PLoS ONE plos plosone PLOS ONE 1932-6203 Public Library of Science San Francisco, CA USA 10.1371/journal.pone.0301886 PONE-D-23-30534 Study Protocol Medicine and health sciencesMental health and psychiatry Research and analysis methodsDatabase and informatics methodsDatabase searching Research and analysis methodsResearch assessmentSystematic reviews Medicine and health sciencesMental health and psychiatryMental health therapies Medicine and health sciencesMental health and psychiatryMood disordersDepression Research and analysis methodsResearch assessmentCitation analysis Engineering and technologyEquipmentCommunication equipmentCell phones Biology and life sciencesEcologyEcological metricsSpecies diversity Ecology and environmental sciencesEcologyEcological metricsSpecies diversity The role of sociodemographic factors on the acceptability of digital mental health care: A scoping review protocol Socio-demographics and acceptability of digital mental health care https://orcid.org/0009-0007-5071-9688 Abouzeid Nagi Conceptualization Investigation Project administration Visualization Writing – original draft 1 2 https://orcid.org/0000-0002-7501-5018 Lal Shalini Conceptualization Project administration Resources Supervision Writing – review & editing 1 2 3 * School of Rehabilitation, University of Montréal, Montréal, Québec, Canada Youth Mental Health and Technology Lab, University of Montréal Hospital Research Centre, Montréal, Québec, Canada Douglas Research Centre, Montréal, Québec, Canada Titi Maher Abdelraheim Editor King Saud University Medical City, SAUDI ARABIA

SL is an Associate Professor at the University of Montreal and leads a research program in the field of digital mental health. In the past 5 years SL has received research funding from the Canadian Institutes of Health Research, Canada Research Chairs program, Hoffman-La Roche, Foundation of Stars to advance this work. All of these are unrelated to this specific study. NA is a graduate student at the University of Montreal and is conducting this work towards partial fulfillment of requirements for a Masters of Science degree under the supervision of SL. This does not alter our adherence to PLOS ONE policies on sharing data and materials

 * E-mail: shalini.lal@umontreal.ca 26 4 2024 2024 19 4 e0301886 22 9 2023 22 3 2024 2024 Abouzeid, Lal This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Introduction

Many individuals experiencing mental health complications face barriers when attempting to access services. To bridge this care gap, digital mental health innovations (DMHI) have proven to be valuable additions to in-person care by enhancing access to care. An important aspect to consider when evaluating the utility of DMHI is perceived acceptability. However, it is unclear whether diverse sociodemographic groups differ in their degree of perceived acceptability of DMHI.

 Objective

This scoping review aims to synthesize evidence on the role of sociodemographic factors (e.g., age, gender) in the perceived acceptability of DMHI among individuals seeking mental health care.

 Methods

Guided by the JBI Manual of Evidence Synthesis, chapter on Scoping Review, a search strategy developed according to the PCC framework will be implemented in MEDLINE and then adapted to four electronic databases (i.e., CINAHL, MEDLINE, PsycINFO, and EMBASE). The study selection strategy will be piloted by two reviewers on subsets of 30 articles until agreement among reviewers reaches 90%, after which one reviewer will complete the remaining screening of titles and abstracts. The full-text screening, data extraction strategy, and charting tool will be completed by one reviewer and then validated by a second member of the team. Main findings will be presented using tables and figures.

 Expected contributions

This scoping review will examine the extent to which sociodemographic factors have been considered in the digital mental health literature. Also, the proposed review may help determine whether certain populations have been associated with a lower level of acceptability within the context of digital mental health care. This investigation aims to favor equitable access to DMHI among diverse populations.

 The authors received no specific funding for this work. Data Availability No datasets were generated or analysed during the current study. All relevant data from this study will be made available upon study completion. Introduction

Many living with mental health complications face barriers when attempting to access mental health services (e.g., limited availability of services, costs) [1]. To bridge the existing treatment gap, digital mental health innovations (DMHI) have proven to be valuable additions to standard treatment due to their ability to enhance access to care for those living with precarious mental health conditions (e.g., anxiety, depression) [2–7]. DMHI are digital health technologies used to assess, prevent, or treat mental health difficulties [8]. An important aspect to consider when evaluating the utility of DMHI is perceived acceptability. Acceptability broadly refers to the way individuals perceive, and experience a given digital innovation; it is also a significant predictor of an intervention’s effectiveness [9].

Over the past decade, reviews of the literature, including systematic reviews, have been conducted to synthesize the available evidence on acceptability in the context of digital health care [10–16]. However, these reviews focused on specific populations (e.g., adults with depression and college students) [10–12,14,16], included interventions beyond those relating to mental health (e.g., sexual health) [14], and did not report on associations between sociodemographic characteristics and perceived acceptability [10–15].

As demonstrated, there have been limited efforts to systematically investigate the role of sociodemographic characteristics on the perceived acceptability of DMHI among diverse populations. Specifically, it is unclear whether there are any discernible trends of lower or higher levels of perceived acceptability among various sociodemographic groups within the context of digital mental health care. Such a synthesis is important, considering the impact of perceived acceptability in sustaining user engagement [9]. Research has shown that a greater level of engagement with DMHI is significantly associated with improved mental health outcomes [17]. Therefore, to enhance user engagement and maximize therapeutic outcomes, it is important to gain a deeper understanding of acceptability and its associated factors within the context of digital mental health care.

The proposed scoping review (registered in OSF: osf.io/dvr53) intends to synthesize research that reports on associations between sociodemographic characteristics and the perceived acceptability of DMHI. In the context of this review, the term “association” extends beyond its statistical sense and refers to the presence of qualitative patterns of association between specific sociodemographic groups, and their perceived acceptability of DMHI. This review will help to determine whether a more systematic investigation on the topic, such as a meta-analysis, is needed. Moreover, we may find that certain sociodemographic characteristics have been inadequately accounted for in the development and delivery of DMHI. This undertaking is aligned with a broader objective aiming to ensure underserved populations have access to DMHI that they perceive as acceptable.

Numerous factors informed the decision to opt for a scoping review as opposed to another type of review. First, a scoping review can be used to investigate broad topics of inquiry without requiring a quality assessment of the studies that are discussed [18]. In contrast, a systematic review will generally seek to answer a more specific research question and will require an assessment of the methodological rigor of the studies included [18]. Considering these differences, a scoping review is a more suitable option due to the broad scope of the proposed investigation. Moreover, it is difficult to evaluate the feasibility of conducting a full systematic review without first conducting a preliminary mapping of the literature that would help justify such an undertaking.

Objective and review questions

The primary objective of the proposed review is to synthesize evidence on the role of sociodemographic characteristics on the degree of perceived acceptability of DMHI. The research questions listed below have been informed by the primary objective of the proposed scoping review as well as the population, concept, and context (PCC) framework proposed by the Joanna Briggs Institute (JBI) manual of Evidence Synthesis [19]:

What are the different sociodemographic factors that have been considered in the evaluation of perceived acceptability of DMHI?

