PONE-D-19-26947

Predictors of self-management practice among diabetic patients attending western Oromia hospitals, Ethiopia

PLOS ONE

Dear Dereje Chala Diriba

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.

==============================

The topic appears to be the most studied in most part of Ethiopia including Oromia region.

Abstract:

The methods are very short sighted to provide proper information. The result looks fragmented. The conclusion drawn not based on the finding?

Introduction:

This section included literature review from different part of the world including Ethiopia. I found this necessary to make a strong argument in the discussion section. However, the write up looks very inconsistent and juggling from the beginning to the end. You should follow introduction writing guide line. Since, the topic is highly researched in various part of Ethiopia I recommend authors to incorporate as many literature from Ethiopia as possible.

Methods:

I have noticed similar study had been conducted one year prior to this study in Nekemet, Western Oromia region. What is your rationale to Nekemete Hospital in this study?

How you operationally defined the study variables in this research? What is your dependent and independent variables?

How you developed the questionnaire? How you validate your questionnaire? Where you pretested the questionnaire?

Result:

The socio-demographic section seems to have included junk of information and redundancy. You must take account of socio-demographic variables than unrelated information. In general, the result section is full of in consist, in comprehensive and fragments of data. Most of the paragraph appears to have a copy and paste. I would recommend the authors to give appropriate time to evaluate the manuscript from the beginning to the end before submission to make sure the information built-in is clear and vivid information to understand.

Discussion:

As it has been said this topic is one of the most studied, hence the chance to get appropriate literature to make a strong argument on the finding is likely very high even in Ethiopia. However, the arguments are shallow, not based on evidence and weak. Why you cited literature which doesn’t have any similarity to the study setting, for instance America and others. This makes the discussion very shallow and inadequate.

What is the limitation of this study?

Conclusion:

How do you measure whether self-care is good or bad? There is no single statement in the methods section that clearly defined self-care and how it was measured. Overall, the conclusion not inferred from the analyzed result.

==============================

We would appreciate receiving your revised manuscript by Dec 06 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.

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We look forward to receiving your revised manuscript.

Kind regards,

Solomon Assefa Woreta

Academic Editor

PLOS ONE

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4. Please include additional information regarding the survey or questionnaire used in the study and ensure that you have provided sufficient details that others could replicate the analyses. For instance, if you developed a questionnaire as part of this study and it is not under a copyright more restrictive than CC-BY, please include a copy, in both the original language and English, as Supporting Information.

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Additional Editor Comments (if provided):

The topic appears to be the most studied in most part of Ethiopia including Oromia region.

Abstract:

The methods are very short sighted to provide proper information. The result looks fragmented. The conclusion drawn not based on the finding?

Introduction:

This section included literature review from different part of the world including Ethiopia. I found this necessary to make a strong argument in the discussion section. However, the write up looks very inconsistent and juggling from the beginning to the end. You should follow introduction writing guide line. Since, the topic is highly researched in various part of Ethiopia I recommend authors to incorporate as many literature from Ethiopia as possible.

Methods:

I have noticed similar study had been conducted one year prior to this study in Nekemet, Western Oromia region. What is your rationale to Nekemete Hospital in this study?

How you operationally defined the study variables in this research? What is your dependent and independent variables?

How you developed the questionnaire? How you validate your questionnaire? Where you pretested the questionnaire?

Result:

The socio-demographic section seems to have included junk of information and redundancy. You must take account of socio-demographic variables than unrelated information. In general, the result section is full of in consist, incomprehensive and fragments of data. Most of the paragraph appears to have a copy and paste. I would recommend the authors to give appropriate time to evaluate the manuscript from the beginning to the end before submission to make sure the information built-in is clear and vivid information to understand.

Discussion:

As it has been said this topic is one of the most studied, hence the chance to get appropriate literature to make a strong argument on the finding is likely very high even in Ethiopia. However, the arguments are shallow, not based on evidence and weak. Why you cited literature which doesn’t have any similarity to the study setting, for instance America and others. This makes the discussion very shallow and inadequate.

What is the limitation of this study?

Conclusion:

How do you measure whether self-care is good or bad? There is no single statement in the methods section that clearly defined self-care and how it was measured. Overall, the conclusion not inferred from the analyzed result.

[Note: HTML markup is below. Please do not edit.]

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

Reviewer #3: Partly

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

Reviewer #1: Yes

Reviewer #2: No

Reviewer #3: Yes

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

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

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4. 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: No

Reviewer #2: No

Reviewer #3: No

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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: This is a study on self-management practice among diabetes patients in Ethiopian hospital setting. The authors do a great job in providing the big picture of diabetes in Ethiopian context and identifying those predictors of self-management practice. They followed a rigor procedure in their study design, analysis and reporting. This study adds a valuable information in the management of diabetes in western Oromia hospitals by providing some predictors for self-management practice.

This study has several issues that need to be addressed before being considered for publication.

• The introduction is well written but does not inform the reader about the importance of measuring the self-management practice among diabetes patient. Why we should seek to measure the self-management practice of diabetes among other chronic illness should be explained.

• What self-management is not described to a reader in the introductory section, rather the definition happened in a latter section of the manuscript (at the beginning of the discussion). This is not good without introducing the concept at the beginning but presenting the result and defining the term in the discussion.

• As the authors reviewed there are several studies conducted in Ethiopia (Harar, Nekemte, Addis Ababa). Therefore, why they are interested to do same topic in Ethiopia at western Oromia is not clear. The justification made as to why this study is conducted is not very convincing. For instance, 45% of participants at Nekemte referral hospitals had poor diabetes self-management though 54.3% of them had diabetic related knowledge, it worth doing a study why such level of practice with higher level of knowledge and what are the factors for such low self-care practice using other study design such as case-control than repeating same study in same place.

