Datafication of Care: Security and Privacy Issues with Health Technology for People with Diabetes^†

Round 1

Reviewer 1 Report (Previous Reviewer 6)

Comments and Suggestions for Authors

The paper improves a lot due to review process. The authors very well response to the comments. I do not have any further objections from this paper. The paper could be accepted.

Author Response

We are very grateful to the reviewer for the time dedicated to our paper. Their comments were extremely helpful in improving our work. We extend our sincere thanks.

Reviewer 2 Report (Previous Reviewer 5)

Comments and Suggestions for Authors

Thank you to the authors for the changes they have made to their submission. All have improved the work as expected. The changes that remain to be made primarily regard finding updated supporting references for citations. In several instances, the reviewer has offered suggestions for the location of supporting references.

 

Line by line suggested edits

6 Change “A qualitative” to “Qualitative”.

7 Change “individuals in” to “individuals with Type 1 diabetes in”.

36 Please find a reference published since 2020 to support citation 14.

49 Please define grounded theory, citing seminal research and current research demonstrating the continued relevance of grounded theory for this type of study.

83 Please find a study published since 2020 to add to the list of those cited.

84 Please find a study published since 2020 to add to the two cited.

88 Please find a study published since 2020 to support citation 30.

102 Please find a study published since 2020 to support citation 44.

107 Please find a study published since 2020 to support citation 46.

113-122 Please find a study published since 2020 to support citation 48.

138-151 Please find a reference published since 2020 to support citations 55 and 58. This paper may be valuable in this regard: https://link.springer.com/article/10.1007/s11205-023-03199-2

177 Please find research published since 2020 to support that of Zuboff. This publication may be relevant in this regard: https://doi.org/10.1016/j.socscimed.2023.115810

446 Please find a study published since 2020 to support citations 96 and 98.

508 Please find a study published since 2020 to support the five citations. This research may be helpful in this regard: https://doi.org/10.1093/eurjcn/zvaa034.

1877 Please find a reference published since 2020 to support citation 55. The Springer reference above may be helpful in this regard.

880 Please find a reference published since 2020 to support Nissenbaum. The following book may be helpful: Handbook of Social Media Use Online Relationships, Security, Privacy, and Society Volume 2: Volume 2; ISBN: 0-443-28805-4.

944 Please provide research published since 2020 to support citations 104 and 105. Here is a Google Scholar search indicating that there are many publications to choose from in finding a supporting citation: https://scholar.google.ca/scholar?hl=en&as_sdt=0%2C5&as_ylo=2020&q=portal+technology+for+self-care&btnG=

947-948 Please find current supporting research for these five citations. This Google Scholar search demonstrates that there has been much research on this topic since 2020: https://scholar.google.ca/scholar?as_ylo=2020&q=benefits+that+the+use+of+continuous+glucose+monitoring+devices+and+insulin+pumps+have+for+optimal+disease+management,+reduction+of+disease+complications+and+quality+of+life&hl=en&as_sdt=0,5

Comments on the Quality of English Language

Any comments on the English language are in the Comments and Suggestions for Authors. Generally, the English is excellent.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 3 Report (New Reviewer)

Comments and Suggestions for Authors

How can you guarantee a coherent and efficacious application of the theoretical notions of datafication, dataism, and dataveillance? Can you provide more concrete examples from your discoveries that directly depict these concepts in play?

Your decision to use semi-structured interviews in this study is worth explaining. How do you ensure that the sample of participants from Poland and Italy is representative and large enough to draw sensible conclusions? What did you do about possible biases in the way the respondents would have reacted?

Comments on the Quality of English Language

Minor editing of English language required

Author Response

Please see the attachment

Author Response File: Author Response.pdf

Round 2

Reviewer 3 Report (New Reviewer)

Comments and Suggestions for Authors

The authors have addressed all the concerns.

This manuscript is a resubmission of an earlier submission. The following is a list of the peer review reports and author responses from that submission.

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

This has the potential to be an interesting article but I think perhaps you have tried to achieve too much with the different components of the study not really linking together. There is a key assertion underpinning this paper which is that there should be a specific identification of issues in the context of diabetic patients but there is no clear rationale for this. What is it about diabetes that means it cannot be covered by general law? There is a leap between ideas at times and the paper would have benfitted from a single, narrow focus. If you are focussing on the law and relevant provisions then references need to be provided - it is generally not enough to simply state what the law provides. This article would benefit from a narrowing of goals and the presentation of one part only of the study.

Comments on the Quality of English Language

Please take care to review your written word, some of your conclusions do not quie match the preceding narrative. Also please take care with tense - for example on pg 7 of 17, final paragraph you are writing about 'Before the entry of the GDPR , the pivotal document was ...' You then write of this in the present tense, does it still exist? I suggest clarifying. 

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

This study deals with datafication and security issues in digital healthcare for diabetic patients in Poland and Italy. Various literature surveys were conducted based on various references, and it is a high-quality study that provides insight into datafication and security through interviews with 52 diabetic patients in both countries.

