PONE-D-20-11202

Measuring Italian Citizens’ Engagement in the First Wave of the COVID-19 Pandemic Containment Measures: A Cross-sectional Study

PLOS ONE

Dear Dr. Barello,

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.

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Wen-Jun Tu

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

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

Reviewer #1: No

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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: 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

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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: The manuscript by Barello et al presents the results of online survey administered between February 28th and March 4th 2020 among 1000 persons in Italy. It has several interesting and potentially important findings, however, the manuscript should be substantially revised to overcome numerous pitfalls listed below.

1. The manuscript requires correction of English, since sometimes there are expressions which hard to understand. The manuscript should be checked for the vocabulary, and some non-existing words like “iperactive” should be corrected.

2. In the “Abstract” the description of statistical methods “To investigate the relationship between Health Engagement and these variables, a series of ANOVAs, Logistic regressions and crosstabs have been carried out” should be changed to avoid plural form of analyses, and clarify what does the “crosstabs” mean.

3. The “Abstract” should include a brief characteristic of the “Health Engagement (PHE-S)” metric.

4. The authors cite their own previously published papers to support the patient health engagement importance, and in general it is normal if not excessive. However, the “patient health engagement” search in PubMed returns over 30,000 results, and more equilibrated balance between self-citation and citation of other research groups would be much better.

5. The only two references supporting the detailed explanations of the “Patient Health Engagement model” at line 116 present the papers published by the authors. If this model is unique and has not been applied by others, this should be stated explicitly. The lack of validating studies for this model from independent research groups (if this is a case) should also be indicated.

6. Moreover, the description of the model itself at lines 116-140 is not very clear and should be revised. The consequences of four model positions should be provided. The description of the first “blackout” phase (in the authors’ terminology) as “psychologically frozen and behaviorally paralyzed” is not very compliant with the current epidemic, since many persons continued to follow their routine life style soon after the initial epidemic. The overall details provided for the model is very scarce.

7. The statement at line 201 “For this study purposes the PHE- s® was slightly revised in order to adapt the items formulation to the specific contest of the health emergency” indicates the modification of the original model. But no details provided about this “slightly revised” model.

8. In the “Methods” it is not clear how “using random digit dialing” the participants were selected for the online survey.

9. The authors stated that almost 3% of involved survey participants were excluded because they indicated during the survey wrong age or sex compared to initially registered in the commercial panel they used. But if the discrepancy for sex or age is as high as 3%, how we could be confident that the participants provided the meaningful answers to other questions and not just click over answers to receive a financial incentives for completing the survey?

10. While the authors stated the sample was representative, they did not provide comparison to the Italian adult population data, and the representativeness of the sample remains questionable.

11. At line 182 the authors stated that “Ethical approval was obtained from the institutional review board at Catholic University of Milan (IRB#2019-12)”, that seemingly indicate the IRB occurred in December 2019, when nobody known about COVID-19 epidemic. Please could you address this issue, and provide the Ethical approval in the Supplement?

12. The idea to study the trust to authorities is very interesting, but the questions used seem questionable. Particularly, the statement “I fully trust the National Healthcare System” rated by on a scale ranging between 1 (completely disagree) to 5 (completely agree) is very non-specific, and could reflect not the trust to authorities but believes about financial stability of the NHS. This is a strong limitation, since it is among the central topics of the manuscript, and requires a caution reflection in the “Discussion”.

13. Moreover, the question about media reliability (lines 228-231) is not related at all to the trust to authorities, and thus the whole analysis on measurement of trust to authorities become very questionable.

14. The question “have you reduced meals in ethnic restaurants?” at line 244 has no sense for persons who not visiting ethnic restaurants.

15. The description of questions regarding changes in purchasing behaviors at lines 250-260 is limited and does not contain the possible answer.

16. As a general consideration, instead of describing all questions in the “Study measures” section, the authors could provide the complete questionnaire used during survey in the Supplement, and describe in the “Study measures” more precisely the meaning of the questions used.

