Peer Support for Improving Student Engagement and Learning Outcomes in Postgraduate Public Health and Health Sciences: A Qualitative Study

Section

Reviewer feedback

Author Response

Background

I enjoyed reading the background, but it could be improved with clearer research questions and hypotheses, maybe explicitly stated. Consider adding a dedicated section or explicitly framing them within the introduction.

Thank you for your feedback. The suggested revisions have been made. Please see page 3 line 99-101

Methodological rigor

The qualitative research design is well-described, but additional details on participant recruitment and data analysis validation would strengthen the rigor of the methodology.

Thank you for your feedback. Participant recruitment is described under the "Study Participants and Data Collection" section. Please see 3-4 line 145-151

Additional details have been added to section 2.6 Rigor, about data analysis validation. Please see page 4 lines

Primary research studies to be cited

Some of the references focus on theoretical perspectives without strong empirical backing. I’d recommend incorporating more primary research studies that evaluate peer support interventions, especially those conducted in similar educational settings. 

Thank you for the feedback. Whilst other studies (1-3)have been published on the importance of student peer support and mental health support for international students or in other related disciplines, none has specifically focused on postgraduate international students in terms of their academic performance and learning. This has been added to the manuscript as well to show the clear gap. Please see page 5 lines 200-205

Literature

It would also strengthen the paper to dive deeper into the effectiveness of online peer learning compared to in-person models, bringing in additional literature where possible. Additionally, discussing the policy or institutional implications of these findings. Especially in terms of how universities can better support peer learning in both online and face-to-face settings.

Thank you for your valuable feedback. Some more literature of the effectiveness of online versus in-person peer learning has been incorporated, along with a discussion on the policy and institutional implications.

Section

Reviewer feedback

Author Response

General

Thanks for writing about this interesting topic.

Thank you for the encouragement.

Introduction

1.Refine in-text citations for accuracy and consistency.

Thank you for your feedback and apology for the oversight, we have now reform in text citations for accuracy and consistency.

2. Revise objectives to improve clarity and focus.

Thank you for your feedback, we have revised the objectives (similar to Reviewer ‘s comment) for clarity and focus.

3. Streamline the methodology section for enhanced readability and comprehension. As it is, the section is too long and difficult to follow.

Thank you for the insightful comment. We have sought to provide an adequate amount of information on study's setting, participants, and data collection and analysis to evidence our research rigor. We have now reduced the word counts in an attempt to focus the methodology section.

4. In the introduction you focus on engagement more than learning outcomes.

Thank you for your feedback. We have revised the introduction to provide a more balanced focus on both student engagement and learning outcomes. 

L. 50 Hakimzadeh and colleagues, please use proper in text citation.

Thank you for your feedback. The in-text citation has been corrected.

58 Zhang and colleagues please use proper in text citation.

Thank you for your feedback. The in-text citation has been corrected.

Significance of the study is not reported.

Significance has been reported in the introduction. Please see page 3

Problem of the study is not reported.

What is the contribution of your study to the field?

Thank you for your valuable feedback. We have expanded the introduction to include a comprehensive overview of the topic and clearly defined the research problem and the contribution of our study to the field, please see page 2-3

64 van der Meer, please Capitalize Van and use proper citation.

Thank you for your feedback. The in-text citation has been corrected.

More literature is needed. Analysis and criticizing the literature is needed.

You wrote” he present study aims to explore students’ experiences and perceptions of the peer 82 support intervention and better understand how these experiences of peer support im- 83 pacted their engagement and learning outcomes”, Are  you investigating experiences and perceptions? Or engagement and learning outcomes?

Where are the research questions?

I suggest that the authors include a theory informing the study to enhance understanding and analysis of the study.

Thank you for your feedback. More literature have been added to the introduction section and the research questions have been added to the introduction. The study was conducted based on Self-Determination Theory (SDT).

Methodology

What is the source of the content of the focus group questions in the outline used in the paper? How are the specific dimensions constituted? Why are they designed this way? The design of the focus group outline is crucial to the entire research findings and needs to be explained clearly.

describe the iterative process of data coding (such as the discussion of negative cases).

Please use a coding book to clarify coding of themes.

Your themes do not show any relation to your variable” learning outcomes”

Thank you for the opportunity to elaborate. The focus group questions were derived from a comprehensive literature review and researchers' insights, focusing on engagement, benefits, and areas for improvement in peer support. We used Braun and Clarke's inductive reflexive coding, involving iterative coding and theme development, with discussions of negative cases to ensure robustness. A coding book clarified the themes, ensuring consistency. This has been described in methods section.

Discussion

549 lutions The fol-, please pay attention to punctuations.

The punctuation has been corrected.

It is advisable to revise the discussion, based on the theoretical foundation. There are serious inconsistencies in language and terminology that need to be thoroughly revised.

Thank you for your feedback. The requested revisions have been completed.

Discussion is one-sided; find studies that are disagreeing.

Studies showing contrary results are cited in the discussion to make it balanced.

Recommendations and implications should be stated.

Recommendations and implications have been added in the discussion section.

Complete and verify all references to ensure accuracy. DOI and page range are missing.

Thank you for your feedback. References are verified for accuracy.

Please revise the journal referencing system

Referencing system has been revised as per journal referencing system.

Language editing is required so that the article reads better.

Thank you for your feedback. Language editing has been initiated to improve the readability of the article.

Section

Reviewer feedback

Author response

Comment 1 (References)

I recommend reviewing the 'instructions for authors' provided by the Journal, as your in-text citations and reference list do not fully comply with these guidelines.

Thank you for your recommendation. The in-text citations and reference list have been adjusted to fully comply with these guidelines. 

