Modeling the Theory of Planned Behaviour to predict adherence to preventive dental visits in preschool children

Maryam Elyasi; Hollis Lai; Paul W. Major; Sarah R. Baker; Maryam Amin

doi:10.1371/journal.pone.0227233

Peer Review History

Original SubmissionSeptember 18, 2019
23 Oct 2019 Decision Letter - Frédéric Denis, Editor PONE-D-19-26262 Modeling the Theory of Planned Behaviour to predict adherence to preventive dental visits in preschool children PLOS ONE Dear Dr. Amin, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. We would appreciate receiving your revised manuscript by Dec 07 2019 11:59PM. When you are ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. 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Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 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: Major points -Figure 2 is difficult to understand and needs to be re-done. Consider breaking the information up into two graphics, adding a color code, and/or move the significant figures to a legend. As it is, arrows overlap the shapes, the shapes are arranged without a discernable pattern, and the significant figures are small and hard to read and it is difficult to determine which metrics go with each interaction effect. -I worry about bias occurring in the study results. By being at the health center, parents were actively engaged in attaining health care for their children and therefore might not be representative of the greater population. Do you have any studies to confirm that 42% a parents seeking dental care visits is close to the average rate. Likewise, is it possible that the context in which the subjects were questioned ( a community health centers ) may have influence healthcare related intentional behavior? Were subjects in a similar context(s) in the other studies you cite that extend the TPB models to: adolescents, young adults, and adults? I would like to see both of these points addressed in the discussion as potential limitations. - Please explain in more detail how an subject’s dental attendance metric was derived from their Oral Health behaviors survey results (sub-section ‘d’ from the Materials and Methods section) – likewise please include the descriptive statistics on these answers in Table 1. Minor points -On lines 324 to 325 you say ‘…83% 325 of children had dental insurance…’ but in Table 1 you report that 74.8% of children had dental insurance – please fix the discrepancy. -The sentence fragments below need to be re-worded (lines 341-343) – One surprising finding was from studying the TPB components. While they were all linked to a higher behavioural intention. However, the behavioural intention was not associated with greater dental attendance. Reviewer #2: Dear Editorial Manager Thank you for having choosing me as a reviewer. • This article is very interesting because it deals with an essential topic : how to predict a healthy behaviour (e.g. preventive visits at the dental office) and how to explain the transition between the intention and the actual attendance. • This article is modeling the true life of our patients : they think they (or their children) must visit the dentist, they want but the actual attendance has never happened or later on. We can read that even the possibility of free preventive visits is underutilized. Is it due to the age of the children ? But as AAPD recommends, the awareness of oral health begins at birth. Do the AAPD recommendations are known by parents ? • This article shows that SOC is very important in the decision. Using SOC for extending the TPB is a good manner to approach the understanding of behaviours related to preschoolers’ oral health and particularly dental attendance. • Knowledge may influence also these oral health behaviours. In a future study, may be a questionnaire on children’ oral health : importance and roles of temporary teeth, formation of the oral microbiote and its consequences etc.... • Just a minor revision : lines 165 and 166 : the results of the Cronbach’s alpha must be in the section « Results ». It’s already written in lines 234 and 235. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). 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Revision 1
6 Dec 2019 Author Response Reviewer: #1 Major points “Figure 2 is difficult to understand and needs to be re-done. Consider breaking the information up into two graphics, adding a color code, and/or move the significant figures to a legend. As it is, arrows overlap the shapes, the shapes are arranged without a discernable pattern, and the significant figures are small and hard to read and it is difficult to determine which metrics go with each interaction effect.” � Response: We appreciate the reviewer’s constructive suggestion. The information provided in Figure 2 is represented in two separate figures, New Figure 2 and Figure 3, to demonstrate the direct and indirect relationships between variables distinctly. Adjustments were made to eliminate overlaps, arrange the shapes, and enlarge the figures. Also, the metrics applied to evaluate the interaction effects were clarified in new figures. “I worry about bias occurring in the study results. By being at the health center, parents were actively engaged in attaining health care for their children and therefore might not be representative of the greater population. Do you have any studies to confirm that 42% a parents seeking dental care visits is close to the average rate? Likewise, is it possible that the context in which the subjects were questioned (a community health centers) may have influence healthcare related intentional behavior? Were subjects in a similar context(s) in the other studies you cite that extend the TPB models to: adolescents, young adults, and adults? I would like to see both of these points addressed in the discussion as potential limitations.” � Response: The reviewer’s abovementioned important points were addressed in the Methods and Discussion sections. The parents were recruited through vaccination programs that