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Research Article | DOI: https://doi.org/10.31579/2690-4861/938
1Translational Health Research Institute, School of Medicine, Western Sydney University, NSW Australia.
2Faculty of Medicine & Health, School of Clinical Medicine, Discipline of Psychiatry, University of New South Wales, Kensington, NSW 2052, Australia.
3Mental Health Research and Teaching Unit, Liverpool Hospital, SWSLHD, NSW Health, Liverpool, NSW, Australia.
4School of Psychological Sciences, University of Newcastle, Callaghan, New South Wales, Australia.
5South-Western Sydney Metabolic Rehabilitation and Bariatric Program, Campbelltown Hospitals, Camden, NSW, Australia.
*Corresponding Author: Nasim Foroughi, Translational Health Research Institute, School of Medicine, Western Sydney University, NSW Australia.
Citation: Foroughi N, Mohsin M, Raman J, K. Piya M, and Hay P, (2025), Barriers to Engagement in a Psychological Therapy group in a Multidisciplinary weigh Management Program: a Qualitative Study (Hapifed-M), International Journal of Clinical Case Reports and Reviews, 29(1); DOI:10.31579/2690-4861/938
Copyright: © 2025, Nasim Foroughi. 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.
Received: 04 August 2025 | Accepted: 19 August 2025 | Published: 02 September 2025
Keywords: executive function; qualitative study; obesity; cognitive deficits; binge eating; psychological distress; physical health; positive and negative feedback
Background: Participant feedback is critical in assessing how interventions influenced both their learning process, cognitive, and psychological outcomes. This qualitative study explored views and barriers to engagement in a psychological therapy group program as part of a multidisciplinary Weight Management Program (WMP) from the perspectives of individuals with higher body weight (HBW).
Methods: This cohort comprised of individuals with obesity Class 3 (BMI ≥ 40 kg/m²), who were enrolled in a longitudinal WMP and had achieved a ≥10% body weight reduction. To maintain physical and mental health improvements, an in-person maintenance group focusing on consolidation of gains and relapse prevention was offered Healthy APproach to weIght management and Food in Eating Disorders-Maintenance (HAPIFED-M).
Results: Following a thematic analysis using the Framework method, positive and negative feedback was provided by 19 participants in this study, examining six key themes: (1) Positive content of therapy, (2) Positive socialization and support, (3) Positive therapist features, (4) Negative time of therapy/personal circumstances, (5) Negative process of therapy, and (6) Negative content. Barriers to engagement included a preference for alternative activities and practical impediments.
Conclusions: The findings highlight the importance of the therapeutic engagement, practical features such as timing of groups, and tailoring psychotherapy content to participant’s needs in order to achieve therapeutic engagement.
WMP, Weight Management Program; HBW, Higher body weight; Healthy APproach to weIght management and Food in Eating Disorders-Maintenance, HAPIFED-M
Higher body weight (HBW), particularly Class 3 obesity (BMI ≥ 40 kg/m²), is recognized as a significant global health issue associated with chronic physical conditions such as type 2 diabetes, hypertension, and cardiovascular disease [1]. In addition to physical health risks, individuals with HBW commonly experience mental health comorbidities, including depression, anxiety, and disordered eating [2] [3] [4] [5-8].
Many individuals with HBW engage in Weight Management Programs (WMPs) to improve health outcomes, achieve weight loss, and enhance overall quality of life, with evidence showing that such programs, particularly commercial and dietitian-led interventions, can lead to significant improvements in physical, psychological, and cardiometabolic outcomes [9] [10] [11].
Although initial weight loss is often achieved through WMPs, long-term maintenance remains a critical challenge, with most individuals maintaining only 3.0 kg (23% of their initial weight loss) 4 or 5 years post WMP [12]. A recent review by Rosenbaum et al. (2003), discussed the contributing mechanisms to weight regain following weight lost regardless of the methods used [13]. The authors reported metabolic adaptation, changes in appetite-regulating hormones, and alterations in fat cell biology as key contributors to the challenge of sustaining weight loss over the long term [13].
