End-Users’ Perspectives on Implementation Outcomes of Digital Voice Assistants Delivering a Home-Based Lifestyle Intervention in Older Obese Adults with Type 2 Diabetes Mellitus: A Qualitative Analysis

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Manuscript ID: technologies-3948551

This study aimed to explore end-user perspectives on implementation outcomes (adoption, costs, appropriateness, acceptability, fidelity, feasibility and sustainability) of a home-based lifestyle program for older adults with obesity and T2DM delivered by DVAs to inform future real-world implementation of similar digital health interventions. The manuscript presents a pertinent theme, but it requires improvement to meet the quality standards of MDPI. The method section presents several flaws. My comments are described below:

 

• Please mention in the title that it is a qualitative study.
• Data collection occurred in 2021. Please justify why you are submitting for evaluation almost 5 years later.
• Methods are confusingly described. First, you describe an RCT with DVA and control groups. Control group was not well described. Then you describe the use of some participants (n = 10) from the DVA group in this study. In this sense, lines 75 to 78 should be revised to show only the group and method used in this part of the research. It seems that the authors divided the work to increase the number of publications.
• Line 75: Why did you choose 12 weeks?
• Line 83: Please insert more information about the semi-structured interview.
• Lines 94-100: Please describe only the participants of this part of the study. It is not an RCT, but a qualitative study performed with a sample that was also used in another study.
• Lines 101 – 102: Were they randomly selected? Explain the selection protocol.
• I recommend you insert a flowchart to illustrate the method.
• Line 483: Why did you not use all the participants of DVA group?
• Line 490: Why did you choose this period?
• Some recent studies on T2DM device construction and evaluation were not included.

 

 

Thank you for the opportunity to review this manuscript!

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

I appreciate the opportunity to evaluate your work, which shows considerable interest and represents a valuable contribution to the use of new technologies to improve the care of patients with diabetes. Here are some observations in order to optimize your work:

• The magazine requires a specific bibliographic format that, if applicable, is not fulfilled. I recommend that you consult the instructions section for the author, in particular the references section, to adapt your bibliography to the format required by the journal.
• There is a possibility of an interviewer bias, which should be addressed with greater thoroughness in the limitations section of his study, given that the interviewer was directly involved in the design and development of the DVA.
• Claiming that a sample of n=10 is sufficient without presenting clear evidence of thematic saturation could compromise the credibility of the study. Therefore, it is suggested that the authors provide evidence that the thematic saturation of the qualitative data obtained has been calculated.
• To conclude that DVAs are "widely accepted", considering that the population studied has a medium-high educational level (only 10% have a maximum of secondary education), is an excessively bold statement, taking into account that this type of technology can represent an entry barrier for people with lower educational levels.
• Although the limitations of the study mention the brevity of the period of time (12 weeks), it would be convenient to include some form of future correction for this limitation.
• It is mentioned that participants with comprehension difficulties receive training. It would be beneficial to deepen the process followed in this aspect.
• Given the limited sample and the specific population in terms of educational level, it is inappropriate to extrapolate that 60% of the participants would be willing to pay for this technology. The implementation of such techniques, which involve an initial economic barrier, could exacerbate socioeconomic disparities, thus deepening social gaps. Therefore, it would be highly recommended that this study be replicated in socially disadvantaged populations to obtain more representative data in this area. I consider this aspect to be the weakest of his work.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

This study is a very interesting read. I enjoyed reading the manuscript. However, some comments may improve the quality overall.

Introduction:

The introduction is crafted effectively, yet the term 'lifestyle' is mentioned multiple times. It would be beneficial to specify which aspect of lifestyle is being addressed. For example, in the method section, there's an emphasis on home-based lifestyle program (exercise/physical activity), but the rationale for including exercises or physical activity isn't clear.

It would be helpful for the readers to clearly understand that authors should write a paragraph explaining the rationale.

Methods

The authors need to explain the development process of the structured questionnaires; there’s no such information written in the methods.  

Did these questionnaires align thematically with the study's objectives?

I recommend including these questionnaires as a supplementary file.

Additionally, the authors should specify the duration of each interview, how much time each interview lasted?

I wonder, why were focus group interviews not conducted? In my view, this omission represents the study's main limitation, and the authors should clearly articulate the reasoning behind not implementing focus group interviews.

Discussion

The results were discussed very well throughout the entire section.

Lines 446-458 lack references. I suggest this study:
https://doi.org/10.2147/DMSO.S291468,  found that physically inactive persons are at risk of T2DM, especially those over age 40 years.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

Dear authors,

You addressed most of my comments and made improvements to your manuscript accordingly. I suggest some additional improvements:

1) Insert the information from your responses to queries 2, 3, 4 and 9 in the main text. In this sense, the methodology will be clearly described.

2) I could not identify the references you mentioned you inserted in the manuscript since you did not highlight them. Considering the list of references, I believe you could insert important new references in the area of study.

Thank you for the opportunity to review this manuscript!

 

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

After carefully reviewing the changes made by the authors, I consider the modifications introduced to be appropriate and sufficient.

Author Response

Thank you for your review.