Review report on ” Data-driven implementation strategy to optimise clinician behaviour change at scale in complex clinical environments: A multicentre emergency care study” (JAN-2024-0837) submitted to Journal of Advanced Nursing.

The present study aimed to develop a theory-informed behaviour change driven strategy to maximise implementation and uptake of HIRAID® (History including Infection risk, Red flags, Assessment, Interventions, Diagnostics, communication, and reassessment) in 30 Australian rural, regional and metropolitan emergency departments.

The text is generally well-written, consistent, and easy to follow. However, there are some grammatical errors, omissions or other mistakes, e.g. lines 161-162: “Prior to integration of qualitative and qualitative findings” should be “and quantitative”, line 178 “who is to delivered it”, line 199: ”the quantitative and quantitative results” should be “qualitative and”. Table 1: km2 is not “kilometre” but “square kilometre”. To mention just a few. The paper is thus in need of some proof-reading.

Major comments
Page 9: The authors write that “The association between implementation sites and variables of interest, namely staff characteristics, behavioural analysis and use of HIRAID® were examined using Chi square test (for categorical variables) and Kruskal- Wallis H test (for numeric variables).” However, this is not tests of associations (in a statistical sense) but tests of differences. It is thus not correct to state e.g. that “There was a statistically significant association between sites and years of emergency nursing experience” (page 10). It should instead read e.g. “years of emergency nursing experience differed significantly between sites”.

When referring to results in the Results section, please include which table you are referring to. Moreover, the P-values referred to in the text should be found in the tables referred to,

Table 2: Please include P-values in this table. Specify when there are more than one possible answer.

Why are data on age and sex missing? These are important demographic characteristics that should be included in Table 2.

Minor comments
Lines 144-148: Please give short descriptions of the domains in the text, e.g., how is knowledge, skills, reinforcement etc defined? or refer to Table 3 regarding this.

Line 192-193: Please explain why α was set to 0.008 in the Bonferroni adjustment.

The resolution of Figures 1 and 2 is too low, making the text especially in Figure 2 hard to read. Please change to figures with higher resolution (likewise for those in the supplementary files).

Review report on ”Data-driven implementation strategy to optimise clinician behaviour change at scale in complex clinical environments: A multicentre emergency care study” (JAN-2024-0837.R1) submitted to Journal of Advanced Nursing.

The authors have answered most of the comments satisfactorily. The are however still some remaining errors that should be corrected:

Row 307: “There concerns were strongly reflected in qualitative responses”: I think the authors meant “These concerns…”

Row 319: “only 13.3%of respondents”: There should be a space between “13.3%” and “of”: “13.3% of…”.

Row 327-328: “Supplementary file 2 Table 2”, add a comma: “file 2, Table 2”.

The resolution of the figures is still too low, 236 x 236 dpi for figures 1-4. This should be increased to at least 300 x 300 dpi, which is the standard print resolution for high resolution output.