17. The presentation of the “Results” in Table 1, 3 and 4, 7 is not compliant for publication but resembles more the output from statistical software.

18. Table 1 contains the description of the classification of participants according to the “Chronic patient” category, but any details about its definition are absent in the “Methods”.

19. The “Partial Credit Rasch Model” described in “Results” should be described in the “Methods”, and of course it should be supported by the relevant references to the literature (that is insufficient in the manuscript now).

20. Tables should not include abbreviations in the title, or should include footer with their explanations.

21. The authors introduce some concepts “on the fly” in the “Results” without any explanations in the “Methods”, like “Person Separation Index”.

22. The calculation of the “Health Engagement Level“ is not clear, and not described in the manuscript. The authors should provide the exact explanations on which questions they used for defining one of the four possible levels. Without knowing how it was calculated, all subsequent discussion about the role of Health Engagement (that is a central idea of the manuscript) seems not having substantial ground.

23. The same concerns also all metrics mentioned in the Table 4. How the authors calculated “Risk severity”.

24. The description of differences between groups provided at lines 333-336 is repetitive. The same concerns lines 343-346.

25. Many lines that authors put in “Results” to describe statistical methods should be used in “Methods”.

26. Table 6 should not use plural for “logistic regression”, but most importantly should clearly define whether it was uni- or multivariable LR.

27. In the “Discussion” the authors stated that “many of Italian citizens experienced panic and enacted maladaptive behaviors”, without any examples that should be provided.

28. The discussion is rather weak and includes rather few references to studies measuring impact of previous epidemics in other countries. This should be corrected.

29. “Limitations” should include issues pointed above.

30. In the “Practical implications” the authors propose, for example to provide during the “ “psychological blackout”, reassuring messages, aimed at sustaining the emotional

elaboration of the emergency and related worries would be particularly needed”. But they did not clarify what messages they exactly mean, and did not refer previously to any literature suggesting the content of such “reassuring messages”. The same concerns also other proposed by the authors stages of “Patient Health Engagement”. Thus, the practical implications remain rather vague.

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Reviewer #1: No

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PONE-D-20-11202R1

Measuring Italian Citizens’ Engagement in the First Wave of the COVID-19 Pandemic Containment Measures: A Cross-sectional Study

PLOS ONE

Dear Dr. Barello,

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.

Please submit your revised manuscript by Sep 26 2020 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're 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.

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). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

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

We look forward to receiving your revised manuscript.

Kind regards,

Wen-Jun Tu

Academic Editor

PLOS ONE

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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 #2: (No Response)

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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 #2: Partly

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

Reviewer #2: N/A

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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 #2: No

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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 #2: No

**********

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 #2: In table1, chronic patient contained what types of disease and also the YES or No respectively represent the proportion of men and women or the proportion of chronic diseases in the total population?

In table3, the item was HE1,2,3,4,5,what does these mean?

In the part results, which contains too many methods,so please revise and reorganize the results and methods.

4.The following references should be discussed in the revision text.

Cao JL, Hu XR, Tu WJ., & Liu Q. (2020). Clinical Features and Short-term Outcomes of 18 Patients with Corona Virus Disease 2019 in Intensive Care Unit. Intensive Care Medicine, DOI: 10.1007/s00134-020- 05987-7.

Cao JL, Tu WJ, Hu XR, & Liu Q. (2020). Clinical Features and Short-term Outcomes of 102 Patients with Corona Virus Disease 2019 in Wuhan,China. Clinical Infectious Diseases,DOI: 10.1093/cid/ciaa243/ 5814897.

5.While the authors stated the sample was representative, they did not provide comparison to the Italian adult population data, and the representativeness of the sample remains questionable,So on behalf of the people who participated in the research, how to explain the reliability of the experiment

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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.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

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 #2: No

[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.]

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 PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Measuring Italian Citizens’ Engagement in the First Wave of the COVID-19 Pandemic Containment Measures: A Cross-sectional Study

PONE-D-20-11202R2

Dear Dr. Barello,

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

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Wen-Jun Tu

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

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