Review Reports

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Content

Introduction

- The statement of the issue of use of health promotion and disease prevention strategies by individuals in public housing is clear. This is a worthwhile topic to explore.

- Lines 49-61 – In this paragraph you discuss the barriers to utilization of HP and DP strategies. However, I suggest that some additional points need to be considered: (a) the lack of walkability of the surrounding environment affects the uptake of physical activities – it’s not only about the distance to services. Many people know they need to exercise but they don’t feel safe, for example. (b) Low literacy does affect awareness of available services but it also affects awareness and understanding of the interventions themselves. (c) Digitization is an interesting idea but poverty and literacy affect the availability of digital components to a public housing population.

- Readers need your definition of public housing in the Introduction to understand why you excluded government owned housing. What is so different? Does it serve a different population? Is the housing of a different quality? What kind of homogeneity are you trying to achieve? Age range? Cultural diversity? Level of income? This attempt to be homogeneous in the context is a difficulty for me. There are too many variables in public housing populations. The most consistent aspect could be income thus there should be no reason to exclude government-owned housing. When government-owned housing is excluded, what kind of housing is left? In Canada, for example, public housing is almost always government-owned. This is potentially a big drawback of your scoping review. You need to be really clear about what kind of homogeneity you are trying to achieve and why.

Materials and Methods

- This section is fine except for the definition of public housing and what you are including and excluding through your definition. 

- I am sad that you are only focused on individually-oriented interventions because the health promotion field has shown greater success of interventions when they include changing environmental conditions and healthy public policies to be supportive of individual behaviour change. However, I accept that you have put that limitation on your inclusion criteria. I suggest that this is a limitation of your review and should be mentioned in the limitations section.

Results

- On the whole, I have problems with the way the results are reported. In the overview paragraph, general statements are made which imply that all articles did this or achieved this and that is not true. I would be more comfortable if the reporting more accurately reflected the articles rather than implying these are general truths. The wording of 3.3.1 Health Promoter Programs is better. Using words like “often” or giving a range helps to reflect the findings from the articles. Even though I have made some suggestions below, I think you need to review and possibly rewrite all of the summary paragraphs for all sections.

- Lines 194-195 – “No change in average servings of fruit and vegetables” is very difficult to understand when the next part of the sentence is that there were trends indicating an increase in intake. In Table 2, several of the articles mention that they observed increases in vegetable intake and only one said there was no change. When reporting the findings, it seems to me to be more accurate to state that “several (most?) of the programs resulted in an increase in uptake of vegetables and/or fruits. Only one article stated there was no change in average servings …”

- lines 212-216 – I’m not sure of the conclusions expressed in these lines. Three of the articles in Table 3 showed significant improvements. Only 1 article reported issues with follow-up, yet that is the focus of these sentences. Can you shift the emphasis to more correctly reflect your findings?

Discussion

- lines 322 – 331 – I appreciate your enthusiasm about digital components of health interventions, but your 5 articles do not support the conclusions you draw in these lines. These 5 studies did not have results. In my experience in low income communities, they have limited access to computers and the internet, even cell phone service. Households of 2-12 are sharing computers and internet access because they are can only afford the cheapest plan possible. Many people in this group have low literacy and this is exacerbated when English (or Danish) is their second language. Maybe there is a good reason there are so few articles about this topic. I think you should be more cautious in your discussion about the applicability of digital components in public housing communities.

Limitations

- As a qualitative researcher, I do not believe that narrative synthesis is poorer in quality and value than quantitative studies. In fact qualitative research can be far better at capturing nuance and complexity than quantitative studies. (Eakin et al 1996) This is a scoping review and not a systematic review so the attention to homogeneity around definition of public housing does your review a disservice. Perhaps you could discuss the limitations of your definition of public housing and your concept of homogeneity. You could talk about the limitations of focusing on individually-oriented health promotion interventions in light of the breadth and depth of the health promotion field and that all of the Ottawa Charter strategies interact for better success. Your review identified the importance of community engagement to the success of the selected health promotion interventions, which is classical health promotion work. Community engagement has also created problems for conducting quantitative research, especially randomized controlled trials (e.g. Dressel et al 2018). Health promotion has some unique challenges for research (e.g. Meyer et al 2018) which means that any review needs to include both quantitative and qualitative work to ensure it covers the optimal scope.

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Joan Eakin, Ann Robertson, Blake Poland, David Coburn, Richard Edwards Towards a critical social science perspective on health promotion research Health Promotion International, Volume 11, Issue 2, June 1996, Pages 157–165, https://doi.org/10.1093/heapro/11.2.157

Dressel A, Schneider R, DeNomie M, Kusch J, Welch W, Sosa M, Yeldell S, Maida T, Wineberg J, Holt K, Bernstein R. Assessing Health Promotion Interventions: Limitations of Traditional Research Methods in Community-Based Studies. Health Promot Pract. 2018 Jul;19(4):573-580. doi: 10.1177/1524839917725489. Epub 2017 Sep 7. PMID: 28882076; PMCID: PMC6137725.

Meyer SB, Edge SS, Beatty J, Leatherdale S, Perlman C, Dean J, Ward PR, Kirkpatrick SI. Challenges to evidence-based health promotion: a case study of a Food Security Coalition in Ontario, Canada. Health Promot Int. 2018 Oct 1;33(5):760-769. doi: 10.1093/heapro/dax011. PMID: 28379371; PMCID: PMC6202923.

Comments on the Quality of English Language

On the whole, the English was mostly good. There are some issues as given below:

- line 165 – change “should” to “could”

- line 178 – “… built trust …”

- line 181 – experienced

- Table 1 – “basis” should be “basic”, “Their” should be “they” in many cases,

- “The healthy family advocates experienced to effectively built with residents, which facilitated better health outcomes.”  This sentence does not make sense. Please revise.

                - several sentences in the table lack a verb

- line 217 – change “were” to “was”

- line 225 – change “advises” to “advice”

- lines 300 & 301 are repeated.

- lines 319-320 – “Only five (16 %) of the included studies had a digital component incorporated, besides having promising effect on health outcomes related to health promotion and disease pre-vention [24–28].” I don’t understand what the “besides …” part of the sentence means. Do you mean – “…despite the potential to have a promising effect …”? Or “…and they did not affect the results”?

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

These are my comments to the respected authors.

 

The title is concise and informative.

Abstract is well written and contains all the necessary information.

Introduction is comprehensive and offers a solid point on the importance of the subject. It is informative enough and easy to follow.

Materials and methods are described in sufficient detail.

Result are written cohesively and efficiently.

Please, check the use of term “their” in table 1, under column “Intervention” – there seems to be a problem with sentences beginning with “their”.

In table 2, last row, last column, the Authors state “The education was well-received by the residents.” This seems too vague to be included as an effective outcome. Could this be clarified? The same applies to table 5, last row, last column. It has been touched upon in the Discussion section (lines 332-334), but still, the descriptions in these specific table cells offer insufficient info.

Overall, it would be advisable for references to be added within text, and not solely in the tables (as is done in section 3.3.9 for example). This would greatly enhance the legibility of the text.

Discussion in solidly led and well written.

Conclusions are sound, and in line with the aims.

References are up-to-date and relevant.

Sincerely,

The reviewer

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

Thank you for addressing the comments I raised in the first review. The paper is greatly improved and better presented.