This pattern, often referred to as weight cycling, can negatively impact both physical and psychological well-being. Weight cycling has been associated with increased emotional distress and a sense of failure that can further hinder motivation and engagement in future weight management efforts [14]. Typically, multidisciplinary approaches including psychological, behavioral, and nutritional interventions have been incorporated in these programs with the main purpose of promoting long-term weight loss and weight maintenance [15]. However, the most significant challenge, particularly for individuals with HBW remain to be engagement and adherence to such programs. A variety of psychological, social, and practical barriers contribute to this challenge [16] [17]. Understanding participants’ lived experiences is crucial for addressing these challenges effectively.
Participant qualitative feedback is critical for understanding the effectiveness of such programs and for identifying factors that may hinder or promote engagement [18] [19]. While previous studies have explored the impact of various interventions in WMPs, there is a need for qualitative research to examine the barriers and facilitators to engagement, specifically from the perspectives of individuals with HBW. It is important to explore participants' perspectives, particularly regarding the maintenance phase and the transition from clinical to community care settings [20].
In an exploratory study, we examined the community-based care needs of adults with HBW (class 3 obesity) following a WMP and found significant gaps in support during the transition from hospital to community care, including social isolation, fragmented services, and a lack of integrated care [21]. The findings of this study highlighted the urgent need for better-connected healthcare systems and ongoing support to improve long-term outcomes for individuals with severe obesity [22].
In addition, in an earlier study we found an integrated mental health and behavioural weight loss group program for people with disorders of recurrent binge eating was associated with significant improvements in general mental health and function as well as reduction in binge eating [3] named a Healthy APproach to weIght management and Food in Eating Disorders-Maintenance (HAPIFED). We modified and adapted this therapy (HAPIFED-M), for relapse prevention and to extend mental health gains for people undergoing a WMP. The aim of HAPIFED-M was to provide new knowledge for participants on the relationships between weight loss maintenance, cognitive style and mental health in a real-world setting [3] [8] [7].
The aim of current study was to explore in people with an HBW:
a psychological therapy group program as part of a multidisciplinary WMP with a particular focus on the weight loss maintenance.
Between March 2018 and June 2021 participants were invited to participate in a group therapy program. Participants were from a clinical cohort of people who were enrolled in a multi-disciplinary WMP (including endocrinologists, dietitians, psychologists, physiotherapists, a gastroenterologist, a psychiatrist, and a specialist nurse). The WMP was conducted in a publicly funded hospital-based outpatient program in Sydney, Australia. Adults (age ≥18 years) categorised as Class 3 obesity (BMI ≥ 40 kg/m²), [23] [8] [24] [7] with at least one medical comorbidity associated with their body weight.In order to maintain physical and mental health improvements, a psychological therapy maintenance group (HAPIFED-M) focusing on consolidation of gains and relapse prevention was offered to all those in the multi-disciplinary WMP who had achieved a ≥10% body weight reduction in the WMP. The WMP has been described in previous publications [8] [7] [3]. As a publicly funded program, participants were representative of socioeconomically disadvantaged communities in New South Wales, Australia.
The present study offering a psychological therapy program on the maintenance group was approved by the Human Research Ethics Committee of Western Sydney University (H13832, August 2020) and the South-Western Sydney Local Health District Research Ethics Committee (2019/ETH12128). Participants provided written informed consent at the time of initial recruitment. The Maintenance therapy group (HAPIFED-M)
HAPIFED-M is a manualized program [3] for individuals with a high body mass index (>25 kg/m2) who are in a weight maintenance phase (Table 1). This program combines and adaptation of the evidence-based standard therapy for eating disorders, which is cognitive behavioral therapy – enhanced for eating disorders (CBT-E) [25] (excluding interventions for underweight individuals) with behavioral weight loss therapy and multidisciplinary strategies to promote weight loss maintenance. Additional therapy components included 2 case vignette discussion points and cognitive remediation therapy [26]. The HAPIFED-M group comprised of twelve 60-minute sessions over 12 weeks. The therapist was a psychologist, and the sessions were conducted at the site of the WMP. Each session addressed a specific topic designed to improve mental health and thinking style.