Which sociodemographic factors have been positively, negatively, or not associated with the perceived acceptability of DMHI?

Which DMHI have been positively, negatively, or not associated with perceived acceptability among specific sociodemographic groups? (Please see the Study Selection and Extraction section below for more details on how the various DMHI will be categorized)

 Eligibility criteria

The PCC framework proposed by the Joanna Briggs Institute (JBI) manual of Evidence Synthesis [19] will inform the inclusion and exclusion criteria (Table 1) of the proposed scoping review.

10.1371/journal.pone.0301886.t001 Inclusion and exclusion criteria.
Inclusion Criteria
• Human participants receiving digital mental health care.• Reports on the age, gender, sexual orientation, race, education level, or health status of participants.• Relative acceptability among subgroups is reported, absolute acceptability per subgroup is reported, or the study sample is homogeneous for at least one sociodemographic factor of interest.• The study reports on the perceived acceptability, utility, or ease of use of digital mental health innovations.• Acceptability is evaluated retrospectively.• Acceptability is evaluated through quantitative methods.• Mental health care is partly or completely delivered through technology.• Digital innovations that primarily aim to enhance psychological, emotional, or social well-being.• Articles written in French or English• Articles published between January 2013 and June 2023• Primary Sources
Exclusion Criteria
• Clinicians and/or researchers evaluating the acceptability of digital mental health care.• Acceptability is measured using objective measures (e.g., adherence, use).• Qualitative studies
Population

The proposed scoping review will include studies conducted with human participants. To be considered for inclusion, participants must receive mental health care through the use of DMHI. The proposed scoping review will consider six different sociodemographic dimensions: age (e.g., youth, adult, and elderly), race (e.g., Arabic, Asian, and White), gender identity (e.g., male, female, and genderfluid), sexual orientation (e.g., heterosexual, homosexual, and bisexual), highest level of education completed (e.g., primary school, high school, and bachelor’s degree), and health status (e.g., depression, schizophrenia).

Moreover, for studies to be considered eligible, they must either report on the relative acceptability among participants (e.g., women demonstrating a higher level of acceptability compared to men) or the absolute acceptability (e.g., women rating the innovation with a 4 out of 5 in terms of perceived acceptability). Regarding absolute acceptability, we will consider studies as eligible if the perceived acceptability of subgroups within the larger sample is reported or if the study sample is homogeneous for at least one of the sociodemographic factors of interest.

 Concept

In this scoping review, the concept of interest is acceptability, a multidimensional notion with various definitions [20]. Acceptability is broadly defined as the way individuals perceive and experience a given digital health innovation [9]. More specifically, two important factors contributing to the perceived acceptability of a given technology are perceived usefulness and ease of use [21]. To be considered for inclusion in the proposed review, the studies must focus on examining the perceived acceptability (as defined by the author(s) of the studies being reviewed), utility, or ease of use of DMHI. Moreover, to be considered for inclusion in the proposed review, acceptability must be evaluated retrospectively. Therefore, studies that evaluate the prospective acceptability of DMHI will not be included in the proposed review. For instance, studies that assess the acceptability of a digital technology among potential users, who have not yet engaged with the innovation, will be excluded from the proposed review. In addition, to be considered for inclusion, acceptability must be evaluated through quantitative methods (e.g., questionnaires and scales), these may or may not have been validated. Studies that examine the perceived acceptability of users entirely through qualitative methods (e.g., focus group discussions, open-ended questions) will not be considered for inclusion in the proposed review.

Moreover, the concept of acceptability is person-centered. Therefore, any studies that define or assess acceptability without considering the perspective of the user will be excluded from the proposed review. For instance, any study that examines the theoretical utility of a technology from the perspective of clinicians as opposed to the perceived utility of a technology from the perspective of users will be excluded from the proposed review. The purpose of these eligibility criteria is to establish clear boundaries for the broad concept of acceptability and to ensure a consistent conceptualization across the included studies. Furthermore, the definition of acceptability, as proposed in each of the included studies, will be reported to ensure that readers have a clear understanding of the concept presented.

 Context

In this scoping review, the focus will be on DMHI delivered in both clinical settings (e.g., hospitals) and non-clinical settings (e.g., community). DMHI refer to the use of technology in the assessment, prevention, and treatment of mental health difficulties [8]. To be considered for inclusion, the mental health intervention must be delivered digitally, such as through a computer, smartphone, or wearable device. There will be no studies excluded based on the specific digital care medium used to deliver the mental health intervention. Some examples of DMHI include, but are not limited to, internet-based cognitive behavioral therapy, chatbots for mental health support, smartphone applications that support ecological momentary assessment, web-based psychotherapeutic platforms, psychosocial assessments through video conferencing solutions, and exposure therapy assisted by virtual reality [22–24].

Interventions delivered in a blended format (i.e., involving in-person and digital components) will only be considered for inclusion if the acceptability of the digital component is assessed independently. For example, studies will not be considered for inclusion if they report a global acceptability score for an intervention comprised of three in-person therapy sessions and two online therapy sessions. However, studies that report on the acceptability of the digital component (i.e., online sessions) independently will be considered for inclusion.

To delimit the broader concept of mental health, interventions that primarily aim to enhance the psychological (e.g., cognitive biases), social (e.g., isolation), and emotional (e.g., sadness) well-being of an individual will be considered for inclusion. Moreover, interventions that target sleep difficulties within mental health populations will be considered for inclusion.

The proposed review will not include DMHI that address both mental health and physical health (e.g., exercise, nutrition), sexual health (e.g., HIV prevention), cognition (e.g., attention, memory), or pain management where the primary objective is not focused on optimizing mental health. For instance, a digital intervention that aims to reduce rumination while promoting physical activity to reduce the risk of cardiovascular diseases would not be included in the proposed review. If this review were to include interventions with an emphasis on health targets beyond those related to mental health, it would be difficult to determine whether the role of sociodemographic factors is associated with mental health care, physical health care, or both. Moreover, digital interventions that aim to improve medication adherence (e.g., SSRI, SNRI) to enhance mental health outcomes will be considered for inclusion. However, digital interventions that aim to improve medication adherence to enhance physical health outcomes (e.g., HIV, diabetes) would not be considered for inclusion.

Any study that does not satisfy the aforementioned eligibility criteria will be excluded from the proposed scoping review.

 Types of sources of evidence

Moreover, there are other notable eligibility criteria unrelated to the PCC framework. First, only materials available in French and English will be included in the proposed scoping review. Second, to ensure the recency and relevance of the synthesized materials, only materials disseminated between January 2013 and June 2023 will be included in the proposed review; this will help ensure that the findings reported are relevant to the present societal context. Any secondary sources (e.g., meta-analysis and systematic reviews), study protocols, commentary or opinion letters, or non peer-reviewed materials will be excluded from the proposed review. Studies with a purely qualitative design will also be excluded from the proposed review. Any study that does not satisfy the aforementioned eligibility criteria will be excluded from the proposed review.

