Rethinking the Vulnerability of Groups Targeted in Health-Promoting Sports and Physical Activity Programs
Round 1
Reviewer 1 Report
Comments and Suggestions for AuthorsDear author (s),
You have chosen an important topic as well as an important target group; that it is important to get more knowledge about. I have some reflections that I hope will develop your paper further. First, I will reflect on some major issues that are perspectives visible in several parts of the paper; then I will chronologically present some other reflections and questions.
Major reflections
My major concern is your use of the concept health promotion. You state in many places that you have used HP research, and you also use the concept a lot. However, I can´t see that you have used the definition of HP and its full potential at all. You write several times about HP as a goal or an outcome when the definition of HP (WHO, 1986) is that it is a process. Some of the research that you use seem to be more focused on health care than HP. If you will keep the HP focus this needs to be properly revised throughout the paper. You also use a very old definition of health, there are newer that talks of health more as a continuum than a state.
You also call this walking program a health promoting sport program. Is it? And why is it? First, is this sport or is this more physical activity? Second, if it is a health promoting sport program, why is it and how – there is a lot of research on this concept and what the indicators for a HPSC are. In one place you also call it recreational sports program. You must strengthen this with some references. Sport is also quite invisible throughout the paper, which is maybe natural since this is more a physical activity program or?
Developing these perspectives will probably also influence your discussion.
Other reflections
Why is rethinking risks and vulnerability necessary – what problem will that solve? This must be clearer when introducing your paper.
The aim is different in the abstract and in the paper.
In the abstract it is a very long, hard to read sentence, from line 9-12. It would benefit by being two or three sentences.
I couldn´t get a clear picture of the interviews with the health professionals, what did you ask them? And what did you plan to observe when you participated in the walks?
In p. 6, line 303 you say that participants delt with multidimensional challenges. What dimensions do you refer to? If you properly, for example, define HP and its determinants with for example Whitehead and Dahlgren´s health determinants, then these multidimensional challenges could be more visible.
In p. 9, line 447-448 you say…towards health promotion (among others societal goals). Again, HP as an outcome, but also what societal goals are outside a definition of HP?
What were your main findings of your paper. This could be made clearer in the last section.
There are some language mistakes throughout, which you can fix by a proper last reading.
Comments on the Quality of English LanguageA few mistakes that you will fix by a last reading.
Author Response
Thanks very much for your rigid review; please accept our excuses for the work in progress character of the original submission. The revised version has been thoroughly revised. Please see our response to your comments below:
Comment: My major concern is your use of the concept health promotion. You state in many places that you have used HP research, and you also use the concept a lot. However, I can´t see that you have used the definition of HP and its full potential at all. You write several times about HP as a goal or an outcome when the definition of HP (WHO, 1986) is that it is a process. Some of the research that you use seem to be more focused on health care than HP. If you will keep the HP focus this needs to be properly revised throughout the paper. You also use a very old definition of health, there are newer that talks of health more as a continuum than a state.
Response: Thanks for noting this; we have revised the article paying attention to your observations. In general we have taken out promotion among others when we refer to wider health research.
Comment: You also call this walking program a health promoting sport program. Is it? And why is it? First, is this sport or is this more physical activity? Second, if it is a health promoting sport program, why is it and how – there is a lot of research on this concept and what the indicators for a HPSC are. In one place you also call it recreational sports program. You must strengthen this with some references. Sport is also quite invisible throughout the paper, which is maybe natural since this is more a physical activity program or? Developing these perspectives will probably also influence your discussion.
Response: You're right that the walking program might not be described as a health promoting sports program; we have simply called it a health promoting program now, while relating our search to the types of such programs that involve physical activity and sport.
Comment: Why is rethinking risks and vulnerability necessary – what problem will that solve? This must be clearer when introducing your paper. The aim is different in the abstract and in the paper.
Response: We have revised our description of the aim and made sure that the introduction also points to the relevance of rethinking vulnerability.
Comment: In the abstract it is a very long, hard to read sentence, from line 9-12. It would benefit by being two or three sentences.
Response: The abstract has been thoroughly revised.
Comment: I couldn´t get a clear picture of the interviews with the health professionals, what did you ask them? And what did you plan to observe when you participated in the walks?
Response: We have clarified relevant question posed in the interviews and our focus in the observations.
Comment: In p. 6, line 303 you say that participants delt with multidimensional challenges. What dimensions do you refer to? If you properly, for example, define HP and its determinants with for example Whitehead and Dahlgren´s health determinants, then these multidimensional challenges could be more visible.
Response: We have changed the sentence and provided more background information about the neighborhood and the target group of the health promotion unit.
Comment: In p. 9, line 447-448 you say…towards health promotion (among others societal goals). Again, HP as an outcome, but also what societal goals are outside a definition of HP?
Response: The sentence has been changed.
Comment: What were your main findings of your paper. This could be made clearer in the last section.
Response: The results have been revised and our findings have been made clearer in the conclusion.
Comment: There are some language mistakes throughout, which you can fix by a proper last reading.
Response: Sorry about our lacking English abilities, a language check has been made.