| STAGE 1 INTRODUCTION |
| Session 1: Introduction and Psychoeducation about Weight and Behavioural Weight Loss Management |
| Session 2. Psychoeducation about Disordered eating and weight loss |
| STAGE 2 CORE SKILLS |
| Session 3. Mindfulness / Social Environment |
| Session 4: Relaxation/Barriers to Change |
| Session 5: Physical Activity Education / Healthy vs Excessive Exercise |
| Session 6: Unhelpful Thinking Styles |
| Session 7: Changes in eating related to Events and Moods |
| Session 8: Dissatisfaction with Body Weight and Shape / Body Checking, Comparison and Avoidance |
| Session 9: Nutritional Education and Problem Solving |
| Session 10: Increasing Self-Confidence |
| STAGE 3 PREPARING FOR ENDING |
| Session 11: Relapse Prevention (Part 1) |
| Session: 12: Relapse Prevention (Part 2) |
Table 1: HAPIFED-M: 12 sessions led by Clinical psychologist [3]
Survey measures
Socio-demographic characteristics and Body Mass Index (BMI)
Socio-demographic data were obtained at baseline (pre-group), which included participants age, gender, and employment status. Participants height and body weight measured with calibrated scales during the initial presentations to the clinic at pre-group and at 12-months follow-up assessment (post-group); BMI (kg/m2) was calculated based on height and weight [3].
Mental health outcome measure
Psychological distress was assessed by Kessler-10 (K-10) psychological distress questionnaire [27] which is used in health surveys for epidemiological and clinical purposes [27]. The Cronbach’s alpha for K-10 was 0.94, indicating excellent internal consistency and moderate reliability [28]. An average score to indicate positive mental health ranges from 10-15 [29]. The Cronbach’s alpha (α) for the participants of this study (n=244) was 0.78 at pre-group; and for the subset of participants (n=58) was 0.83 and 0.91 at both pre-group and follow-up, respectively.
Participant’s Quality of Life (QoL) was measured using the 12-item Short Form Survey (SF-12) questionnaire [30] which has a sound reliability and validity [31]. The scoring is from 0-100 (lowest to highest health level) with the mean and standard deviation score of 50±10 [30].
The Eating Disorder Examination Questionnaire (EDE-QS) was used to assess eating disorder symptoms over the past 7 days [30] [32]. The EDE-QS measure used in this study consists of 12 items on a four-point rating scale, ranging from 0 (“0 days” or “not at all”) to 3 (“6–7 days” or “markedly”) with total score between 0 to 36, where higher scores indicate more frequent and severe eating disorder symptomatology. A total score of 15 has been proposed as a threshold score to identify high risk of eating disorder [33]. Subscale scores and a global score are derived and Australian community normative data for these are published [34]. This scale has acceptable internal consistency, test–retest reliability and temporal stability.
In this study, Cronbach’s α for the 12-item pool of EDE-QS was 0.82 for all the participants (n=244), 0.85 at pre-group, and 0.76 at follow-up assessment for the subset of participants (n=58). Question 10 of the EDE-QS questionnaire was used as an indicator of the binge eating frequency (question 10: On how many of these days (i.e., days on which you had a sense of having lost control over your eating) did you eat what other people would regard as an unusually large amount of food in one go?)
Feedback Questionnaire
For the purpose of the current study, a maintenance program for relapse prevention (HAPIFED-M), an invitation was sent to those participants who had achieved a ≥10% body weight reduction. A total of 56 people were invited to enrol in the current study; 35 people consented to participate of whom 30 completed the pre-group assessments; 19 participants completed the 12-weeks therapy sessions with the psychologist.
At the 12-weeks post-group assessment session, a feedback questionnaire (Table 2) was read over the phone by the study’s researcher (NF) to the 19 participants who completed the 12-weeks HAPIFED-M sessions. All of them completed the feedback questionnaire.
Thank-you for providing us with feedback on your experiences in the HAPIFED-M group therapy. Would you please take a few moments to tell us:
|
Table 2: Feedback questionnaire
Statistical and Qualitative Analysis
The descriptive statistics for sociodemographic characteristics and mental health outcome measures of the participants is presented. Categorical variables are shown as percentages; continuous variables as means and standard deviations (SD). All the analyses were conducted by using the Statistical Package for Social Sciences (SPSS), Version 28.
We analyzed open-ended responses collected by NF using a phone interview transcript. A Framework Method was utilized to conduct a thematic analysis. After familiarization with the data, initial codes were developed both inductively from the data and deductively based on the study objectives. The research team (NF & PH) created a working analytical framework which was then applied systematically across the dataset.