 Methodology

The proposed scoping review will be guided by the recommended methodology put forth in the JBI Manual of Evidence Synthesis [19] and the PRISMA-P checklist (S2 File) (http://www.prisma-statement.org/Extensions/Protocols.aspx).

Sources of evidence

The information sources that will be used to identify materials pertinent to the proposed review have been selected to ensure the review is as extensive and comprehensive as reasonably possible on the topic of inquiry. Four electronic databases will be examined using distinct search strategies (i.e., PsycInfo through Ovid, MEDLINE through Ovid, CINAHL through EBSCO, and Embase through Ovid). Moreover, the reference list of secondary sources identified as relevant to the topic of inquiry will be examined.

 Search strategy

Initially, A1 developed the concept plan for the search strategy in consultation with A2. A search strategy was then developed by A1 and later refined in collaboration with A2 and an experienced librarian at the University of Montreal. As a first step in the development of the search strategy, a preliminary search of MEDLINE and CINAHL was conducted. These databases were selected due to their extensive assortment of literature on health research. This was then followed by the selection of keywords identified in the abstracts and titles of retrieved papers along with indexed terms used to categorize the publications. The keywords and index terms were considered to inform the development of a complete search strategy for MEDLINE (S1 File).

The search strategy incorporates three topics of interest, which are acceptability, digital technology, and mental health. For acceptability, one indexed keyword heading (i.e., Patient acceptance of healthcare) (line 1) was searched along with three sets of search terms (line 2, 3 and 4) relating to acceptability (e.g., client acceptance, perceived utility). The indexed keyword and the first three sets of listed terms were then linked with the Boolean operator “OR” (line 5).

For the topic of digital technology, 10 indexed keyword headings (e.g., Internet-based interventions, mobile applications) were searched (lines 6,7,8, 9,10,11, and 12) along with one set of search terms incorporating many concepts related to digital technology (e.g., digital, bots) (line 13). This set of search terms was complemented by a list of keywords proposed by Lal et al. [23] in a systematic review pertaining to the priority afforded to technology in government-based mental health strategy documents. The indexed keyword headings relating to digital technology along with the related set of search terms were then linked with the Boolean operator “OR” (line 14).

For the topic of mental health, four indexed keyword headings were searched (e.g., mental health, mental disorders) (lines 15,16,17, and 18) along with five sets of search terms relating to mental health (e.g., low mood, mania, bereavement) (Line 19,20,21,22, and 23). These initial sets of search terms were bonified by the mental health disorders listed in the ICD-11 [25] and DSM-V [26] along with their associated symptoms. The indexed keyword headings relating to mental health along with the sets of related search terms were then linked with the Boolean operator “OR” (line 24). Lines 5, 14, and 24 were then combined using the Boolean operator “AND” to identify relevant citations that will be considered for inclusion in the proposed scoping review. The search was then further limited by year of publication (i.e., 2013 to current) and language (i.e., French and English). With the guidance of an experienced librarian, A1 will adapt and implement the MEDLINE search strategy to three other electronic databases (i.e., PsycINFO, CINAHL, and Embase).

 Study selection and extraction

The inclusion and exclusion criteria outlined above have been established to guide the selection of studies that are concordant with the primary objective of the proposed scoping review. The citations obtained from the literature search will be imported into Covidence, a software used to assist in evidence synthesis. Covidence has the ability to extract citations, remove duplicates, and allows for a multiphase review of citations by up to two reviewers [27].

First, as proposed in the JBI Manual of Evidence Synthesis [19], the study selection strategy for titles and abstracts will be piloted on a random subset of citations to ensure that reviewers have an adequate understanding of the eligibility criteria and selection process. The screening process will be guided by the eligibility criteria of the proposed review. To begin, a subset of 30 citations will be selected from the pool of obtained studies. These articles will then be screened independently by two reviewers. Once completed, the reviewers will discuss any discrepancies in the perceived eligibility of studies to determine if the eligibility criteria require any further clarifications. This process will be repeated until the eligibility agreement between reviewers reaches 90%. Once achieved, the complete screening of citations by A1 will begin. The citations that do not contain sufficient information in the titles and abstracts to assess eligibility or those that are deemed eligible will then undergo full-text screening.

Once the screening of titles and abstracts is completed, a three-step process will be used to determine which studies will be included in the proposed scoping review. First, the full-text screening strategy will be piloted on 15 citations selected from the pool of obtained studies. These articles will then be screened independently by two reviewers. Once completed, the reviewers will discuss any discrepancies in the perceived eligibility of studies to determine if the eligibility criteria require any further clarifications. This process will be repeated until the eligibility agreement between reviewers reaches 90%. Once achieved, the complete screening of full-text citations by A1 will begin. A second reviewer will then validate all the studies deemed eligible by A1. If discrepancies arise in the process of eligibility assessment, A1 will meet with the second reviewer to reach a final consensus. If a consensus cannot be reached, a third reviewer will be consulted.

Once eligible articles have been selected, the process of data extraction and charting will begin. To facilitate the process of extracting data and ensure its validity, a legend will be developed. This legend will clearly identify and describe the information that should be included in each category of the charting tool. The categories and their corresponding data will be organized in an Excel sheet. As a first step, we will consider data categories listed in the JBI Manual of Evidence Synthesis [19]. These include basic descriptive information found within citations (i.e., title, Digital Object Identifier (DOI), author(s), and year of publication), as well as the country of origin, sample size, study design, study objective(s), and key outcomes. Key outcomes will be identified based on their degree of responsiveness to the research questions put forth by the proposed scoping review.

Furthermore, these categories will be further complemented by data relating to the PCC framework and research questions of the proposed review. Considering the population component of the PCC framework, we will extract data relating to the study sample, including their health status (e.g., diagnosed with a major depressive disorder) and reported sociodemographic characteristics (e.g., age, gender, race, sexual orientation). In relation to the concept component of the PCC framework, the conceptualization of acceptability (e.g., perceived ease of use) put forth in the articles along with the method(s) used to evaluate acceptability (e.g., self-report questionnaire) will be extracted. Lastly, considering the context component of the PCC framework, we will extract information on the type of DMHI evaluated (e.g., ICBT), the purpose of the innovation (e.g., assessment), its mental health target (e.g., anxiety), and the technology used (e.g., smartphone).