Comment 2 (Introduction)

The introduction section appears to be relatively brief. Given that your manuscript does not include a literature review section, I recommend expanding the introduction to provide a more comprehensive overview of the topic. This should include a discussion of relevant studies, key findings from previous research, and their relevance to your work. By incorporating more references to related publications, you can better contextualize your study within the existing body of knowledge and highlight its significance.

Thank you for your valuable feedback. We have expanded the introduction to provide a more comprehensive overview of the topic. This includes a detailed discussion of relevant studies, key findings from previous research, and their relevance to our work.

Comment 3 (Introduction)

I would suggest you formulate at least one research question to better guide your study design, data collection, analysis, and interpretation of the findings.

Thank you for your suggestion. A research questions have been added to the introduction section. Please see page 3 line 99-101

Comment 4 (Methods)

I recommend that you provide a detailed presentation of your research instrument— the interview—within your manuscript. It would be helpful to clearly describe its overall structure (e.g., the number and types of questions, such as open- or closed-ended), the format used (such as semi-structured, structured, or unstructured), and any theoretical or methodological framework that informed its design.

Thank you for your recommendation. The focus group guide has been attached as supplementary material. Additionally, text has been added to describe the format used (semi-structured) and the theoretical and methodological framework that informed its design.

Comment 5 (Methods)

I recommend that you provide more detailed information regarding the structure and format of the discussions conducted in the Focus Group Discussions (FGDs). Specifically, it would be helpful to elaborate on the following aspects: (a) What were the main topics covered during the discussions? (Are they listed in Table 2?) (b) Who was responsible for selecting these topics (the experienced researchers?), and what criteria or process was used to determine them? (c) In what ways did participants contribute to the discussions, and to what extent were they actively engaged? (d) Who oversaw or coordinated the discussions to ensure their quality and effectiveness? (e) Did the coordinator follow a specific set of guidelines or a structured framework while facilitating the discussions? (f) Were the discussions recorded for reference, analysis, or documentation purposes? If so, how was confidentiality handled? (g) Were the discussions among the members of each group or extended between the groups?

Thank you for your feedback. Following are the answers to the question provided: a. Based on a systematic search of reviews on peer learning, the main topics covered during the Focus Group Discussions (FGDs) are listed in Table 2. b. & c. The entire team selected these topics through group discussions.  d. Participants actively contributed by sharing their experiences and insights during the focus group discussions, facilitated by three experienced researchers, one of whom took field notes. e. The discussions followed a interview guide, ensuring consistency. f. FGDs were recorded, and field notes were taken, with confidentiality maintained through anonymization. g. Discussions were conducted within each group, not across groups, due to language differences. 

These details are incorporated in the methods section.

Comment 6 (Results)

Your results are currently presented in a primarily descriptive manner, which provides a general overview of the findings. However, the clarity and strength of your analysis could be significantly enhanced by incorporating relevant statistical data from the interviews.

Thank you for your feedback. Since this is a qualitative study, the use of statistical data may not be relevant. Instead, the focus is on providing a rich, detailed description of the findings. Qualitative research emphasizes understanding the depth and complexity of participants' experiences, which is best captured through descriptive analysis rather than statistical data.

Comment 7 (Section 3.1.3)

In this section, you refer to an 'assessment,' but it is unclear what exactly is being assessed. The term is introduced without sufficient context or explanation. For instance, in line 290, you mention the assessment of "content and resources." However, this raises several important questions that need clarification. Does this imply that students are expected to contribute to the evaluation of the course content and learning resources? If so, is this assessment formally integrated into their responsibilities?

Thank you for your feedback. The term "assessment" has been clarified to refer to assignments that post-graduate students complete and submit as a requirement to pass the unit. This ensures the context is clear and accurately reflects the students' responsibilities. The text has been added to describe what the term assessment/assignment mans in this context. Also, the assessment has been replaced with assignment in the manuscript of for clarity and uniformity.

Comment 8 (Section 3.3.2)

In this section, you outline various barriers that hindered participants' engagement in group discussions, which could, in turn, impact the validity and accuracy of your results. Given these challenges, how do you ensure the reliability of your findings?

Thank you for your insightful feedback. To clarify, the term "group discussion" in this context refers to participation in the peer support group discussions/engaging/chatting with group members during 14 week semester, not the focus group discussions.

Comment 9 (Discussion)

In the title of your study, you used the keyword of ‘peer support.´ However, in the text, in many places (e.g., introduction, discussion), you used ‘peer learning’ interchangeably. To avoid confusion for readers, it would be beneficial to consistently use either ‘peer support’ or ‘peer learning’ throughout the manuscript. Using consistent terminology will enhance clarity and improve the overall coherence of your explanation. If you decide to choose ‘peer learning’, you should modify the title.

Thank you for your feedback. This has been corrected.

Comment 10 (Discussion)

The research gap you have identified—namely, the limited evidence on the impact of peer support among postgraduate students in public health and health sciences—is both relevant and important. To strengthen your discussion and situate your findings within the broader academic context, it would be beneficial to compare and contrast your results with those of similar studies. Where possible, consider highlighting both the similarities and differences between your findings and existing research, whether conducted among postgraduate or undergraduate student populations. Doing so will not only enhance the depth of your analysis but also provide valuable insights into how peer support may function differently across educational levels, disciplines, or institutional settings. This comparison can help underscore the unique contribution of your work while also identifying areas for further exploration.

Thank you so much for your very valuable feedback. We have incorporated the feedback into discussion with providing similarities and differences between our findings and existing research.

Comment 11 – (Conclusion

This section is very short. It is better to develop it and include the findings of your work.

Thank you for your feedback, The section has been developed further and now includes the key findings of the study.