Key themes were identified and charted into a matrix to facilitate comparison across participants. The analysis was conducted manually, and emergent themes were reviewed and refined to ensure coherence and consistency. This process enabled a structured yet flexible approach to theme development, suitable for addressing the applied nature of the research.
Table 3 presents socio-demographic characteristics and clinical features of the 19 participants who provided feedback at post group. Those who did not elect to enrol in the study (n=21), or did not attend the pre-group assessment session (n=5), or did not complete the 12-weeks therapy sessions (n=11) provided reasons and barriers that included: lack of interest due to differing personal priorities or mindset; work commitments or conflicting schedules preventing full participation; alternative preferred current activities such as health and fitness routines, intensive dieting or attending the gym daily; chronic health conditions including multiple ongoing medical issues, older age and comorbidities, particularly diabetes, impeding travel to attendance; a preference for remote participation, with some individuals favoring online classes; caregiving responsibilities, including caring for a family member at home.
| Socio-demographic | n=19 | |
| Characteristics | Number | % |
| Gender | ||
| Female | 14 | 73.7 |
| Male | 5 | 26.3 |
| Age groups | ||
| 18-44 | 4 | 21.0 |
| 45-64 | 9 | 47.4 |
| 65 and above | 6 | 31.6 |
| Mean age (SD) | 57.4(12.1) | |
| Employment status | ||
| Full/Part Time | 3 | 16.7 |
| Unemployed/other/not employed | 4 | 22.2 |
| Retired/pension | 11 | 61.1 |
| Weight (kg) | 123.9 | |
| Body Mass Index (BMI) | 44.6 | |
| SF12-PCS | 38.9 | |
| SF12-MCS | 42.3 | |
| Total K-10 score | 19.7 | |
| Total EDEQ score | 12.9 | |
| EDEQ-10 (BE) | 0.6 | |
Table 3: Pre-group socio-demographic characteristics of the participants (n=19)
# Employment status missing for one participant. Non-completers are not presented due to low numbers and potential breach of confidentiality, all were women, aged ≥45 years, and none were employed; BMI: Body Mass Index (kg/m2); PCS & MCS: Physical & Mental Component Scores of SF12 [30]; K10: The Kessler Psychological Distress Scale [28]; EDEQ-10: Eating Disorder Examination Questionnaire short form [35]; EDEQ-10 (BE): question 10 of EDEQ-10 questionnaire indicating the binge eating frequency.
Theme 1: positive content of the therapy
Theme 2: positives of socialization and support
Theme 3: negative aspects of therapy
Theme 4: negative aspects of the process
Theme 5: positive suggestions for improvement
Theme 6: Negative Content
Discussion
The current study aimed to investigate participants’ perspectives, feedback and barriers to engagement in an in-person group therapy program that had a focus on weight loss maintenance that was embedded in a multidisciplinary WMP. We used the Framework method for thematic analysis and identified six key themes that highlighted both the positive and negative aspects of the therapy, including: (1) Positive content of therapy, (2) Positive socialization and support, (3) Positive therapist features, (4) Negative time of therapy/personal circumstances, (5) and Negative process of therapy, and (6) Negative content. This research found that therapeutic engagement will only be achieved with attention to both systemic factors and therapy content that is person centered.
Theme 1: Positives of the content of therapy highlights that participants generally found the therapy sessions helpful, particularly regarding the focus on eating behaviours, food-related advice, and mindfulness exercises. These elements align with existing evidence that integrated psychological and nutritional interventions can enhance mental health outcomes and reduce disordered eating in individuals with HBW [2, 3, 6]. However, some noted that the delivery could have been improved, such as clearer communication or more engaging presentation.
Theme 2: Positives of socialization and support indicates that participants valued the opportunity for group interaction and the sense of comfort derived from shared experiences, echoing findings that social support is a key facilitator in weight management engagement [18, 19]. However, there was frustration with low attendance, which limited the potential for full social support an issue also noted in prior evaluations of WMPs [17].
Theme 3: Negative aspects of therapy revealed that personal circumstances, such as medical issues or family commitments, prevented some participants from attending sessions regularly, consistent with previous research identifying these as key obstacles to engagement in WMPs [16, 17].
