Title: Co-developing a digital mindfulness- and acceptance-based intervention for
endometriosis management and care: A qualitative feasibility study
Version: 1 Date: 08 Mar 2025
Reviewer:  Allyson C. Bontempo
Reviewer's report:
Thank you for the opportunity to review this revised manuscript, entitled, “Co-developing a
digital mindfulness- and acceptance-based intervention for endometriosis management and care:
A qualitative feasibility study.” This is a very well-designed intervention and the manuscript
itself is very well written. I do have a few points of feedback.
Abstract
1. Line 27: Could the authors clarify what are “negative” symptoms?
2. Line 32: Was diagnosis confirmed? Or was it self-reported?
3. Line 39: Is there not more than one generic theme? Why are the authors only naming one?
Background
1. Line 97: Could the authors clarify what type(s) of skills?
Methods
1. Should the aim subsection not be in the Introduction?
2. Lines 125-126: Could the authors clarify if this was a self-reported diagnosis? If so, this
should be stated.
3. Line 131: Would not “audio” be more appropriate of a word than “sound”?
4. Line 133: An interview is something that is “completed” or “conducted,” not “collected,” yes?
5. Line 138: Shouldn’t “interview” be plural since there are four listed?
6. Lines 174-181: Was thematic saturation reached for all resulting themes? If so, I recommend
the authors state this.
7. Could the authors provide the reflexivity and positionality of the researcher who did the
interviews and data analysis?
Results
1. Line 197: Could the authors specify “suggestions” for what?
2. Line 208: Are the authors referring to the consequences of endometriosis or their resulting
physical and psychological well-being?
3. Lines 214-217: Participants’ emotional response seems different from endometriosis-related
literacy, yes? Is there perhaps a better place for this?
4. Line 224: Can the authors clarify how patterns of action are different than habits?
5. Line 260: According to clinical psychotherapy practice (CBT, etc.), is panic something to be
avoided, or, rather, is it something that is resolved? Avoidance perpetuates the anxiety/panic
cycle, so I encourage the authors to be cognizant of their framing here.
6. Line 267: Could the authors specify limitations of what?
7. Line 269: Could the authors provide an example of what kind of consequences?
8. For the “Learning to control and trust my body” section, personally I feel like the need
for control is in opposition with acceptance (the previous theme). Is acceptance not about
surrendering control and accepting what is? I strongly encourage the authors to consider this
in their analysis.
9. Lines 281-282: Can the authors explain how this is different than the theme “changing the
mindset”? For example, the exemplar provided for that centered on feelings of control as well
(“I have always felt like I cannot do anything about it. That I just had to live with it.”).
10. For the “Alliance and motivation” section, I wonder, too, if accountability (specifically to
the researcher) played a role as well, as this theme seems to hint at.
Discussion
1. Line 372: Could the authors clarify limitations such as what?
2. Line 372: Could the authors clarify more open-minded than what/who?
3. Line 373: In cognitive behavioral therapy “reframing” is also referred to as cognitive
restructuring (i.e., restructuring one’s thoughts).
4. Line 382: Since this is self-report data, I encourage the authors to reword this to “they
*reported* they could…”