The data charting tool that will be used is subject to an Iterative process. As data are extracted, additional categories may emerge that warrant inclusion in the charting tool. As recommended in the JBI Manual of Evidence Synthesis [19], the data charting tool will be piloted by extracting data from 15 studies. This process will help ensure that the data charting tool is comprehensive and easy to use. Two independent reviewers will be involved in the pilot data extraction process. Any discrepancies that may arise during the data extraction or categorization process will be discussed by two reviewers to reach a final consensus. If consensus cannot be reached, a third reviewer will be consulted to examine and resolve any identified discrepancies. Once completed and sufficient concordance among extracted data has been achieved, A1 will begin the data extraction process for the complete list of eligible citations. The extracted data will then be validated by a second reviewer.

 Data synthesis and presentation

First, a table will be used to represent the various DMHI that have had their acceptability evaluated through a consideration of sociodemographic characteristics. This table will include data on the various types of DMHI (e.g., ICBT), their mental health targets (e.g., anxiety), their purpose (e.g., assessment), and the technology used (e.g., smartphone). Secondly, a table will be presented to illustrate the different sociodemographic characteristics that have been considered in the evaluation of acceptability of DMHI. The extracted data will be summarized and presented using descriptive statistics (e.g., frequency and percentages).

Finally, key findings on the role of sociodemographic characteristics on the perceived acceptability of DMHI will be presented in tables, including information on whether the association is positive (i.e., high perceived acceptability), neutral (i.e., no association) or negative (i.e., low perceived acceptability). These findings will be categorized based on the technology examined (e.g., smartphone app), sociodemographic factor(s) of interest (e.g., age), and whether they are relative (e.g., men demonstrated a higher level of perceived acceptability than women for this technology) or absolute (e.g., men demonstrate a high level of perceived acceptability for this technology).

For absolute acceptability, the cut-off scores reported in the literature for the various measures used to measure acceptability across studies will be used to indicate whether the reported scores represent high or low acceptability. If such scores are not available, the acceptability scores that have been evaluated using the same measures across studies will be contrasted. For studies that utilized ad-hoc measures to examine the perceived acceptability of users, the author’s interpretation of these scores will be reported in the proposed review. The approach used to interpret the various scores will be finalized depending on how acceptability is being measured across the included studies.

Furthermore, as the data extraction strategy is piloted, additional findings may be reported based on their relevance to the inquiries put forth in the proposed scoping review. Moreover, throughout the screening and extraction processes, notable patterns may emerge across studies, which may not have been specified in this protocol. These may include methodological limitations (e.g., many studies did not report on the socio-demographics of study dropouts), the overrepresentation of specific digital mental health innovations (e.g., virtual reality), or their mental health targets (e.g., depressive symptoms).

Moreover, depending on the volume of findings uncovered (i.e., over 100 studies included), it may be necessary to use additional forms of visual representation, such as graphs and Venn diagrams. These may be used to provide readers with a complementary depiction of findings to facilitate greater comprehension.

 Limitations

To the authors’ knowledge, the proposed scoping review will be the first of its kind to synthesize and report on the associations between various sociodemographic characteristics and the perceived acceptability of DMHI. However, such an undertaking is not without limitations.

First, this review will not evaluate the methodological rigor of the included studies. Such an undertaking would help determine the quality of the evidence on the role of sociodemographic characteristics on the acceptability of DMHI. These findings may then potentially be used to demonstrate the necessity for culturally adapted DMHI and guide their future development. To alleviate the impact of this limitation, the study design (e.g., randomized controlled trial, case study) of the included citations will be reported.

Second, considering the diversity of terminology employed in the field of digital mental health care [28], it is possible that the proposed search strategy does not capture all studies that warrant inclusion in the proposed scoping review. To address this limitation, A1 and A2 collaborated with an experienced librarian to develop a search strategy that will be adapted and implemented in four electronic databases. The search strategy was also supplemented with search terms put forth in a systematic review by Lal et al. [23]. However, given the rapid evolution of technological advancements, eligible studies may still go undetected and hence not be included in the proposed scoping review. Moreover, the decision to omit related terms such as “satisfaction” and “preference” from the search strategy, while helping with feasibility and limiting the scope of this review to the specific concept of acceptability, also stands as a potential limitation of the proposed review.

Third, after conducting pilot testing of the screening strategy, only one reviewer will be responsible for assessing the eligibility of abstracts. However, mitigation strategies have been implemented to minimize the impact of this limitation. For instance, at the stage of full-text screening, a second reviewer will validate all the studies deemed eligible by A1.

Finally, based on the volume of results obtained through a preliminary screening of the literature, non peer-reviewed materials (e.g., Theses) will not be considered for inclusion in the proposed review.

 Conclusion

Despite its limitations, the proposed scoping review will aim to map the available scientific evidence pointing to associations between sociodemographic characteristics and perceived acceptability of DMHI. These findings will allow us to determine the extent to which sociodemographic characteristics are being considered in the digital mental health literature along with their reported associations with perceived acceptability. Specifically, the proposed review will enable us to determine whether certain sociodemographic groups have frequently been linked with lower perceived acceptability of DMHI. This investigation represents a first step to ensure that diverse populations can access and engage with DMHI that they perceive as acceptable.

Moreover, the proposed scoping review will provide insights for future research on ways to assess and report on the role of sociodemographic characteristics when evaluating the perceived acceptability of DMHI. This synthesis of knowledge can also serve as a justification and provide guidance for conducting a systematic review and meta-analysis on the topic of inquiry, within which the methodological rigor of included studies will be examined. The findings from this type of review may serve as evidence to guide the development and delivery of culturally tailored DMHI.

 Supporting information Detailed search strategy for MEDLINE.

(DOCX)

 PRISMA-P checklist.

(DOCX)

The authors would like to acknowledge and thank Sarah Cherrier, a librarian at the University of Montreal, for her assistance and support in the development and implementation of the search strategy presented in this protocol.

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The technology acceptance model: its past and its future in health care. J biomed inform. 2010 Feb 1;43(1):159–72. doi: 10.1016/j.jbi.2009.07.002 19615467 Baños RM, Herrero R, Vara MD. What is the current and future status of digital mental health interventions?. Span j psychol. 2022;25:e5. doi: 10.1017/SJP.2022.2 35105398 Lal S, Siafa L, Lee H, Adair CE. Priority given to technology in government-based mental health and addictions vision and strategy documents: systematic policy review. J med internet res. 2021 May 5;23(5):e25547. doi: 10.2196/25547 33949955 Lal S. E-mental health: promising advancements in policy, research, and practice. Healthc manage forum. 2019 Mar;32(2):56–62. 23. doi: 10.1177/0840470418818583 30739487 World Health Organization (WHO). International Statistical Classification of Diseases and Related Health Problems, 11th Edition. WHO; 2019. Available from: https://icd.who.int. American Psychiatric Association (APA). Diagnostic and statistical manual of mental Disorders, 5th Edition. Arlington, VA: APA Publishing; 2013. Kellermeyer L, Harnke B, Knight S. Covidence and rayyan. J med libr assoc. 2018 Oct;106(4):580. Smoktunowicz E, Barak A, Andersson G, Banos RM, Berger T, Botella C, et al. Consensus statement on the problem of terminology in psychological interventions using the internet or digital components. Internet interv. 2020 Sep 1;21:100331. doi: 10.1016/j.invent.2020.100331 32577404 10.1371/journal.pone.0301886.r001 Decision Letter 0 Titi Maher Abdelraheim Academic Editor 2024 Maher Abdelraheim Titi This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Submission Version 0