Additionally, Theme 4: Negative aspects of the process pointed out that participants were dissatisfied with the structure and format of therapy, particularly that some sessions felt rushed, repetitive, or lacking depth underscoring the challenge of maintaining participant adherence in real-world, outpatient settings [22]. A common concern was that the therapy content was too general and did not address specific needs, especially post-surgery.
Theme 5: Positive suggestions for improvement showed that participants wanted more tailored content, including practical advice on food substitutions and stress management, along with longer sessions and follow-up. Aligning with evidence that dietitian-led interventions improve cardiometabolic and quality-of-life outcomes [11], many suggested that the inclusion of dietitians in the therapy process would improve the relevance and applicability of food-related guidance.
Finally, Theme 6: Participants expressed that some therapy content was unclear, superficial, or misaligned with their needs. Brief discussions, such as those about hunger, were seen as lacking depth, and some felt the group focus was more on food than psychological support. This disconnect particularly affected those not yet in the maintenance phase, leading to reduced engagement, reinforcing the importance of stage-appropriate and emotionally sensitive therapy content to reduce disengagement and promote retention [3, 7]. Additionally, certain activities, like games, were viewed as unhelpful or boring, and some content was described as emotionally triggering, prompting early dropout. These findings highlight the need for more personalized, emotionally sensitive, and stage-appropriate content to improve therapeutic engagement and participant retention.
Overall, the positive outcomes appear to exceed the negative effects, especially when it comes to the content of therapy and the social support aspects. However, the negatives related to session structure, the generality of content, and attendance issues highlight significant areas that need attention. The positive feedback regarding content and social support aligns well with the suggestions for improvement, such as the desire for more tailored, practical advice and longer, more in-depth sessions.
The findings of this study suggest several areas for potential improvement in the therapy program. Tailoring the content more specifically to the individual needs of participants, particularly those post-surgery or facing unique challenges, would address concerns that the therapy felt too general. A more structured and engaging delivery of content is also necessary to maintain participant engagement and ensure that key points are communicated clearly.
Given the positive feedback regarding social support, it may be valuable to strengthen group dynamics and ensure consistent attendance. Addressing attendance issues could involve creating flexible scheduling options, such as evening or weekend sessions, to better accommodate participants' personal commitments or introducing virtual/ online sessions. Incorporating dietitians into the therapy sessions could enhance the practical aspects of the program, providing participants with more concrete guidance on meal planning, food substitutions, and healthier cooking practices.
Finally, expanding the session length and providing follow-up opportunities could enhance the depth and effectiveness of the program. These changes could help address the feedback that sessions sometimes felt rushed or incomplete. In summary, the therapy program has a solid foundation, but the findings indicate that making it more personalized, interactive, and practical could significantly improve participants' experiences and outcomes.
We consider these findings suggest the importance of addressing both the psychological and practical aspects of weight management interventions to enhance engagement and long-term outcomes for individuals with HBW. These insights contribute to the understanding of how to tailor weight management interventions to better suit the unique needs and challenges faced by individuals with HBW, ultimately aiming to improve engagement, therapeutic outcomes, and long-term success in WMPs [36] [37].
Future research could focus on exploring personal barriers that hinder therapy attendance, such as medical or family issues, to develop strategies for improving engagement. Additionally, studying the impact of tailored content, particularly for post-surgery participants, could provide valuable insights into how personalized therapy influences outcomes. Research on incorporating dietitians into therapy and enhancing social support dynamics in group settings would also be beneficial to improve the overall effectiveness of the program.
Participants appreciated the therapy's content, especially regarding eating behaviours, mindfulness exercises, and social support, but they expressed dissatisfaction with its generality and lack of depth. Common concerns included session timing, low group attendance, and personal barriers preventing consistent participation. To address these issues, recommendations include offering more personalized therapy, improving session engagement, incorporating dietitians, and increasing scheduling flexibility by offering an online or hybrid sessions. Strengthening group dynamics and ensuring consistent attendance would also enhance social support, making the therapy more effective for participants.
Strengths and Limitations
This is a real-world study in an outpatient multidisciplinary WMP. The population studied had class 3 obesity, where data is significantly lacking. The main limitation of this study was that the feedback was only from a small sample size. The analysis was a content analysis, and the interview was not designed to explore people’s experiences in depth. A further limitation was a reliance on self-reported assessments, which may be subject to reporting and recall biases. However, the strength of the study was that we obtained feedback from the entire sample whether or not they perceived they have improved.
