment for detailed responses to your comments, and the corresponding changes in the re-submitted file.

 

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

The authors tried to see if the Diabetes Remission Clinical Trial (DiRECT)  can be suitable for strong cultural emphases on food and shared eating populations. They performed a qualitative study on Maori and Pacific island ethnicities, with limited participants involved in a 3- and 12-month trial. The study was designed well and performed carefully. This study can supply useful information for how to make the education and intervention of diet and life change in T2DM populations. The methodology is questionnaire, other related things are caring and consulting. Based on all the phrases quoted from the questionnaire, this manuscript described a small sample study, the conclusion is not so concluded, but at this stage it's acceptable. The references are appropriate. Although a little bit not so new, it's a small field in the metabolism study field.

Author Response

Thank you for reviewing our manuscript and providing these comments. 

In the re-submitted file, revisions to the text are included in track changes, and any other changes or areas of note are highlighted in yellow.