Review Reports

Round 1

Reviewer 1 Report

I think this paper is valuable for the first step in developing a theory-driven intervention designed to enable the delivery of behavior change techniques during genetic counseling as stated by the author.

I have two comments as follows.

#1 About "Materials and Methods"

The range of years of service as a genetic counselor was 0.5~22 years, but I doubted the difference was large. Would it have been difficult to limit the number of years of service to those who have worked as a genetic counselor for 10 years, for example?

#2 About Results

I thought the description of results 3.2.1 through 3.2.3 was somewhat redundant. Would it be possible to make the description some more concise?

Author Response

We thank Reviewer 1 for their time and helpful comments.

Reviewer 1, comment 1: 'The range of years of service as a genetic counselor was 0.5~22 years, but I doubted the difference was large. Would it have been difficult to limit the number of years of service to those who have worked as a genetic counselor for 10 years, for example?'

Authors’ response: Whilst we could have limited the number of years of service to 10 years as suggested, we would have missed participants who had gained behaviour change training from their master’s programs. As stated in 2.1, masters training in Australia did not commence until 2008 (10 years before our study). We purposively sampled genetic counselors to achieve those who trained 10 or more years ago (to explore views of experienced genetic counselors), and those who trained less than 10 years ago (to explore views of those who may have received training in behaviour change during their master’s training). In the manuscript, we have clarified the mean number of years overall and for each group.  We have also clarified that some education in behaviour change is a requirement of accreditation for masters programs in Australasia.

Reviewer 1 comment 2: 'I thought the description of results 3.2.1 through 3.2.3 was somewhat redundant. Would it be possible to make the description some more concise?'

Authors’ response: We added quotations for each point to provide evidence. However, we accept that this makes this section somewhat repetitive. In the manuscript, we have therefore reduced the number of quotes in the text (all quotes are available in the supplementary information) and removed reference to the focus groups/interview unless there is a quote. 

 

Reviewer 2 Report

The authors conducted qualitative research regarding genetic counselors' perceptions of their role in supporting clients' behavior change. The manuscript is well-written and insightful.

 

The manuscript is ready for publication, and I have a few questions.

 

Minor suggestions

 

1- The authors briefly summarize the COM-B psychological model aspects. Later in the manuscript, the authors comment the first Australasian master's level genetic counseling degree started in 2008. Is this COM-B model included in the curriculum of this course and other relevant courses around Australasia? If some of the authors are in teaching positions, do they intend to introduce this conceptual framework to new genetic counselor candidates?

 

2- Some of the interviewed participants refer to excessive workloads and low budgets as barriers to effective behavior change in patients. However, there are no summaries regarding these aspects. Can you provide an overview of mean weekly work hours, salary, budget, etc. (per State, for example, in Table 1)? Therefore, authors can assess which centers could be amenable to interventions to improve client behavior outcomes.

Author Response

We thank Reviewer 2 for their time and helpful comments.

Reviewer 2, point 1: ‘The authors briefly summarize the COM-B psychological model aspects. Later in the manuscript, the authors comment the first Australasian master's level genetic counseling degree started in 2008. Is this COM-B model included in the curriculum of this course and other relevant courses around Australasia? If some of the authors are in teaching positions, do they intend to introduce this conceptual framework to new genetic counselor candidates?’

Authors’ response: The HGSA Accreditation guidelines include ‘theory of health behaviour and health promotion’ as a curriculum content area for Master of Genetic Counselling programs (see page 23). In the manuscript, we have added a sentence to made this point clear. Students on the UTS program are introduced to behavior change in the first and second years of the program. They are taught about several behavior change models and theories including the COM-B model. We have not commented on this in the manuscript but could explain this if Reviewer 2 would like us to.

Reviewer 2 point 2:  ‘Some of the interviewed participants refer to excessive workloads and low budgets as barriers to effective behavior change in patients. However, there are no summaries regarding these aspects. Can you provide an overview of mean weekly work hours, salary, budget, etc. (per State, for example, in Table 1)? Therefore, authors can assess which centers could be amenable to interventions to improve client behavior outcomes.’

Authors’ response: These data are not readily available, but we agree that this information would be helpful. A census of the Australasian workforce is currently being conducted by the HGSA so this information may be available in the future. In the manuscript, we have added reference to an audit of workload and budgets to triangulate these findings.

Round 2

Reviewer 1 Report

I think the revised manuscript is better than the initial one. I also appreciate your consideration of the points I have commented on.