PONE-D-19-16962

Encouraging Perspective Taking: Using Narrative Writing to Induce Empathy for Others Engaging in Negative Health Behaviors

PLOS ONE

Dear Dr Shaffer,

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Paula Pérez-Sobrino, Ph.D.

Academic Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: I Don't Know

Reviewer #2: I Don't Know

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Dr. Frans Derksen

Researcher Primary Health Care/ Gender & Women's Health

Frans.Derksen@radboudumc.nl

Radboud university medical center

Dept. of Primary and Community Care

P.O. Box 9101

6500 HB Nijmegen

The Netherlands

Review manuscript: Encouraging Perspective Taking: Using Narrative Writing to Induce Empathy for Others Engaging in Negative Health Behaviors

Reviewer: Frans Derksen

Comments to the authors:

Dear authors,

Prior Comments: This is a very helpful paper on an important topic. Because too little research has been performed about the interaction of narrative writing with empathy and how this improves the efficiency in patient-GP communication.

Reading the manuscript I realized that it describes two studies, which causes, in my opinion, a hybrid situation (see my remarks). That’s why my remarks mostly are structurally characterized and less about the content of the manuscript.

Abstract: presents the central themes sufficiently but can be more clear when it is presented in a structure such as: goal, method, results, discussion, conclusion.

Introduction: describes important topics, however it is too much and too long. Many topics belong, in my opinion, to the discussion. For instance in a paragraph as “comparison with other research”. Furthermore dated references are used (1993, 1997).

At the end of the discussion a description of a precise gap in research is lacking and the goal of the study has been described ambiguously. In my opinion due to the hybrid situation as described above.

After the general introduction a new introduction starts of study 1, that is confusing.

Method: is a very long paragraph. In my opinion it is useful to summarize. Moreover sometimes the method is mixed up with items from the results paragraph.

Results: after the results the description of the second study starts and after this description a discussion starts. And the discussion lacks a clear arrangement (summary of the study, strengths and limitations, comparison with existing literature) .

Sorry, but at that moment my interest in the manuscript has been disappeared because of the overload of information.

I surely hope it can be published after major improvement. I strongly recommend to separate both studies.

Reviewer #2: • Overall Impression: This study has value for interventions that may help mitigate bias, promote perspective-taking and empathy, and foster considerations for the impact of social determinants of health on patient decision-making and health outcomes.

• Recommendations for writing style/grammar:

o It may be slightly awkward to start the first sentence of the abstract with “People,”. Perhaps something like, “It is very common for people, including health professionals….” OR “Societal expectations of self-care and responsible actions toward others may produce bias against those who engage in perceived self-harming behavior. This is especially true for health professionals, who have dedicated themselves to helping reduce the burden of illness and suffering.”

o In the last sentence of the abstract, the definition of the adjective “dubious” with regard to behavior does not seem to align with the authors’ intended use. Perhaps “irresponsible,” “self-harming” or “adverse” would be clearer to readers?

o Typo, top of page 16, “. There were no prepost differences in reported hopelessness, sadness, excitement, happiness, or concern, p > ,05.” – comma should be replaced with a period to read “p> 0.05.”

o Page 20, for the sentence, “There were no significant time by condition interactions observed for sadness, excitement, happiness, concern, and hopelessness, p > .005.” – did you mean to say “p> 0.05.” rather than 0.005? My understanding is that you were stating that the results in these domains were not significant (eg, p not equal to or less than 0.05), correct?

o Statements in the Results section, such as, “This is unsurprising given that one of the two writing prompts asked participants to specifically write about their character engaging in a difficult situation.” would likely be better placed into the Discussion Section. Results should be stated as such, with any interpretation thereof held until the discussion.

• Study Materials & Study Design

o In future iterations of the study, consider adding “Other/Non-binary” to gender options

o Consider collecting demographic data that includes intended career pathway (helping professions vs other) and past experiences with smoking that might bias a participant (eg, does the study participant has a family member who smokes, or is the participant a current or past smoker? These are variables that may influence perspective-taking.

• Discussion

o I did not see any discussion of limitations to the study. This should be added to the Discussion section.

� Examples:

• Limiting participants to females (study 1) significantly limits generalizability of results, as females have been shown in numerous studies to statistically significantly test at higher empathy levels than males.

• Limiting the study to undergraduate students also limits generalizability to health professionals.

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Reviewer #1: Yes: Frans Derksen

Reviewer #2: No

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Encouraging Perspective Taking: Using Narrative Writing to Induce Empathy for Others Engaging in Negative Health Behaviors

PONE-D-19-16962R1

Dear Dr. Shaffer,

We are pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it complies with all outstanding technical requirements.

Within one week, you will receive an e-mail containing information on the amendments required prior to publication. When all required modifications have been addressed, you will receive a formal acceptance letter and your manuscript will proceed to our production department and be scheduled for publication.

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With kind regards,

Paula Pérez-Sobrino, Ph.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Dear authors, I am pleased to inform you that both reviewers agree that their suggestions and comments have been appropriately addressed, and that the manuscript is entirely improved. Many thanks for your hard work and the great spirit with which you have incorporated the suggestions. Congratulations!

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: I Don't Know

Reviewer #2: Yes

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Every part of the manuscript is corrected. The manuscript is entirely improved and allows much more insight into the subject.

Reviewer #2: The authors have incorporated recommended edits. The revised manuscript is substantially stronger, clearer, more transparently and thoughtfully discussed. Well done!!

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

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Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: Yes: Frans Derksen

Reviewer #2: Yes: Jennifer R. Hartmark-Hill, MD, FAAFP