The nature of the qualitative research such as this present study is that it is subjective and may not generalize. Future research should build on this qualitative study with experimental methods to test the hypothesis generated for example, the efficacy of a revised therapy manual that has a capacity to more person centered and the reducing the barriers that were identified in the delivery of the therapy.
Weight loss maintenance is one of the major challenges facing people with HBW who participate in WMPs. We present results to better understand how a focused psychological group therapy may help people in this critical phase of treatment. The findings highlight the importance of therapeutic engagement, as well as practical elements such as the timing of therapy sessions and content that is tailored to participants' needs. Designing therapy programs should be seamlessly integrated with the broader weight management approach to avoid conflicting or redundant messaging. For individuals with eating disorders, it is crucial to prioritize mental health by addressing key areas such as adaptive functioning, interpersonal difficulties, mood regulation, emotional tolerance, and trauma. These aspects must take precedence above weight-related concerns to ensure a comprehensive and effective treatment plan.
Ethics Approval
This study was approved by the Human Research Ethics Committee of Western Sydney University (H13832, August 2020) and the South-Western Sydney Local Health District Research Ethics Committee (2019/ETH12128). Participants provided written informed consent at the time of initial recruitment
Declaration of Helsinki Strobe reporting guideline
This study was conducted in accordance with the Declaration of Helsinki.
Data Availability
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Author Contributions
Conceptualisation, M.P. and P.H.; methodology, M.P., N.F., and P.H.; formal analysis, M.M. and N.F.; investigation, M.P., N.F..; resources, M.P.; data curation, M.M. and N.F.; writing-original draft preparation, N.F.; writing-review and editing, M.P., M.M., and P.H. All authors have read and agreed to the published version of the manuscript.
P.H. receives sessional fees and lecture fees from the Australian Medical Council, Therapeutic Guidelines publication, and New South Wales Health Education and Training Institute and royalties from Hogrefe and Huber, McGraw Hill Education, and Blackwell Scientific Publications, and she has received research grants from the NHMRC and ARC. She is the Chair of the National Eating Disorders Collaboration Steering Committee in Australia (2019-current) and was Member of the ICD-11 Working Group for Eating Disorders (2012–2018) and was the Chair of the Clinical Practice Guidelines Project Working Group (eating disorders) of RANZCP (2012–2015). She has prepared a report under contract for Shire Pharmaceuticals (July 2017) and received travel and consulting fees for educational activities from Takeda (formerly Shire). M.P. has received travel and consulting fees for educational activities from Takeda Pharmaceuticals, Novo Nordisk, Eli Lilly, Johnson and Johnson, and iNova Pharmaceuticals and was on the guideline development committee for the National Eating Disorder Collaboration ‘Management of eating disorders for people with higher weight: clinical practice guideline (2022)’. All the views in this paper are their own.
This study was funded by the Ainsworth Foundation as a charitable research grant to PH through Western Sydney University.
The Authors would like to acknowledge the valuable time and effort of the volunteers and the staff at the South-Western Sydney Metabolic Rehabilitation and Bariatric Program at Camden Hospital who have participated in this study. Special thanks to Catherine Tesoriero, clinical psychologist who conducted the groups and Liz Stellino who helped organise the groups and collate some of the data.
Foroughi N, mohsin m, Piya M, and Hay P. Barriers to engagement in a psychological therapy group in a multidisciplinary weight management program: a qualitative study. J psychiatry brain sci. 2025, submitted for review.
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I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.
To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina
Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.
Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.
Dear Maria Emerson, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. I am delighted to have published our manuscript, "Acute Colonic Pseudo-Obstruction (ACPO): A rare but serious complication following caesarean section." I want to thank the editorial team, especially Maria Emerson, for their prompt review of the manuscript, quick responses to queries, and overall support. Yours sincerely Dr. Victor Olagundoye.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. Many thanks for publishing this manuscript after I lost confidence the editors were most helpful, more than other journals Best wishes from, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Agrippa Hilda, Editorial Coordinator, Journal of Neuroscience and Neurological Surgery. The entire process including article submission, review, revision, and publication was extremely easy. The journal editor was prompt and helpful, and the reviewers contributed to the quality of the paper. Thank you so much! Eric Nussbaum, MD
Dr Hala Al Shaikh This is to acknowledge that the peer review process for the article ’ A Novel Gnrh1 Gene Mutation in Four Omani Male Siblings, Presentation and Management ’ sent to the International Journal of Clinical Case Reports and Reviews was quick and smooth. The editorial office was prompt with easy communication.