In order to increase the overall completeness of this study, please modify the following.
-Please clearly describe the contribution or findings of this study later or at the end of the abstract.
-In 1. Introduction, briefly explain why this study chose two countries, Poland and Italy. In other words, explain the differences, for example, between the medical systems and medical laws of the two countries.
-It is recommended to introduce the survey participants introduced in Section 3.3 in 2. Materials and Methods, such as the survey participants' selection method and consent to use personal information, etc.
-Describe how to prove that the interview introduced in Section 3.3 is true.
-It is recommended to introduce the last paragraph of Chapter 4 Discussion (a paragraph starting with "Indeed,,,,,") under the title of Limitations as a subtitle.
-It is recommended to describe the conclusion of this study separately by preparing Chapter 5 Conclusions.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

In modern healthcare, digital technologies play a significant role in improving patient diagnosis, treatment, and health monitoring. However, the integration of digital solutions, particularly in chronic conditions like diabetes, raises crucial issues of data security and system integrity.

AUTHORS  explore the datafication and safety concerns associated with digital health technologies, focusing on patients with diabetes.

THEIR study presents a comparative analysis between Poland and Italy through a mixed-methods approach based on documentary analysis and qualitative research through in-deep interviews among 52 individuals with T1 diabetes. The documentary analysis has brought to light similarities in the regulation of health technologies in both contexts. Both Italy and Poland have implemented advanced regulatory measures addressing data privacy and patient safety in the realm of digital health technologies. However, there seems to be a deficiency in addressing security concerns related to the specific disease of diabetes. There is a lack of recommendations, guidelines, or interventions promoted by patient associations and scientific societies targeted specifically at individuals with diabetes. The qualitative research additionally provided an opportunity to explore the social perception held by individuals with diabetes regarding the process of datafication.

AUTHORS con lude that THEIR findings are consistent with previous research that highlighted the "agentic possibilities" empowered by technologies in individuals.

 

Interesting study,

I have a few comments for the authors with a pure academic spirit

1.      Abstract must better summarize the section

2.      In the method the sentence “This study presents a comparative analysis between Poland and Italy through a mixed-methods approach based on documentary analysis and qualitative research among individuals with T1 diabetes.” Is still the aims

3.      The section Methods needs improvement, there are a lot references to other studies  and very low on the design

4.      Try to use a table or something else in some passages of the results (see for example rows 532-536 )

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 4 Report

Comments and Suggestions for Authors

This manuscript is on health technologies for people with diabetes: balancing datafication of care and security. Unfortunately, the manuscript suffers from several shortcomings, including a lack of clear rationale, methodological flaws, and insufficient discussion of practical and theoretical implications. Additionally, the study's findings lack generalizability and representativeness, exacerbated by the unnecessary length of the article relative to its substantive content.

The introduction section as well as other sections are deficient in references (presumably due to the obvious use of AI-generated content), failing to provide a robust foundation for the study's context and significance. Moreover, the rationale behind the selection of study countries remains inadequately elucidated.

Notably, the sample size from Poland is disproportionately smaller than that from Italy, and the absence of an ethics vote, particularly for the Polish sample, raises concerns regarding research ethics and procedural transparency.

Despite claims of conducting a comparative study between the two countries, the analysis fails to provide a comprehensive comparison of the responses gathered.

Several methodological aspects crucial to the study, such as the recruitment process and translation procedures for the interview guide, are omitted, undermining the reliability and validity of the findings.

A more detailed analysis of the frequencies of the four macro-categories is warranted to provide a nuanced understanding of the data.

While the authors cite privacy restrictions as a barrier to data availability, the omission of strategies for anonymizing data is a notable oversight that could enhance the study's credibility.

The absence of authorship details and contributions, as well as the lack of an ethics protocol number, further detract from the transparency and accountability of the research process.

The reference list suffers from inconsistencies in formatting, and non-English references lack accompanying translations, hindering accessibility and comprehension for a broader audience.

In summary, while the manuscript addresses an important topic, significant revisions are required to strengthen its methodological rigor, theoretical coherence, and transparency.

Comments on the Quality of English Language

Extensive editing of English language ans scientific style required

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 5 Report

Comments and Suggestions for Authors

This is a study of 15 Polish and 37 Italian interviewees with Type 1 diabetes regarding how they perceive the datafication and security issues concerning the digital health technologies they use particularly investigating the main aspects of the awareness regarding these technologies that need to be improved for those with diabetes based on these interviewees responses.

 

This well-constructed study with an extensive introduction regarding these new and increasingly evolving technologies. What is missing from the introduction is a focus on explaining why these technologies were introduced and what current research has to say regarding how the technologies are generally thought to have greatly improved the lives of those with type 1 diabetes. This study should be interpreted within that context as the research questions appear to focus on what is problematic at the expense of what is good about the technologies.