• The last section of introduction mentioned the absence of diabetic self-management education program in the country. However, the relevance of mentioning this concept in this section is not explained. The authors know this idea in advance and makes them even to forward a recommendation on establishing the education center. The claims are not placed properly in the context of the previous literature. Generally, the introduction should be re-written signifying the importance of doing this study in the light of “effective patient self-management is necessary to prevent adverse health outcomes of diabetes” among diabetes patients in lower-middle income countries including Ethiopia.

Reviewer #2: Abstract:

• Under method section number of study participants needs to be included

• Under result number of those who have either good or poor self care management needs to be indicated.

• The conclusion should be in line with the pertinent finding described under abstract

• Recommendation is not in line with conclusion.

Introduction

• Definition of self care management needs to be included.

• References needs to be in logical order.

Methods

The study setting is not well described.

Tools used to assess self care management was not clearly indicated.

Analysis method for self care management is not indicated.

Under ethical clearance future tense was used.

Result

• Standard deviation of mean age should be reported in plus or minus, not only plus

• Under table 1 you put asterisk on the other category of religion, but not define it below the table as footnote.

• Eye problems which is considered as one complication of DM is indicated by two different numbers.

• Rather than including other information better narration follows similar table.

• There is redundancy of narration about patients believe of diabetic treatment before and after table 2

• Under statements which is written above the title “predictors of self management” under result section, there is a statement which says figure 2, but there is no figure in the document.

• Better you include all variable you consider for logistic regression to table 3 with their respective confidence interval and odds ratio rather than duplicating it under table 4

• How you found at the end two predictor variable using logistic regression is not clearly explained.

• Revise your interpretation of logistic regression especially your comparison of occupation.

• How self care management is measured?????????? And classified as good and poor under the title “level of self care practice” are not clearly indicated.

Discussion

Your discussion needs revision. Implications given by the researcher is not satisfactory.

Conclusion

The conclusion is not in line with that of the title of the study and there are repeated copying and pasting of what is already described under result section.

Reference

Some of the references listed are not utilized for preparation of the manuscript

Finally competing interest and list of abbreviations/acronyms are not included to the manuscript

Reviewer #3: The authors tried to make allignment between title, objective, results and conclussion . However the manuscript need further revision and modification particularly the reporting format and language used during reporting.

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: Yes: Markos Desalegn Beyene

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files to be viewed.]

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Attachments

Attachment

Submitted filename: reviewer comments on predictors of self managment among diabetic patient.docx

Attachment

Submitted filename: Manuscript review feed back dm.docx

PONE-D-19-26947R1

Predictors of self-management practices among diabetic patients attending hospitals in western Oromia, Ethiopia.

PLOS ONE

Dear Dr. Dereje Chala,

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.

==============================

I gain would like to applaud for putting together the effort to make the necessary improvement on the manuscript. Most of the comments and feedback that have been given by reviewers appears to be corrected and incorporated accordingly, but there are few issues need to be addressed in order to proceed to the next step. For instance, the definition used to describe knowledge has a preconceived notion. Did you evaluate knowledge based on individual question mean or the summation mean of the knowledge questions? Secondly, the argument used to discuss the finding seems to be so frail and not enough to provide vivid clarification. In general, this section needs to have literary supported evidence with clear reference or citation for your argument. For example, the first paragraph in the discussion section has compared and contrasted other studies with your current, but the statement used to ornate the argument read as “This could be related to change to diabetic education in different ways. Thus, sustainable scheduled diabetic education is very crucial to increase self-management practice.” Where did you get this information? Is this information research driven or based on the predetermined knowledge? Hence, all the argument you might reach need to have study based explanation or argument. Make sure you make the necessary changes in this section to eliminate the inconsistency.

==============================

We would appreciate receiving your revised manuscript by Mar 21 2020 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.

To enhance the reproducibility of your results, we recommend that if applicable you deposit your laboratory protocols in protocols.io, where a protocol can be assigned its own identifier (DOI) such that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). This letter should be uploaded as separate file and labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. This file should be uploaded as separate file and labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. This file should be uploaded as separate file and labeled '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.

We look forward to receiving your revised manuscript.

Kind regards,

Solomon Assefa Woreta

Academic Editor

PLOS ONE

Additional Editor Comments (if provided):

I gain would like to applaud for putting together the effort to make the necessary improvement on the manuscript. Most of the comments and feedback that have been given by reviewers appears to be corrected and incorporated accordingly, but there are few issues need to be addressed in order to proceed to the next step. For instance, the definition used to describe knowledge has a preconceived notion. Did you evaluate knowledge based on individual question mean or the summation mean of the knowledge questions? Secondly, the argument used to discuss the finding seems to be so frail and not enough to provide vivid clarification. In general, this section needs to have literary supported evidence with clear reference or citation for your argument. For example, the first paragraph in the discussion section has compared and contrasted other studies with your current, but the statement used to ornate the argument read as “This could be related to change to diabetic education in different ways. Thus, sustainable scheduled diabetic education is very crucial to increase self-management practice.” Where did you get this information? Is this information research driven or based on the predetermined knowledge? Hence, all the argument you might reach need to have study based explanation or argument. Make sure you make the necessary changes in this section to eliminate the inconsistency.

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files to be viewed.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email us at figures@plos.org. Please note that Supporting Information files do not need this step.

Predictors of self-management practices among diabetic patients attending hospitals in western Oromia, Ethiopia.

PONE-D-19-26947R2

Dear Dr. Diriba,

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.

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Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: