Co-Creating a Digital Resource to Support Smartwatch Use in COPD Self-Management: An Inclusive and Pragmatic Participatory Approach

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

This study presents a well-designed co-creation process to develop a digital resource supporting smartwatch use in COPD self-management. The participatory approach and integration of patient and healthcare professional perspectives are clear strengths, and the resulting resource appears relevant and usable. However, the very small number of participants with COPD, reliance on self-reported diagnosis, and lack of formal effectiveness evaluation limit generalisability. Greater methodological detail on the qualitative analysis and a more explicit discussion of potential risks would strengthen the manuscript.

Line 117-121. Recruitment via social media introduces sampling bias toward digitally literate users. The author should acknowledge it.

Table 1. Self-reported COPD diagnosis with no verification weakens clinical validity.

Line 185. The authors should provide more detail on the rapid qualitative analysis process. At least explain how the interviews or feedback were analyzed. For example, “Rapid analysis was conducted using thematic grouping at each phase on areas for development informing the next workshop/interview”. Who did the coding, how do the author decide the themes, how many researchers were involved in this process, etc. Currently, this is relatively vague.

Line 227. Device type reported but details like frequency/length of experience is missing

Line 234. Researchers and respiratory charity group represents people from different background. Should consider present them separately.

Line 396. Here is another example of missing technical details. More evidence is needed to support the claim of “positive”. What analysis was done to show the positiveness?

Line 429. The author might consider discuss the potential risks such as the cognitive burden identified in the results section.

 

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Overall
1. Assessment of originality and relevance

While much existing research focuses on whether wearable devices can improve COPD outcomes (effectiveness), this study addresses a more practical gap: how patients and healthcare professionals can effectively utilise commercially available devices (implementation and education). The co-creation of guides not only for patients but also for healthcare professionals simultaneously represents a significant novelty.

2. Critique and Proposed Revisions (Robustness, Data, Bias)
    The process employing the ‘Three Co’s Framework (Codefine, Codesign, Corefine)’ is logical, maintaining the rigour expected of qualitative research. The conclusion refrains from asserting ‘effectiveness’, instead stating the guide is ‘relevant and acceptable’, demonstrating humility and scientific validity.

    The use of ‘rapid qualitative analysis’ carries the risk of shallower depth compared to in-depth phenomenological analysis. While acceptable given the resource development objective, justification for the analytical depth is required.

 ② Data Sufficiency (Substantiation)

The total number of participants across the entire process (N=21) is within acceptable limits for qualitative research.
The key issue is that only four COPD patients participated.
Compared to the 11 healthcare professionals (HCPs), the number of patients – who should be central – is far too low. As a study touting “co-creation”, there is a very high risk of being perceived as having a power imbalance heavily skewed towards the healthcare provider side. This is the primary weakness.

③ Attention to Bias

    As recruitment was primarily conducted via SNS (Twitter/X) and online channels, there is a high likelihood of bias towards “digitally literate individuals” or “those already positive towards technology”. The voices of digitally inexperienced elderly patients may not be adequately reflected.
    Given that the majority of participants are healthcare professionals, concerns remain that the content may be ‘medically accurate but overly formal for patients’ (while the results state ‘patient perspective was prioritised,’ a bias in the data composition persists).

Emphasising the methodological approach – ‘though a small group, their opinions were placed at the core of the design, with healthcare professionals' views positioned solely as supporting input’ – would enhance the paper's persuasiveness.

 

Author Response

Please see the attachment.

Author Response File: Author Response.pdf