 

In this field that is changing rapidly, all references should be to research that has been published in the last five years. This is not the case for the majority of the Introduction or for the Materials and Methods. The quality of referencing improves greatly beginning with subsection 1.2. From there until the Materials and Methods section, almost all the references are to articles published within the last five years. This is the standard that should represent the referencing of the entire manuscript regarding citations.

 

Please see https://www.mdpi.com/journal/societies/instructions for the instructions regarding references and redo the references according to the style requirements—this includes using English for “Available online: URL (accessed on Day Month Year)”.

 

Line by line suggested edits.

4-20 

The word limit for abstracts is 200. This abstract is 221 words. Please reduce it to 200 words. When reducing the words, at the same time, please explain what the author means by “Awareness appears to be low”. It is unclear as to what this awareness relates.

21 

“privacy” does not appear in the abstract. If the authors would like to include privacy as a keyword, please also include this word in the abstract.

25-29 

Each phrase in this opening paragraph is a claim, yet, there are no citations. For every claim that is made, there must be a citation to a peer-reviewed reference published within the last five years to substantiate it. Please add such a citation to support each phrase.

31 

Please briefly explain in the text the main reason why Poland and Italy were the countries selected for this study. 

31-32 

Please provide two supporting citations—one for each phrase of this sentence—to peer-reviewed references published within the last five years.

32-34 

Please provide a citation to a peer-reviewed reference published within the last five years to support this claim.

38 

Please explain in the text why the authors thought it important to focus on potential security risks and reference a least one recent article that demonstrates these security risks may be a problem.

41 

Please explain in the text why the authors decided to analyze the legal frameworks and implementation practices and reference a least one recent article that demonstrates investigating these legal frameworks and implementation practices is valuable regarding the use of technology by diabetic patients.

42 

Please state the type of research methodology to be used in analyzing the interviews.

44-45 

Please provide a citation to a peer-reviewed reference published within the last five years to support this claim.

50-59 

There are many claims made in this paragraph with no citations. Please provide a citation to a recent peer-reviewed article to support each claim.

60-96 

For these paragraphs of this page of this subsection, there are 15 citations. Only citations 4, 10, and 15 are to publications from the last five years. Please find new current references to support the claims that have been supported by citations on this page. As well, there are several claims in these paragraphs that have no citations. Please provide citations to peer-reviewed references published within the last five years to support these claims.

100-153

This page is intended to provide recent research. However, only citations 15, 19, and 22 are to research from the last five years. Please find recent research to support these claims on this page. Given that these are the sections that define the important terms for this study, information regarding the definitions must be up to date.

154-170 

None of the articles referenced here are ones published within the last five years. Please find updated references to support these claims.

259

Please find an up-to-date reference to replace or support 40.

345

Please find an up-to-date reference to replace or support 49.

419

Please cite the reference to the data breach.

437

Please provide more details in the text on the method of qualitative inquiry selected including citations to current research.

442 

Please provide recent research supporting the use of quota sampling in contexts similar to that of this study.

463 

These citations to grounded theory on their own are too old. The authors must provide citations from the last five years to research that demonstrates their understanding of grounded theory is current and relevant to this type of study.

470 

Please state how informed consent was obtained.

583 

If the authors are referring to a “consequentialist” approach to privacy, there should be a paragraph in the introduction regarding the types of approaches that can be taken to privacy issues of which “consequentialist” is one. This should also include citations to current references.

599-603 

Given that this lack of awareness is an important conclusion of the authors, what they mean by awareness must be discussed in the introduction including the ways that the interviewees should be aware in the view of the authors based on particular risks. Each of the points that would be made also requires citations to current references.

607-664

This discussion is marred by only two of the citations (10 and 22) being to current research. Please update the other citations to current references.

612 

Please cite a reference to the European regulatory framework.

621-622 

It seems a stretch from the information presented in the paper that the majority felt that they were not sufficiently informed about privacy and security. From what has been presented, the authors asked the interviewees “Does the fact that your data is constantly viewed by doctors bother you?” This is very different from the interviewees stating that they were insufficiently informed about privacy and security. Please provide the questions that were asked of the interviewees to demonstrate that they believed they were insufficiently informed about privacy and security issues.

706-710

This conclusion of the authors presents the reason why it is imperative that the results from the study demonstrated that the interviewees felt they were insufficiently informed about privacy and security issues. When making such major recommendations regarding the development of policies by so many regulatory bodies, the data must point to the necessity of this work.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 6 Report

Comments and Suggestions for Authors

The followings are my observations and suggestions while reviewing the paper,

1) The methods needs more clarity. It should be convincing and provide details in some mathematical forms or other technical formats.

2) Technical Diagrams need to be included to support the evidence of proof of experiments and research.

Comments on the Quality of English Language

The followings are my observations and suggestions while reviewing the paper,

1) The methods needs more clarity. It should be convincing and provide details in some mathematical forms or other technical formats.

2) Technical Diagrams need to be included to support the evidence of proof of experiments and research.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

The revised version reflects all of the reviewer's revision requirements.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

NA

Author Response

Please see the attachment.

Author Response File: Author Response.pdf