Hear My Voice! The Experience of Self-Advocacy Among Patients with Enterostomy: A Qualitative Study

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

1. Abstract states "thirteen sub-themes," but Results section (page 3) states "16 sub-themes." Correct to 13 based on listed sub-themes (4 in behaviors, 5 in influencing factors, 4 in benefits).

2. Add frequencies and percentages for categorical variables (7 males [41.2%], 10 females [58.8%]; type of enterostomy: permanent vs. temporary counts; complications: yes/no counts) to summarize demographics properly.

3. Some quotes use "F" (F03 on page 5, F16 on page 6) instead of "P" as in demographics and other quotes. Standardize to "P" for all (assuming typos).

4. Period after surrey should be 'Period after surgery'.

5. The methods section (page 2) states the research was approved by the Ethics Committee (No.124 of 2024), but the Institutional Review Board Statement (page 7) says "Not applicable." This must be reconciled to accurately reflect ethical compliance.

6. The methods section (page 2) mentions written informed consent was obtained from participants, but the Informed Consent Statement (page 7) says "Not applicable." Clarify and correct this contradiction.

7. Participant 06's living arrangement is listed as "live lone," which should be corrected to "live alone" for accuracy and professionalism.

8. As a phenomenological study, there is no discussion of how researchers bracketed their preconceptions or managed potential bias, which is essential for rigor in qualitative research; add a section on this.

9. The data analysis uses Colaizzi's method, but it does not specify if multiple researchers independently coded data or resolved discrepancies; include information on team-based analysis to enhance credibility.

Author Response

Dear reviewer:

Thank you for giving advice to our manuscript submission ID nursrep-3815743 entitled “Hear My Voice! The experience of self-advocacy among patients with enterostomy: a qualitative study”.

We have carefully revised the manuscript according to your comment. We introduced the revisions in this file.

Thanks sincerely for your advice and guidance. We really appreciate your effort in giving us good suggestions.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

The study aimed to understand the experience of self-advocacy among patients with enterostomy, and to identify behaviors, influencing factors, and benefits of self-advocacy. The study uses appropriate methodology.  The ethics statement is appropriate. The conclusions are consistent with the evidence presented. The manuscript is relevant for the field.

Specific comments: Table 1 can be improved by creating numbers and percentages of the various demographic factors. Table 1 title is insufficient.

Author Response

Dear reviewer:

Thank you for giving advice to our manuscript submission ID nursrep-3815743 entitled “Hear My Voice! The experience of self-advocacy among patients with enterostomy: a qualitative study”.

We have carefully revised the manuscript according to your comment. We introduced the revisions in this file.

Thanks sincerely for your advice and guidance. We really appreciate your effort in giving us good suggestions.

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

Comments for Authors

Thank you for the opportunity to review your manuscript, “Hear My Voice! The Experience of Self-Advocacy among Patients with Enterostomy: A Qualitative Study.”  This study is important and provides valuable insights into the lived experiences of Enterostomy patients. The use of a phenomenological approach is appropriate, and its findings have clear relevance to nursing practice, particularly in the context of discharge planning and patient empowerment.

Strengths of the manuscript:

The introduction provides a comprehensive background on colorectal cancer and enterostomy, with up-to-date global and national statistics. The research design is appropriate, and adherence to COREQ enhances methodological rigor. Furthermore, the topics and sections are well-organized and supported by participant quotes, effectively illustrating the findings. Finally, the discussion links the findings to the available literature and highlights practical implications for improving patient care.

Areas for improvement:

Methods:

1. Please clarify whether the interviews were coded manually or using qualitative analysis software.

2. Clarifying how the saturation level was determined would improve transparency.

3. The accuracy of the translation could be described in more detail (for example, whether back-translation was used in addition to professional editing).

   Results presentation:

   Table 1 is comprehensive but crowded; please reformat it to improve readability.

   Figure 1 (themes and subthemes) could be made more visually appealing and clearer in structure.

   Discussion and Conclusions:

   Although the discussion is robust, the focus could be more directly on practical implications for nursing practice. For example, how can nurses integrate self-advocacy into health education during discharge and long-term care?

   Consider expanding on how the findings might contribute to the design of interventions specifically designed to promote self-advocacy in patients.

Comments on the Quality of English Language

The manuscript would benefit from careful editing for English to improve readability. Some sentences are long and could be simplified for clarity.

Some minor typos should be corrected (e.g., "entersotomy" should be replaced with "enterostomy", and "surrey" should be replaced with "surgery").

Author Response

Dear reviewer:

Thank you for giving advice to our manuscript submission ID nursrep-3815743 entitled “Hear My Voice! The experience of self-advocacy among patients with enterostomy: a qualitative study”.

We have carefully revised the manuscript according to your comment. We introduced the revisions in this file.

Thanks sincerely for your advice and guidance. We really appreciate your effort in giving us good suggestions.

Author Response File: Author Response.pdf