Dear Dr. Bongomin,

Thank you very much for submitting your manuscript "Mycetoma: Critical Appraisal of Educational Content on YouTube" for consideration at PLOS Neglected Tropical Diseases. As with all papers reviewed by the journal, your manuscript was reviewed by members of the editorial board and by several independent reviewers. In light of the reviews (below this email), we would like to invite the resubmission of a significantly-revised version that takes into account the reviewers' comments.

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[1] A letter containing a detailed list of your responses to the review comments and a description of the changes you have made in the manuscript. Please note while forming your response, if your article is accepted, you may have the opportunity to make the peer review history publicly available. The record will include editor decision letters (with reviews) and your responses to reviewer comments. If eligible, we will contact you to opt in or out.

[2] Two versions of the revised manuscript: one with either highlights or tracked changes denoting where the text has been changed; the other a clean version (uploaded as the manuscript file).

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Please prepare and submit your revised manuscript within 60 days. If you anticipate any delay, please let us know the expected resubmission date by replying to this email. Please note that revised manuscripts received after the 60-day due date may require evaluation and peer review similar to newly submitted manuscripts.

Thank you again for your submission. We hope that our editorial process has been constructive so far, and we welcome your feedback at any time. Please don't hesitate to contact us if you have any questions or comments.

Sincerely,

Ahmed Hassan Fahal, FRCS, FRCSI, FRCSG, MS, MD, FRCP(London)

Academic Editor

PLOS Neglected Tropical Diseases

Joshua Nosanchuk

Section Editor

PLOS Neglected Tropical Diseases

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Reviewer's Responses to Questions

Key Review Criteria Required for Acceptance?

As you describe the new analyses required for acceptance, please consider the following:

Methods

-Are the objectives of the study clearly articulated with a clear testable hypothesis stated?

-Is the study design appropriate to address the stated objectives?

-Is the population clearly described and appropriate for the hypothesis being tested?

-Is the sample size sufficient to ensure adequate power to address the hypothesis being tested?

-Were correct statistical analysis used to support conclusions?

-Are there concerns about ethical or regulatory requirements being met?

Reviewer #1: 3. Methods: The 3 assessors – are they experienced in the clinical or laboratory aspects of mycetoma? Are they doctors? All presentations need to address particular audiences – so what audience are they?

4. Needs more clarification of DISCERN tool and Global Quality Score – what are the metrics for these results? What is being measured?

Reviewer #2: - It might be helpful to add why videos with less than 100 views were excluded? Is this standard based on past research in video evaluation?

- Consider including how researchers distinguished between consumer and professional groups who uploaded the videos

Reviewer #3: The methodology is well laid out.

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Results

-Does the analysis presented match the analysis plan?

-Are the results clearly and completely presented?

-Are the figures (Tables, Images) of sufficient quality for clarity?

Reviewer #1: 5. Results: is there any data or correlation between the source country and quality? The WHO Mycetoma Collaborating centre is unique. Could these videos be regarded as the ‘highest quality benchmark’ against which to judge others?

6. Presumably with a median duration of 8 minutes, it was impossible for the shorter videos to address clinical presentation, diagnosis and therapy. So how did the these categories of video perform on the quality scores?

7. Can the authors make any general comments about what makes a good video for mycetoma? Clinical photographs? Easily readable slides? Demonstration of diagnostic procedure(s)? Pace of presentation? Depth of data? The reader has no real sense of what the scores are really measuring?

8. The paper should have the listing of all videos scored as a supplementary excel file. Others in the future may wish to address this.

Reviewer #2: Consider putting the actual range of the IQR which may be easier to comprehend quickly for the reader. Right now, it seems like only the upper range is included.

Reviewer #3: The results are clear.

Although the results are interesting, more information on the characteristics of the videos is needed. I suggest include, years, country of publication, type of source (media, user-generated content, health professionals and others) and publication of the videos (news, material created by the user, interviews, advertisements and documentaries).

It is also important to consider information related to the mycetoma discussed in the videos. For example, recommendation for healthcare workers, recommendation for all persons over 18 years of age 15, recommendation for persons 60 years of age or older, diagnosis, treatment, etc.

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Conclusions

-Are the conclusions supported by the data presented?

-Are the limitations of analysis clearly described?

-Do the authors discuss how these data can be helpful to advance our understanding of the topic under study?