10 Nov 2023

PONE-D-23-30534The role of sociodemographic factors on the acceptability of digital mental health care:

A scoping review protocolPLOS ONE

Dear Dr. Lal,

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SL is an Associate Professor at the University of Montreal and leads a research program in the field of digital mental health. In the past 5 years SL has received research funding from the Canadian Institutes of Health Research, Canada Research Chairs program, Hoffman-La Roche, Foundation of Stars to advance this work. All of these are unrelated to this specific study. 

NA is a graduate student at the University of Montreal and is conducting this work towards partial fulfillment of requirements for a Masters of Science degree under the supervision of SL.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions?

The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field.

Reviewer #1: Yes

Reviewer #2: Partly

Reviewer #3: Yes

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2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses?

The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory.

Reviewer #1: Yes

Reviewer #2: Partly

Reviewer #3: Yes

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3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable?

Descriptions of methods and materials in the protocol should be reported in sufficient detail for another researcher to reproduce all experiments and analyses. The protocol should describe the appropriate controls, sample size calculations, and replication needed to ensure that the data are robust and reproducible.

Reviewer #1: Yes

Reviewer #2: No

Reviewer #3: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics.

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(Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: **Summary**

This paper proposes a protocol for a scoping review that synthesizes findings across the literature related to socio-demographic variables that impact acceptability of digital mental health innovations (DMHIs).

The manuscript proposes a worthwhile review and is overall straightforward to read. I also appreciate the transparent and extensive description of the proposed search strategy! I have a number of comments regarding details that could benefit from clarification, which I have listed below.

**Comments**

1. Digital mental health innovations is abbreviated to DMHIs in the abstract but nowhere else in the paper.

2. The terms digital mental health innovations, digital mental health care and digital mental health interventions are used interchangeably. Do these refer to the same or different things?

3. Based on the introduction of the paper, it seems that the main research question is to identify what sociodemographic factors affect perceived acceptability. However, I don’t see this listed as a research question.

4. A broad definition of acceptability is included in the Introduction. Will any study considering acceptability be included, no matter how they measured/defined acceptability? For example, there are validated survey scales assessing acceptability, but acceptability can also be studied in a more qualitative way through interviews.

5. Are there any restrictions on study method or will any study considering acceptability (e.g. both quantitative and qualitative studies) be considered?

6. L50: can the authors give any examples of existing barriers to access mental health services?

7. L59-78 is a bit repetitive describing one review at a time. It may improve flow to succinctly summarize what other reviews have done, what they have not done, and how this review will bridge that gap.

8. L113: can you be more specific than ‘which digital mental health innovations’? How are you going to describe and/or categorize them? By type of platform (e.g. website, app), type of mental health symptoms it intends to address (e.g. anxiety, depression), type of population it focuses on, type of care it offers, etc.

9. Can the authors clarify the inclusion criterion that 90% or more of the study sample needs to represent a specific sociodemographic group? If 60% of study participants identify as men, but the study showed that male participants rated digital mental health interventions significantly higher on acceptability than other gender identities, would this study not be relevant to the review?

10. It would help with readability to include an overview of all inclusion and exclusion criteria in a bullet-point list or table.

11. L215-216: how will the grey literature be used? Will theses and dissertations be included in the review as articles, or will the reference lists of theses be used to identify other peer-reviewed studies?

12. L329: how are absolute findings evaluated? E.g. for the example that is given, ‘men demonstrated a high level of perceived acceptability’ => this may vary across the articles you are including in your review, but how is ‘high’ determined? Are there validated cut-off scores that determine whether something has a high score of acceptability? This goes back to my earlier comment whether only a quantitative measure of acceptability will be considered or if other assessments of acceptability will be included in the review as well.

13. L343: it is mentioned that the review will not evaluate the methodological rigor of the included studies. However, will some kind of other, less rigorous, quality assessment be carried out to screen articles?

Reviewer #2: General comments

=============

I read with interest your scoping review protocol on the role of sociodemographic factors on the acceptability of digital mental health care. This review will add an important contribution to the eMental health field. Below are some suggestions to improve the clarity, and add to the quality, of this proposal. I wish you all the best with your work!

Major inquiries

=============

1. It is unclear to me how research question 1 (page 5, line 113) directly addresses your objective on what is the role of sociodemographics in the degree of perceived acceptability of DMHI (lines 107-108). Can you please clarify?

Of note, while you should describe the sample of studies of DMHI included in the review, that does not mean this summary should form a research question. (Also, if you answer question 3, you will be indicating which interventions have been evaluated through a sociodemographic lens.)

2. Research question 3 (page 6, lines 117-118) does not include the neutral category that you outline in the Data Synthesis section (page 15, line 326). If your objective is focused on the degree of perceived acceptability, it seems that ‘neutral’ would be important to acknowledge as part of the spectrum?

3. Determining study inclusion necessitates a detailed evaluation—1) determining the report of relative or absolute acceptability, and if absolute acceptability is reported, the need to determine if at least 90% of the sample represents a specific sociodemographic group; and 2) determining if acceptability is assessed independently in the case of blended interventions. Given these requirements for inclusion, it is important to include details on the screening strategy (tasks/steps; page 12) and any instructions/parameters for determining these criteria (e.g., Which values are used for calculating the proportion of the study sample? How to determine an independent acceptability assessment – Can multivariable modelling results be used? Does the acceptability finding need to be reported on its own?). The inclusion of these details will further operationalize the review and promote transparency and replicability.

4. Page 15, line 332: It is stated that additional findings may be reported based on the identification of patterns. What analytic approach will be used to identify patterns?

5. Page 15, line 334: You note that it may be necessary to use visual representation if the findings are complex. Can you describe more details regarding ‘complexity’ to promote transparency and replicability? In particular, how are you defining complexity, and what is the process that will be used to determine complexity?

6. I am curious to know more about your approach to defining high acceptability (report in a study of a positive association) (page 15, line 326). Typically, general interpretation of measures of association follows this guide: weak (0.01-0.09), moderate (0.10-0.29), strong (0.30-0.59), very strong (0.60-0.99). Based on your definition, in your review, it reads that you will report a weak, positive association as reflecting high acceptability. Can you share your thoughts on whether or not you think your interpretation of any positive association as ‘high acceptability’ could be misleading, and why/why not?

7. In its present state, the conclusion serves as a detailed account of the strengths and limitations of the review. These should be stated in its own section. The conclusion should serve as a brief summary. Revisions are necessary.

Minor inquiries and comments

=============

1. I understand that you are interested in synthesizing studies of associations between sociodemographics and perceived acceptability. As this is a scoping review, would you consider adding another objective to slightly broaden the focus? In addition to reviewing studies that examined associations, would you also consider reviewing all studies that included examining perceived acceptability of a DMHI. I believe these studies would be included in the search strategy. For this group of studies, you could review the participant characteristics across studies to explore the diversity from which acceptability findings are based on. While this addition broadens the review, it would add value as you could comment on the diversity of study samples and what is needed moving forward in terms of EDI in the DMHI research field.

2. In the introduction, the second paragraph is repetitive in structure: sentence introducing a prior review followed by a sentence starting with ‘however’. This paragraph requires revision to improve reader engagement.

3. On page 5 in the statement of the primary objective, you can remove the examples in brackets “(e.g., age, ethnicity, gender)”. Objectives do not need parenthesized examples as operational details should be described in the methods. This is what you have done on the following page under Population.

4. Page 10, line 213: “Only materials published between January 2013 and June 2023 will be considered.” This is already stated on the previous page (page 9; line 199). Similarly, the content on page 10, line 214 is also duplicative “Moreover, the reference list of secondary sources, identified as relevant to the topic of inquiry, will be examined.” See page 9, lines 202 and 203.

5. Page 14, line 303 should be “As data are extracted” (plural); line 315 should be “The extracted data will be” as extraction is a descriptive word in this sentence.

6. Page 14, line 315. I suggest integrating this sentence where it is relevant as it is not a stand-alone paragraph. (I suspect you can move it to the paragraph starting on line 324, re: summary of the key findings on the role of sociodemographics?)

Reviewer #3: An appropriate and timely protocol proposing to synthesise data on the experience, specifically the acceptability, of taking part in digital health interventions, amongst persons who have taken part in such interventions focused on mental health outcomes. Acceptability as a concept is clearly operationalised. The literature search and analysis approach seem appropriate and the inclusion and focus on demographic sub-group analysis is very important and will ensure the results are meaningful and again there are clear criteria for inclusion or exclusion of studies based on the way the demographic data are presented. Overall, this is a well-written and competently described review protocol. One minor comment - the focus in the opening line on Canada is not necessary or appropriate for an international journal.

**********

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Reviewer #1: Yes: Judith Borghouts

Reviewer #2: No

Reviewer #3: Yes: Prof. Brian McGuire

**********

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 10.1371/journal.pone.0301886.r002 Author response to Decision Letter 0 Submission Version 1

24 Jan 2024

Below are the comments we have received from the reviewers and our responses

Reviewer 1 Comments:

1. Digital mental health innovations is abbreviated to DMHIs in the abstract but nowhere else in the paper

Our response: We made revisions to ensure the abbreviation is used throughout the manuscript.

2. The terms digital mental health innovations, digital mental health care and digital mental health interventions are used interchangeably. Do these refer to the same or different things?

Our response: We used all of these terms interchangeably, however, for greater clarity, we decided to use digital mental health innovations more consistently throughout the manuscript, and we have used digital mental health care only a few times in cases where we felt that it allowed for better flow.

3. Can the authors give any examples of existing barriers to access mental health services?

Our response: We have provided examples of barriers to access to mental health services (e.g., limited availability of services).

4. L59-78 is a bit repetitive describing one review at a time. It may improve flow to succinctly summarize what other reviews have done, what they have not done, and how this review will bridge that gap

Our response: We have revised this section to be more succinct.

5. Based on the introduction, it seems that the main research question is to identify what sociodemographic factors affect perceived acceptability. However, I don’t see this listed as a research question.

Our response: We have added the following question “Which sociodemographic factors have been positively, negatively, or not associated with the perceived acceptability of DMHI?”

6. L113: can you be more specific than ‘which digital mental health innovations’? How are you going to describe and/or categorize them? By type of platform (e.g. website, app), type of mental health symptoms it intends to address (e.g. anxiety, depression), type of population it focuses on, type of care it offers, etc.

Our response: We have provided more information on how the different innovations will be described. Specifically, we have added the following statement “Please see the Study Selection and Extraction section below for more details on how the various DMHI will be categorized”.

7. A broad definition of acceptability is included in the Introduction. Will any study considering acceptability be included, no matter how they measured/defined acceptability? For example, there are validated survey scales assessing acceptability, but acceptability can also be studied in a more qualitative way through interviews.

Our response: We have clarified as part of the eligibility criteria that acceptability will need to be evaluated through quantitative methods.

8. Are there any restrictions on study method or will any study considering acceptability (e.g. both quantitative and qualitative studies) be considered?

Our response: Studies using a qualitative design will be excluded (This has been clarified in the manuscript). We will only consider studies with a quantitative or mixed-methods design (for the quantitative component of those studies).

9. Can the authors clarify the inclusion criterion that 90% or more of the study sample needs to represent a specific sociodemographic group? If 60% of study participants identify as men, but the study showed that male participants rated digital mental health interventions significantly higher on acceptability than other gender identities, would this study not be relevant to the review?

Our response: Yes, these results would be pertinent for the proposed review. We have modified the eligibility criteria in our manuscript. We will only consider studies in which relative acceptability is reported (e.g., Men have higher perceived acceptability than women), the absolute acceptability of a specific group in comparison to another is reported (e.g., The mean acceptability score of men is 4 and the mean acceptability score of women is 3.5) or in which the study sample is homogeneous for at least one sociodemographic factor of interest (e.g., every study participant identifies as a woman).

10. It would help with readability to include an overview of all inclusion and exclusion criteria in a bullet-point list or table.

Our response: The inclusion and exclusion criteria of the proposed review will be added as a table in the revised manuscript.

11. How will the grey literature be used? Will theses and dissertations be included in the review as articles, or will the reference lists of theses be used to identify other peer-reviewed studies?

Our response: As part of our revisions, we have established, based on a preliminary scanning of the literature, that we will not consider non-peer-reviewed studies for inclusion, including theses and dissertations. However, the reference list of peer-reviewed secondary sources will be examined to identify articles that may be eligible for inclusion in the proposed review.

12. *L329: how are absolute findings evaluated? E.g. for the example that is given, ‘men demonstrated a high level of perceived acceptability’ => this may vary across the articles you are including in your review. How is ‘high’ determined? Are there validated cut-off scores that determine whether something has a high score of acceptability?

Our response: We have clarified in the manuscript that we will finalize our approach depending on the way acceptability is measured across included studies. However, as of now, we have added the following clarification: “For absolute acceptability, the cut-off scores reported in the literature for the various measures used to measure acceptability across studies will be used to indicate whether the reported scores represent high or low acceptability. If such scores are not available, the acceptability scores that have been evaluated using the same measures across studies will be compared. For studies that utilized non-standardized measures to examine the perceived acceptability of users, the interpretation of these scores documented in the studies will be reported in the proposed review.”

13. L343: it is mentioned that the review will not evaluate the methodological rigor of the included studies. However, will some kind of other, less rigorous, quality assessment be carried out to screen articles?

Our response: At the moment, we are not planning on conducting a quality assessment of included articles. However, we will report on the methodological design of each article that is included in the proposed review (e.g., RCT, Case study) to help readers in their interpretation of the results. Quality assessments are typically not required in scoping review methodology.

Reviewer 2 Comments

1. Page 10, line 213: “Only materials published between January 2013 and June 2023 will be considered.” This is already stated on the previous page (page 9; line 199). Similarly, the content on page 10, line 214 is also duplicative “Moreover, the reference list of secondary sources, identified as relevant to the topic of inquiry, will be examined.” See page 9, lines 202 and 203.

Our response: We have removed the duplicated information from the Sources of Evidence section.

2. Page 14, line 303 should be “As data are extracted” (plural); line 315 should be “The extracted data will be” as extraction is a descriptive word in this sentence.

Our response: This correction has been reflected in the manuscript.

3. Page 14, line 315. I suggest integrating this sentence where it is relevant as it is not a stand-alone paragraph. (I suspect you can move it to the paragraph starting on line 324, re: summary of the key findings on the role of sociodemographics?)

Our response: This suggestion has been reflected in the manuscript.

4. In the introduction, the second paragraph is repetitive in structure: sentence introducing a prior review followed by a sentence starting with ‘however’. This paragraph requires revision to improve reader engagement.

Our response: We have revised this section to improve the flow.

5. It is unclear to me how research question 1 (page 5, line 113) directly addresses your objective on what is the role of sociodemographics in the degree of perceived acceptability of DMHI (lines 107-108). Can you please clarify?

Our response: We have removed question 1 "Which digital mental health innovations have had their perceived acceptability evaluated through a consideration of sociodemographic factors?" However, as suggested by reviewer 2, this information will be reported in a table.

6. Research question 3 (page 6, lines 117-118) does not include the neutral category that you outline in the Data Synthesis section (page 15, line 326). If your objective is focused on the degree of perceived acceptability, it seems that ‘neutral’ would be important to acknowledge as part of the spectrum?

Our response: This question has been reformulated to the following “Which sociodemographic factors have been positively, negatively, or not associated with the perceived acceptability of DMHI?”

7. I understand that you are interested in synthesizing studies of associations between sociodemographics and perceived acceptability. As this is a scoping review, would you consider adding another objective to slightly broaden the focus? In addition to reviewing studies that examined associations, would you also consider reviewing all studies that included examining perceived acceptability of a DMHI. I believe these studies would be included in the search strategy. For this group of studies, you could review the participant characteristics across studies to explore the diversity from which acceptability findings are based on. While this addition broadens the review, it would add value as you could comment on the diversity of study samples and what is needed moving forward in terms of EDI in the DMHI research field.

Our response: Absolutely, this has been the plan, but we can understand how this may not have been reflected in our first iteration of the manuscript. We have clarified in the introduction what we mean by association. Specifically, we have added the following: “In the context of this review, the term “association” extends beyond its statistical sense and refers to the presence of qualitative patterns of association between specific sociodemographic groups within and across studies, and their perceived acceptability of DMHI.”

8. On page 5 in the statement of the primary objective, you can remove the examples in brackets “(e.g., age, ethnicity, gender)”. Objectives do not need parenthesized examples as operational details should be described in the methods. This is what you have done on the following page under Population.

Our response: We have removed the parenthesized examples from this section.

9. *Determining study inclusion necessitates a detailed evaluation—1) determining the report of relative or absolute acceptability, and if absolute acceptability is reported, the need to determine if at least 90% of the sample represents a specific sociodemographic group; and 2) determining if acceptability is assessed independently in the case of blended interventions. Given these requirements for inclusion, it is important to include details on the screening strategy and any instructions/parameters for determining these criteria (e.g., Which values are used for calculating the proportion of the study sample? How to determine an independent acceptability assessment – Can multivariable modelling results be used? Does the acceptability finding need to be reported on its own?). The inclusion of these details will further operationalize the review and promote transparency and replicability.

Our response: As part of our revisions, we have modified the eligibility criteria in our manuscript. We will only consider studies in which relative acceptability is reported (e.g., Men have higher perceived acceptability than women), the absolute acceptability of a specific group in comparison to another is reported (e.g., The mean acceptability score of men is 4, and the mean acceptability score of women is 3.5) or in which the study sample is homogeneous for at least one sociodemographic factor of interest (e.g., every study participant identifies as a woman). Therefore, the criterion of 90% is no longer relevant for the proposed review. For the second component of your comment on how we will determine if acceptability is assessed independently in blended interventions, we will examine whether the perceived acceptability score for a blended intervention (e.g., In-person psychotherapy and ICBT) is reported as a global score or if the acceptability of the ICBT component was evaluated separately. If it has not been evaluated separately, we would not include the study in the proposed review. All of these clarifications have been reflected in the new iteration of the manuscript.

10. Page 15, line 332: It is stated that additional findings may be reported based on the identification of patterns. What analytic approach will be used to identify patterns?

Our response: This statement specifically refers to the possibility of additional categories of information emerging as pertinent (when the data extraction strategy is piloted) that were not considered in this protocol.

11. Page 15, line 334: You note that it may be necessary to use visual representation if the findings are complex. Can you describe more details regarding ‘complexity’ to promote transparency and replicability? In particular, how are you defining complexity, and what is the process that will be used to determine complexity?

Our response: Complexity here refers to the quantity of data that will be presented to readers. If we find that there is a large amount of data to be extracted for a particular category of information, it may be more accessible for readers to have visual representations of the data to enhance their understanding of our findings. This clarification has been reflected in the new iteration of the manuscript.

12. I am curious to know more about your approach to defining high acceptability (page 15, line 326). Typically, general interpretation of measures of association follows this guide: weak (0.01-0.09), moderate (0.10-0.29), strong (0.30-0.59), very strong (0.60-0.99). Based on your definition, in your review, it reads that you will report a weak, positive association as reflecting high acceptability. Can you share your thoughts on whether or not you think your interpretation of any positive association as ‘high acceptability’ could be misleading, and why/why not?