hold only at community health centers in Edmonton, AB. According to the 2013-14 Alberta Health Services Report, the overall vaccination rate for preschoolers in Edmonton in 2014 was 91.7%. Therefore, approaching community health centers enabled us to recruit a good representative of our target population. Regarding the reported 42% of dental attendance among pre-schoolers in our study, there is another study done by Locker et al. (Ref #26) reported 42.8% of the regular dental visits among immigrant children and 72.6% among non-immigrant children. Although the age group in these two studies are different but our reported percentage was not comparably high. The following statements has added to the Methods and Discussion sections respectively: - Page 7, lines142-143: “According to the 2013-14 Alberta Health Services Report, the overall vaccination rate for preschoolers in Edmonton was 91.7%.” - Page 20, lines 411-416: “Based on the available data, the vaccination rate in Edmonton in 2013-14 was approximately 91%. Nonetheless, it’s recommended to include mothers who refuse immunizations for their children, as they may have different views about taking their children to receive preventive care services, such as regular dental check-ups. Finally, the external validity of the extended TPB model needs to be investigated in other population groups such as adolescents, young adults, and adults in the future studies.” “Please explain in more detail how a subject’s dental attendance metric was derived from their Oral Health behaviors survey results (sub-section‘d’ from the Materials and Methods section) – likewise please include the descriptive statistics on these answers in Table 1.” � Response: The required changes were made in the body of the manuscript (pages 8-9, lines 174-182) and table 1 (pages 11-12) accordingly. Minor points “On lines 324 to 325 you say ‘…83% 325 of children had dental insurance…’ but in Table 1 you report that 74.8% of children had dental insurance – please fix the discrepancy.” � Response: Thanks for the observation; the percentage reported in Table 1 was corrected. The abovementioned discrepancy has been fixed on page 16, line 325. “The sentence fragments below need to be re-worded (lines 341-343: One surprising finding was from studying the TPB components. While they were all linked to a higher behavioural intention. However, the behavioural intention was not associated with greater dental attendance.” � Response: The abovementioned statement was revised on page 17, lines 341-342: “All TPB components in this study are linked to behavioural intention; however, the behavioural intention failed to translate into dental attendance behaviour.” Reviewer: #2 • This article is very interesting because it deals with an essential topic: how to predict a healthy behaviour (e.g. preventive visits at the dental office) and how to explain the transition between the intention and the actual attendance. This article is modeling the true life of our patients: they think they (or their children) must visit the dentist, they want but the actual attendance has never happened or later on. We can read that even the possibility of free preventive visits is underutilized. Is it due to the age of the children? But as AAPD recommends, the awareness of oral health begins at birth. Do the AAPD recommendations are known by parents? • This article shows that SOC is very important in the decision. Using SOC for extending the TPB is a good manner to approach the understanding of behaviours related to preschoolers’ oral health and particularly dental attendance. • Knowledge may influence also these oral health behaviours. In a future study, may be a questionnaire on children’ oral health: importance and roles of temporary teeth, formation of the oral microbiote and its consequences etc.... � Response: We appreciate the reviewer’s thoughtful feedback that will help us design and develop our future studies. • Just a minor revision: lines 165 and 166: the results of the Cronbach’s alpha must be in the section « Results ». It’s already written in lines 234 and 235. � Response: We acknowledge the reviewer’s remark. The results of Cronbach’s alpha removed from the Method’s section (line 166). Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0227233.r002
16 Dec 2019 Decision Letter - Frédéric Denis, Editor Modeling the Theory of Planned Behaviour to predict adherence to preventive dental visits in preschool children PONE-D-19-26262R1 Dear Dr. Amin, 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. Shortly after the formal acceptance letter is sent, an invoice for payment will follow. To ensure an efficient production and billing process, please log into Editorial Manager at https://www.editorialmanager.com/pone/, click the "Update My Information" link at the top of the page, and update your user information. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to enable them to help maximize its impact. If they will be preparing press materials for this manuscript, you must inform our press team as soon as possible and no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. With kind regards, Frédéric Denis, Ph.D. Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0227233.r003
Formally Accepted
26 Dec 2019 Acceptance Letter - Frédéric Denis, Editor PONE-D-19-26262R1 Modeling the Theory of Planned Behaviour to predict adherence to preventive dental visits in preschool children Dear Dr. Amin: I am pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please notify them about your upcoming paper at this point, to enable them to help maximize its impact. If they will be preparing press materials for this manuscript, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. For any other questions or concerns, please email plosone@plos.org. Thank you for submitting your work to PLOS ONE. With kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Frédéric Denis Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0227233.r004

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