-Is public health relevance addressed?

Reviewer #1: Lack of clarity about defines quality

Reviewer #2: - As in introduction, would consider putting some caveats in about actual rise in prevalence of mycetoma rather than just increased reporting due to awareness and diagnostic access.

- Would move the reasoning for excluding videos based on length into methodology section.

- While not systemically evaluated, it could be interesting to touch upon the scientific content that was included (diagnosing, symptoms, etc) and the gaps the authors found in terms of actual content.

- Might be interesting to include some discussion about digital misinformation and the impact on populations trust in medical and public health institutions and how this could impact mycetoma with false information on youtube.

Reviewer #3: Discussion. Include a paragraph with the implications of your findings for public health.

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Editorial and Data Presentation Modifications?

Use this section for editorial suggestions as well as relatively minor modifications of existing data that would enhance clarity. If the only modifications needed are minor and/or editorial, you may wish to recommend “Minor Revision” or “Accept”.

Reviewer #1: Comments

1. Ref 1 is not a good general reference. There are other reviews, including Ref 3.

2. Ref 3 and 4 about the epidemiology and ‘Mycetoma belt ignore the most recent paper of global distribution: https://doi.org/10.1371/journal.pntd.0008397

Reviewer #2: N/A

Reviewer #3: None

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Summary and General Comments

Use this section to provide overall comments, discuss strengths/weaknesses of the study, novelty, significance, general execution and scholarship. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. If requesting major revision, please articulate the new experiments that are needed.

Reviewer #1: This is an interesting topic that has not previously seen much research. YouTube as an educational tool in this field has not been analysed, so the study is novel. The study is well written and results are easy to understand.

Reviewer #2: Thank you so much for the opportunity to review this article examining the quality of mycetoma content on Youtube. The authors take a unique approach to evaluating public health and clinical content on mycetoma, and this article could be really interesting in the context of medical and public health disinformation.

A few considerations for the authors are below:

- Line 51: It is difficult to state the the prevalence of mycetoma is increasing rather than just being reported more often due to raised awareness and access to diagnostics. With very few countries having surveillance systems, consider modifying this language to reflect that cases are being reported more often.

Reviewer #3: In this study aimed at exploring these aspects of YouTube videos on mycetoma. Findings show mycetoma-related videos on YouTube are generally of high quality, with moderate reliability.

Although the study design and results are well described. Information for prevention, diagnosis, management etc. is needed. These recommendations are important for public health and tropical diseases.

Comments:

Although the results are interesting, more information on the characteristics of the videos is needed. I suggest include, years, country of publication, type of source (media, user-generated content, health professionals and others) and publication of the videos (news, material created by the user, interviews, advertisements and documentaries).

It is also important to consider information related to the mycetoma discussed in the videos. For example, recommendation for healthcare workers, recommendation for all persons over 18 years of age 15, recommendation for persons 60 years of age or older, diagnosis, treatment, etc.

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Reviewer #1: No

Reviewer #2: Yes: Dallas J. Smith

Reviewer #3: No

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Dear Dr. Bongomin,

We are pleased to inform you that your manuscript 'Mycetoma: A Critical Appraisal of Educational Content on YouTube' has been provisionally accepted for publication in PLOS Neglected Tropical Diseases.

Before your manuscript can be formally accepted you will need to complete some formatting changes, which you will receive in a follow up email. A member of our team will be in touch with a set of requests.

Please note that your manuscript will not be scheduled for publication until you have made the required changes, so a swift response is appreciated.

IMPORTANT: The editorial review process is now complete. PLOS will only permit corrections to spelling, formatting or significant scientific errors from this point onwards. Requests for major changes, or any which affect the scientific understanding of your work, will cause delays to the publication date of your manuscript.

Should you, your institution's press office or the journal office choose to press release your paper, you will automatically be opted out of early publication. We ask that you notify us now if you or your institution is planning to press release the article. All press must be co-ordinated with PLOS.

Thank you again for supporting Open Access publishing; we are looking forward to publishing your work in PLOS Neglected Tropical Diseases.

Best regards,

Ahmed Hassan Fahal, FRCS, FRCSI, FRCSG, MS, MD, FRCP(London)

Academic Editor

PLOS Neglected Tropical Diseases

Joshua Nosanchuk

Section Editor

PLOS Neglected Tropical Diseases

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