Dear Erin Aust, Editorial Coordinator, Journal of General Medicine and Clinical Practice. We are pleased to share our experience with the “Journal of General Medicine and Clinical Practice”, following the successful publication of our article. The peer review process was thorough and constructive, helping to improve the clarity and quality of the manuscript. We are especially thankful to Ms. Erin Aust, the Editorial Coordinator, for her prompt communication and continuous support throughout the process. Her professionalism ensured a smooth and efficient publication experience. The journal upholds high editorial standards, and we highly recommend it to fellow researchers seeking a credible platform for their work. Best wishes By, Dr. Rakhi Mishra.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. The peer review process of the journal of Clinical Cardiology and Cardiovascular Interventions was excellent and fast, as was the support of the editorial office and the quality of the journal. Kind regards Walter F. Riesen Prof. Dr. Dr. h.c. Walter F. Riesen.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. Thank you for publishing our article, Exploring Clozapine's Efficacy in Managing Aggression: A Multiple Single-Case Study in Forensic Psychiatry in the international journal of clinical case reports and reviews. We found the peer review process very professional and efficient. The comments were constructive, and the whole process was efficient. On behalf of the co-authors, I would like to thank you for publishing this article. With regards, Dr. Jelle R. Lettinga.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, I would like to express my deep admiration for the exceptional professionalism demonstrated by your journal. I am thoroughly impressed by the speed of the editorial process, the substantive and insightful reviews, and the meticulous preparation of the manuscript for publication. Additionally, I greatly appreciate the courteous and immediate responses from your editorial office to all my inquiries. Best Regards, Dariusz Ziora
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation, Auctores Publishing LLC, We would like to thank the editorial team for the smooth and high-quality communication leading up to the publication of our article in the Journal of Neurodegeneration and Neurorehabilitation. The reviewers have extensive knowledge in the field, and their relevant questions helped to add value to our publication. Kind regards, Dr. Ravi Shrivastava.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, Auctores Publishing LLC, USA Office: +1-(302)-520-2644. I would like to express my sincere appreciation for the efficient and professional handling of my case report by the ‘Journal of Clinical Case Reports and Studies’. The peer review process was not only fast but also highly constructive—the reviewers’ comments were clear, relevant, and greatly helped me improve the quality and clarity of my manuscript. I also received excellent support from the editorial office throughout the process. Communication was smooth and timely, and I felt well guided at every stage, from submission to publication. The overall quality and rigor of the journal are truly commendable. I am pleased to have published my work with Journal of Clinical Case Reports and Studies, and I look forward to future opportunities for collaboration. Sincerely, Aline Tollet, UCLouvain.
Dear Ms. Mayra Duenas, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. “The International Journal of Clinical Case Reports and Reviews represented the “ideal house” to share with the research community a first experience with the use of the Simeox device for speech rehabilitation. High scientific reputation and attractive website communication were first determinants for the selection of this Journal, and the following submission process exceeded expectations: fast but highly professional peer review, great support by the editorial office, elegant graphic layout. Exactly what a dynamic research team - also composed by allied professionals - needs!" From, Chiara Beccaluva, PT - Italy.
Dear Maria Emerson, Editorial Coordinator, we have deeply appreciated the professionalism demonstrated by the International Journal of Clinical Case Reports and Reviews. The reviewers have extensive knowledge of our field and have been very efficient and fast in supporting the process. I am really looking forward to further collaboration. Thanks. Best regards, Dr. Claudio Ligresti
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation. “The peer review process was efficient and constructive, and the editorial office provided excellent communication and support throughout. The journal ensures scientific rigor and high editorial standards, while also offering a smooth and timely publication process. We sincerely appreciate the work of the editorial team in facilitating the dissemination of innovative approaches such as the Bonori Method.” Best regards, Dr. Giselle Pentón-Rol.
