The Development of the Relate-Know-Respond Model to Enhance Family-Centred Care

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

This manuscript presents a qualitative study that explores the perspectives of pediatric healthcare service providers and service users in order to inform the development of the "Know-Respond Model," a new service delivery framework designed to support Family-Centred Care (FCC) for disabled children and their families. The research is timely and relevant, addressing a well-recognized challenge in the operationalization and implementation of FCC principles across diverse service settings.

The authors employ a robust and well-justified interpretive paradigm, grounded in constructionist epistemology. The use of semi-structured interviews and focus groups is appropriate for the study aims and provides rich qualitative data. Thematic analysis is carried out using Braun and Clarke’s established framework, with a thoughtful reflexive approach evident throughout the research design and analysis. The sample includes a diverse range of participants across geographic regions, roles, and backgrounds, which strengthens the validity and transferability of the findings.

The paper is well-structured and clearly written. The introduction presents a strong rationale, and the literature review effectively contextualizes the need for a co-designed model to enhance FCC. The findings are presented in a coherent manner, and the themes are clearly derived from the data. The concept of "mutual knowingness" between families and providers is a particularly valuable contribution, offering fresh theoretical insight into relational dimensions of healthcare engagement.

The development and presentation of the Know-Respond Model is well executed, with useful visual figures and actionable clinical strategies. The inclusion of practical tools, resources, and checklists adds value for clinicians and policy makers alike. The clinical implications section is comprehensive and aligns well with the study findings.

While the manuscript is highly informative, it would benefit from some streamlining. Certain sections of the discussion, particularly those reiterating findings at length, could be condensed for clarity and conciseness. Tables, while detailed and useful, may be better placed in supplementary material if length constraints are a consideration.

The manuscript’s language is professional and accessible. Only minor editorial adjustments are recommended for improved flow. Despite being based in the New Zealand context, the findings are clearly applicable to an international audience, and the discussion effectively situates the study within global challenges in disability and pediatric healthcare.

Suggestions for Revision:

1 - Consider reducing repetition and streamlining parts of the discussion and results to improve readability.

2 - Evaluate the placement and length of tables; some material may be moved to supplementary files to reduce the main text's length.

3 – Correct some minor mistakes (e.g. in the reference to figure 3 the authors have a x – line 302).

4 - Quote Attribution: In the results section, clarify quote attribution by consistently referencing participant codes or descriptors (e.g. F1, A6, T3) How can we know which interview do you refer?

This is a valuable and original contribution to the field of disability research and pediatric service delivery. I recommend acceptance pending minor revisions aimed at improving conciseness and clarity.

Author Response

Thank you for your feedback. Please see the attached for our detailed response. 

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

This paper aimed to improve the quality of healthcare delivery to children with disabilities and their families by conducting a qualitative research study to understand the experiences of service users (children with disabilities, their family members) and service providers (advisors and therapists) in New Zealand -- experiences related to Family-Centred Care (FCC). While FCC is not a new concept in New Zealand or globally, the use of constructivist epistemology and relativist ontology to guide the study to focus on experiences that will lead to strategies to improve FCC and healthcare for children with disabilities and their families is unique. Although the sample size is small, the authors indicate they have used reflexivity throughout the study design and analysis. They acknowledge the limitation of including participants who are service providers who provided physical therapeutic service delivery to children (0-21 years) and the exclusion of healthcare providers from other disciplines (e.g., nurses, social workers, developmental pediatricians). This exclusion should be included in Table 1, the Exclusion column, and the Service Providers - Therapists row. That is, the interdisciplinary perspective is limited. What were the disciplines of the Service Providers - Advisors?    

There is redundancy between the Results and the Discussion that the authors could address. Table 4 includes content that is unique to New Zealand. This is understandable, yet could be broadened for readers outside of New Zealand. I recommend careful editing of the content in Table 4 to ensure a consistent writing structure. Clear connections between the Know-Respond Model and the content in Table 4 would be useful. The authors could provide a figure of the process they followed from data collection to data analysis to developing their "new service delivery model." 

The approach used by these authors could be replicated by focusing on professionals from other disciplines and institutions or agencies that include healthcare professionals from other disciplines. As noted above, the content related to FCC is not new. A core set of clinical strategies and actions could be identified that will be transdisciplinary or applicable across other disciplines, with unique strategies, actions, and tools identified for each discipline. 

Author Response

Thank you for your feedback. Please see the attached for our detailed response. 

Author Response File: Author Response.pdf