{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T10:03:03Z","timestamp":1779876183647,"version":"3.53.1"},"update-to":[{"DOI":"10.12688\/f1000research.165171.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T00:00:00Z","timestamp":1767916800000}},{"DOI":"10.12688\/f1000research.165171.2","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T00:00:00Z","timestamp":1767916800000}}],"reference-count":27,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T00:00:00Z","timestamp":1767916800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100010221","name":"Higher Education Commision, Pakistan","doi-asserted-by":"publisher","award":["20-GCF-770\/RGM\/R&ID\/HEC\/2021"],"award-info":[{"award-number":["20-GCF-770\/RGM\/R&ID\/HEC\/2021"]}],"id":[{"id":"10.13039\/501100010221","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns3:p>Background Tuberculosis with co-morbid diabetes mellitus presents a substantial public health challenge, necessitating immediate and coordinated interventions. Such interventions should be sustainable and have a high acceptance rate in real-world settings. Applying the principles of implementation science is essential to enhance the existing system. This research study aims to assess the influence of innovation characteristics on the implementation of an Optimised TB-diabetes integrated care package. Objectives The main objectives of this study are to explore the perceptions and experiences of intervention developers; to understand the experiences of health professionals and patients regarding the Opt TBD integrated care package; assess the content validity of the innovation characteristics instrument; and evaluate the influence of intervention characteristics on the implementation process of the Opt TBD integrated care package. Methods The study will be conducted at thirteen selected TB healthcare facilities across Khyber Pakhtunkhwa and Punjab over a period of 18 months, in three phases. Evaluation will involve qualitative exploration of intervention development, followed by feasibility testing, and finally the definitive implementation of the intervention. The participants will include key stakeholders: intervention developers, TB health professionals, and patients. Conclusion This study will generate critical insights for the Opt TBD integrated care package, focusing on enhancing contextual relevance and improving adoption rates in practical, real-world settings. Specifically, this research study seeks to identify key implementation challenges, evaluate the fidelity of the intervention, and validate the causal relationships between the characteristics of the innovation and its implementation success.<\/ns3:p>","DOI":"10.12688\/f1000research.165171.3","type":"journal-article","created":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T09:44:06Z","timestamp":1767951846000},"page":"599","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Assessing the Influence of Innovation Characteristics on the Implementation Process of an Optimised Tuberculosis Diabetes Integrated Care Package (Opt TBD) -A Mixed Method Study Protocol"],"prefix":"10.12688","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8652-6198","authenticated-orcid":false,"given":"Fatima","family":"Khalid","sequence":"first","affiliation":[{"name":"Institute of Public Health & Social Sciences Peshawar Khyber Pakhtunkhwa 25000 Khyber Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zohaib","family":"Khan","sequence":"additional","affiliation":[{"name":"Office of Research, Innovation & Commercialization (ORIC) Peshawar Khyber Pakhtunkhwa 25000 Khyber Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9080-2220","authenticated-orcid":false,"given":"Saima","family":"Afaq","sequence":"additional","affiliation":[{"name":"Department of Health Sciences York England YO10 University of York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2560","published-online":{"date-parts":[[2026,1,9]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"107140","DOI":"10.1016\/j.ijid.2024.107140","article-title":"Tuberculosis and diabetes mellitus: The complexity of the comorbid interactions.","volume":"146","author":"A Boadu","year":"2024 Sep","journal-title":"Int. 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A unified subsection \u201cQualitative Data Collection Procedures\u201d was added, and stage-specific paragraphs were rewritten to focus only on unique elements. We agree that the original notation used to describe the mixed-methods design could be difficult for readers who are not familiar with advanced mixed-methods conventions. We have revised the sentence to use plain language and now describe the mixed-methods approach as a \u201cconvergent mixed-methods design in which qualitative and quantitative data are collected and analyzed separately and integrated during interpretation.\u201d This improves clarity and accessibility for broader audiences (Methods section, Mixed-Methods Design subsection). Additional detail has been added to clarify the sampling strategy. For the quantitative phase, the rationale for the census-based approach has been expanded to describe potential recruitment barriers (attrition, refusal, turnover) and planned mitigation strategies to support participation. For the qualitative phases, we have specified how data saturation will be operationalized and confirmed during analysis. These revisions have been incorporated in the Methods section (Sampling &amp; Data Collection Procedures). 2. We have now clarified the sampling strategy by adding detail on potential recruitment barriers and corresponding mitigation strategies for the census-based quantitative phase. Additionally, we have specified how data saturation will be operationalized and confirmed during qualitative analysis. 3. Data Analysis Details: We have now added detail to clarify how inter-coder reliability and reflexivity will be ensured. Specifically, at least two researchers will independently code an initial subset of transcripts and reconcile coding decisions to develop a shared coding framework, with discrepancies resolved through discussion and senior review where needed. Reflexivity will be maintained through analytic memos and team debriefing sessions. This addition has been inserted into the Qualitative Analysis subsection of the Methods. We have now clarified the covariates to be included in the multinomial regression model. Specifically, age, gender, education level, province, facility type, and duration of TB-DM comorbidity will be included for patient-level analysis, while professional role, years of clinical experience, and prior training will be included for health worker data. These covariates were selected based on theoretical relevance and established determinants of implementation outcomes. This clarification has been added in the Quantitative Analysis section. 4. We have expanded the Integration section to describe how qualitative and quantitative findings will be brought together using joint displays and matrices to support convergence and interpretation. 5. We also strengthened the Limitations section to explicitly discuss self-report data, variation in facility readiness, and challenges related to implementation fidelity monitoring.&nbsp; The Dissemination section has been revised to highlight knowledge translation activities, including engagement with the National TB Control Program and provincial health departments to support integration of findings into routine TB-DM programming. These revisions improve clarity, transparency, and relevance to policy and practice.","URL":"https:\/\/f1000research.com\/articles\/14-599\/v3#referee-comment-14855","order":1,"name":"referee-comment-14855","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.194708.r448975, Falak Pahwa, The University of Chicago (Ringgold ID: 2462), Chicago, Illinois, 29 Jan 2026, version 3, indexed","URL":"https:\/\/f1000research.com\/articles\/14-599\/v3#referee-response-448975","order":2,"name":"referee-response-448975","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"This research is supported by the Higher Education Commission (HEC) of Pakistan, Reference No. 20-GCF-770\/RGM\/R&ID\/HEC\/2021.","order":3,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}