Our response: In the new iteration of the manuscript, we have clarified what we mean by associations. Here, we will not attempt to interpret or calculate statistical associations, but these will be stated if they are reported by the authors. Instead, we are looking for qualitative patterns in our findings. For example, if we notice that individuals identifying as women have reported high acceptability in 7 studies, this would be reported. To clarify how we will determine whether acceptability is high or not, we have added the following statement to the manuscript: “For absolute acceptability, the cut-off scores reported in the literature for the various measures used to measure acceptability across studies will be used to indicate whether the reported scores represent high or low acceptability. If such scores are not available, the acceptability scores that have been evaluated using the same measures across studies will be compared. For studies that utilized non-standardized measures to examine the perceived acceptability of users, the study’s author’s interpretation of these scores will be reported in the proposed review.” Please note that we will finalize our approach depending on the way acceptability was measured across the included studies.

13. In its present state, the conclusion serves as a detailed account of the strengths and limitations of the review. These should be stated in its own section. The conclusion should serve as a brief summary.

Our response: In the new iteration of the manuscript, we have separated the original Conclusion section into Limitations and Conclusion.

Reviewer’3 Comments:

1. One minor comment - the focus in the opening line on Canada is not necessary or appropriate for an international journal.

Our

Submitted filename: Response to Reviewers_Final Version.docx

 10.1371/journal.pone.0301886.r003 Decision Letter 1 Titi Maher Abdelraheim Academic Editor 2024 Maher Abdelraheim Titi This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Submission Version 1

16 Feb 2024

PONE-D-23-30534R1The role of sociodemographic factors on the acceptability of digital mental health care:

A scoping review protocolPLOS ONE

Dear Dr. Lal,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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Maher Abdelraheim Titi

Academic Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions?

The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field.

Reviewer #1: Yes

Reviewer #4: Yes

**********

2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses?

The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory.

Reviewer #1: Yes

Reviewer #4: Yes

**********

3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable?

Descriptions of methods and materials in the protocol should be reported in sufficient detail for another researcher to reproduce all experiments and analyses. The protocol should describe the appropriate controls, sample size calculations, and replication needed to ensure that the data are robust and reproducible.

Reviewer #1: Yes

Reviewer #4: Yes

**********

4. Have the authors described where all data underlying the findings will be made available when the study is complete?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception, at the time of publication. The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #4: Yes

**********

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Reviewer #1: Yes

Reviewer #4: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics.

You may also provide optional suggestions and comments to authors that they might find helpful in planning their study.

(Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: I thank the authors for their responses to our comments and revision of the paper.

I believe the authors’ efforts to address our comments greatly improve the protocol, and I am happy with the changes made.

Reviewer #4: Thank you for the opportunity to review this paper as a third reviewer. I have seen the previous versions and comments from reviewers 1 and 2 and am glad the issues have been addressed.

I have one suggestion related to the concept of 'acceptability', which is well defined in the paper, but less so in the search strategy which was included as an appendix. The terms 'patient preference', 'consumer satisfaction' and 'patient satisfaction' have not been included, and it seems these very similar - yet admittedly different - concepts may also yield important results. I'm wondering if including these terms in the first lines of the search along with the acceptability terms (lines 1-4) would be useful. If in testing these terms, they are not of use, perhaps a short explanation could be added? I am not confident that other authors will have as well defined a concept of acceptability and will be using other definitions.

**********

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Reviewer #1: Yes: Judith Borghouts

Reviewer #4: Yes: Amanda Ross-White

**********

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 10.1371/journal.pone.0301886.r004 Author response to Decision Letter 1 Submission Version 2

29 Feb 2024

We thank the reviewers for their constructive reviews and are encouraged to receive feedback that our revisions have “greatly improved the protocol”. We greatly appreciate the opportunity to submit a further revision of our paper for your continued consideration. Below, we respond to each reviewer’s comments and provide an overview of the corresponding tracked changes we made in the paper.

Reviewer 1 Comment:

1. I thank the authors for their responses to our comments and revision of the paper. I believe the authors’ efforts to address our comments greatly improve the protocol, and I am happy with the changes made.

Our response: We are happy to hear that the changes we have made are satisfactory. Thank you for the thoughtful feedback to help improve the manuscript.

Reviewer 2 Comments:

1. I have one suggestion related to the concept of 'acceptability', which is well defined in the paper, but less so in the search strategy which was included as an appendix. The terms 'patient preference', 'consumer satisfaction' and 'patient satisfaction' have not been included, and it seems these very similar - yet admittedly different - concepts may also yield important results. I'm wondering if including these terms in the first lines of the search along with the acceptability terms (lines 1-4) would be useful. If in testing these terms, they are not of use, perhaps a short explanation could be added? I am not confident that other authors will have as well defined a concept of acceptability and will be using other definitions.

Our response: We appreciate this suggestion very much. This concern also emerged as we were in the process of developing the search strategies for the present review. Our decision to omit these terms is based on the following: 1) First, the conceptualization of acceptability in this protocol is informed by the Technology Acceptance Model (TAM) and its two core components, perceived ease of use and perceived utility. In contrast to general satisfaction and preference, the TAM suggests, through its two core components, specific criteria to consider as one evaluates a given innovation. Despite the possibility of variations in the conceptualization of acceptability across studies, the general criteria used to evaluate acceptability based on the TAM should generally remain the same; 2) Furthermore, this decision was made to limit the scope of this review. Indeed, as evidenced by our search strategy, we have tried to be as inclusive as possible for the population and context component of this review. However, to ensure the feasibility of this review, this decision also meant that the concept component of the review would need to be scoped down. Our current strategy retrieved 12,894 articles (with duplicates removed) that will need to be screened – demonstrating already a broad approach. All this being said, we can appreciate how these decisions may impact our results. Therefore, we have added in the “limitation” section of the manuscript that the omission of these terms represents a limitation of this review.

Submitted filename: Letter_Response to Reviewers_V2_Feb29th_2024.docx

 10.1371/journal.pone.0301886.r005 Decision Letter 2 Titi Maher Abdelraheim Academic Editor 2024 Maher Abdelraheim Titi This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Submission Version 2

25 Mar 2024

The role of sociodemographic factors on the acceptability of digital mental health care:

A scoping review protocol

PONE-D-23-30534R2

Dear Dr. Lal,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Maher Abdelraheim Titi

Academic Editor

PLOS ONE

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions?

The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field.

Reviewer #4: Yes

**********

2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses?

The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory.

Reviewer #4: Yes

**********

3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable?

Descriptions of methods and materials in the protocol should be reported in sufficient detail for another researcher to reproduce all experiments and analyses. The protocol should describe the appropriate controls, sample size calculations, and replication needed to ensure that the data are robust and reproducible.

Reviewer #4: Yes

**********

4. Have the authors described where all data underlying the findings will be made available when the study is complete?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception, at the time of publication. The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #4: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #4: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics.

You may also provide optional suggestions and comments to authors that they might find helpful in planning their study.

(Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #4: You have adequately explained the search rationale and addressed the limitations. Thank you for this revision.

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #4: Yes: Amanda Ross-White

**********