Reviewer 2 Report
Comments and Suggestions for AuthorsDear Authors,
I was given a manuscript to check titled: Rethinking risks and vulnerability of target groups for health 2 promoting sports programs.
I have several reservations concerning the work
Firstly, the aim of the work is not sufficiently clear to me. In the abstract you stated the aim (to develop a more nuanced understanding of the vulnerability of target groups in health promoting sports programs in order to better support them), while in Part 4. Methods and Material, the aim is somewhat altered: ... the variety not only between but also within a group of program employees and a (target) group of participants in sports programs. For the aim being unclear, we do not learn in Results whether it has been met.
Despite the fact that this is a single-case study, please provide more information about the sample group - the number of participants and their baseline somatic characteristics. And also the number of employees from the health promotion unit (health promotion professionals) involved in this follow-up.
In Methodology you state that 12 semi-structured interviews of around 60 minutes length.
Please indicate the particular interview questions in Methodology or in the annex. You also state that you carried out "participant observation conducted over a one-year period". Please describe in more detail what you were observing in the focus group.
Reconsider adjusting the Results (5.1 and 5.2), from my perspective the results are interpreted rather laxly. Although this is a semi-structured interview, certain conditions do apply here as well.
In chapter 5.2, try to explain more explicitly or elaborate on the sentence from lines 302-304: "It became soon evident for us that the participants dealt with multidimensional challenges, but also frequented the walking program in very different ways."
The Discussion section is only supported by a single study, I firmly recommend to add another ones.
Also, I suggest separating the Discussion and Conclusions sections.
Please correct and consolidate References:
· Some references have the journals listed in italics, some do not
· Ref. 14 is co-authored - Consortium to Examine Clinical Research Ethics. In the text - line 57, in addition, the text lists an author without co-authors (Levin 2004).
· Ref. 13 is listed with 2009 in References, but with 2007 in the text (lines 115 and 164).
Author Response
Thanks very much for your rigid review; I'm sorry about the work in progress character of the original submission. The revised version has been throughly revised. Please see our response to your comments below:
Comment 1: Firstly, the aim of the work is not sufficiently clear to me. In the abstract you stated the aim (to develop a more nuanced understanding of the vulnerability of target groups in health promoting sports programs in order to better support them), while in Part 4. Methods and Material, the aim is somewhat altered: ... the variety not only between but also within a group of program employees and a (target) group of participants in sports programs. For the aim being unclear, we do not learn in Results whether it has been met.
Response: The aim has been clarified and aligned across the paper.
Comment 2: Despite the fact that this is a single-case study, please provide more information about the sample group - the number of participants and their baseline somatic characteristics. And also the number of employees from the health promotion unit (health promotion professionals) involved in this follow-up.
Response 2: We find it difficult to protect the pseudonymity of the health promotion unit, their professionals and program participants, while also providing detailed descriptions that will allow the readers insight into the specific case. We have added more details about the neighborhood, and the fact that the target group of the unit deal with multiple chronic diseases. Concerning the number of health professionals interviewed we thought this was clear when describing that we did 12 semi-structured interviews, but this has been clarified further.
Comment 3: In Methodology you state that 12 semi-structured interviews of around 60 minutes length. Please indicate the particular interview questions in Methodology or in the annex. You also state that you carried out "participant observation conducted over a one-year period". Please describe in more detail what you were observing in the focus group.
Response: We have clarified our main focus in the interviews and observations.
Comment 4: Reconsider adjusting the Results (5.1 and 5.2), from my perspective the results are interpreted rather laxly. Although this is a semi-structured interview, certain conditions do apply here as well. In chapter 5.2, try to explain more explicitly or elaborate on the sentence from lines 302-304: "It became soon evident for us that the participants dealt with multidimensional challenges, but also frequented the walking program in very different ways."
Response: The results sections have been revised and the sentence changed.
Comment 5: The Discussion section is only supported by a single study, I firmly recommend to add another ones. Also, I suggest separating the Discussion and Conclusions sections.
Response: Sorry we have kept the discussion and conclusion integrated. Due to this we only refer to a few studies.
Comment 6: Please correct and consolidate References:
· Some references have the journals listed in italics, some do not
· Ref. 14 is co-authored - Consortium to Examine Clinical Research Ethics. In the text - line 57, in addition, the text lists an author without co-authors (Levin 2004).
· Ref. 13 is listed with 2009 in References, but with 2007 in the text (lines 115 and 164).
Response: Thanks for noting this; all of these issues have been corrected, and the list of references checked.
Round 2
Reviewer 1 Report
Comments and Suggestions for AuthorsDear author (s),
I think you have done a really thorough and good job in revising this manuscript. The focus is now more emphasized on vulnerability than health promotion (as the theoretical underpinning) and then the Health literature you have used work. I think it is wise to call it PA and sports - to broaden the interpretation of what a walking program can be (especially for target groups with different languages and experiences of PA an sport). I am also pleased with more descriptions on your data collection.
Reviewer 2 Report
Comments and Suggestions for AuthorsDear authors,
thank you for accepting the comments, the article is now qualitatively on a higher level
