Review: Community health workers’ perceptions of depression and barriers and facilitators to mental health care in Sierra Leone: A qualitative study {under peer review}

 

Reviewer: Dr. Zyed Achour

Completed: 28-04-2026 08:08

 

Recommendation: Revisions Required

 

 

	Yes	No	N/A
Is the research question clearly defined?		+
Are the methods appropriate and sufficiently detailed?	+
Is the data analysis robust and replicable?		+
Are the conclusions supported by the results?	+
Is the manuscript well organised and clearly written?	+
Are tables, figures, and supplementary material informative and necessary?	+
Is the abstract an accurate summary of the study?	+
Does the manuscript contribute meaningfully to the field?		+
Is it relevant to the field of mental health or related disciplines that are connected to the scope of the Journal?	+
Are ethical approvals and participant consents adequately described?	+
Have competing interests, funding, and data availability been transparently declared?	+

 

Comments for the authors:

 

Thank you for the opportunity to review this manuscript.

This article addresses an important and underexplored topic, namely the mental health literacy of community health workers (CHWs) in Sierra Leone, a country marked by a long history of collective trauma. The empirical contribution is genuine and valuable, particularly the original finding regarding the gap in recognising suicidal ideation among CHWs — a finding with direct implications for training and suicide prevention in resource-limited health systems.

That said, the sample size (n=10, two sites only) limits the transferability of the findings, and I would encourage the authors to exercise caution when drawing broader conclusions, ensuring that generalizations remain within the boundaries of what the data can reasonably support. The suggestions below are intended to strengthen the impact of this article without altering its fundamental structure.

Suggestions to the Authors

1. Explicit formulation of the research question

The article would gain considerably in clarity and impact if a central research question were explicitly stated in the introduction. As currently written, the manuscript presents three distinct aims without a clear hierarchy between them, which makes it difficult for the reader to identify the study's overarching thread. I would encourage the authors to consider formulating a unifying research question that brings these three aims together and strengthens the overall coherence of the manuscript.

2. Precision in quantification

Throughout the results section, the manuscript relies on vague expressions such as "most participants" or "some participants" without specifying the corresponding figures. In a sample of ten individuals, this imprecision is analytically problematic: the difference between six and eight participants is substantive and can meaningfully affect the interpretation of findings. I would strongly encourage the authors to systematically replace these expressions with exact numbers or clear fractions across the entire results section.

3. Analytical progression table

The transparency of the analytical process would be considerably strengthened by the addition of a simple table illustrating the progression from initial codes to subthemes and final themes. This addition would not require any further analytical work, since the analysis has already been completed. It would, however, allow readers to assess the rigour of the thematic process and would meaningfully enhance the credibility of the study.

4. Visual synthesis of the results

Finally, I would suggest adding a summary table presenting the five themes, their respective subthemes, and one representative quotation for each. Such a visual synthesis would greatly improve the readability of the manuscript and strengthen its impact for readers who are less familiar with qualitative methods. The thematic map mentioned in the text but absent from the manuscript could also be included as a complementary figure, and I would encourage the authors to consider this addition.

 

I believe these revisions are all achievable without major restructuring and would allow this article to reach the level of impact that its subject matter deserves. I look forward to reading a revised version.