Gender differences in factors influencing intention to undergo cardiovascular disease health checks: A cross-sectional survey

Ai Theng Cheong; Seng Fah Tong; Karuthan Chinna; Ee Ming Khoo; Su May Liew

doi:10.1371/journal.pone.0239679

Peer Review History

Original SubmissionJune 7, 2020
29 Jul 2020 Decision Letter - Amir H. Pakpour, Editor PONE-D-20-17378 Gender differences in factors influencing intention to undergo cardiovascular disease health checks: a cross-sectional survey PLOS ONE Dear Dr. Cheong, 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 12 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. 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Please refer to our statistical reporting guidelines for assistance (https://journals.plos.org/plosone/s/submission-guidelines.#loc-statistical-reporting). [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: No Reviewer #2: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: No Reviewer #2: No ****** 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 Reviewer #2: Yes ****** 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: 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: Dear author(s), Many thanks for all efforts. Gender differences is one of the insurmountable issues not often dealt with. sexism is always questionable to specialists. your manuscript is overall reasonable and appreciable. However, there are some suggestion below: 1.In Abstract-Results part, please report coefficients with p-value and/or confidence interval. 2.In Abstract-Methods part, please express further information about statistical analysis and present the method of inference. 3.Abstract-Background is too short. please write a bit more about the previous studies before giving the aim of the study. 4.In Abstract- Results part, please follow the usual frame of writing integers, particularly,indexes. I mean SD. please write confidence intervals and p-value with them. 5.In method part, why did not explicate the type of sampling? How did you achieve the number of sub-sample?Is there any way to reach the original data? 6.why did you use hierarchical regression?Were the presumptions checked? 7.How did you apply Pearson correlation while you did use ordinal regression and proportional odds? 8.If you would like to apply log-log function?you should use AIC or BIC for model adequacy checking? 9.why was Pseudo-R2 used? 10.why did you cite some references in your result part??? 11.why does not exist any plot or related path-diagram? Reviewer #2: The study entitled “Gender differences in factors influencing intention to undergo cardiovascular disease health checks: a cross-sectional survey” used a cross-sectional design on a conveniences ample to assess the factors influencing individuals’ intention to undergo cardiovascular disease (CVD) health checks. Below please see my comments. 1. The meanings of internal factor and external factor are unclear. The authors should provide clear definition for internal factor and external factor in both Abstract and the main text. 2. The regression model should include one more block to control the impacts of demographics. That is, age, educational level, marital status, working status, and morbidities should be controlled in all the regression models. 3. The comparisons between males and females are not based on inferential test. The authors should use inferential test to make the comparisons. Please refer to the following papers for more information. Wong, H. Y., Mo, H. Y., Potenza, M. N., Chan, M. N. M., Lau, W. M., Chui, T. K., Pakpour, A. H., Lin, C.-Y. (2020). Relationships Between Severity of Internet Gaming Disorder, Severity of Problematic Social Media Use, Sleep Quality and Psychological Distress. International Journal of Environmental Research and Public Health, 17, 1879. Ou, H.-t., Su, C.-T., Luh, W.-M., & Lin, C.-Y. (2017). Knowing is half the battle: The association between leisure-time physical activity and quality of life among four groups with different self-perceived health status in Taiwan. Applied Research in Quality of Life, 12(4), 799-812. 4. Some languages are not academic (e.g., “This was a subgroup analysis of a bigger study”), I would recommend the authors finding assistance from a professional English editor. 5. The limitations of cross-sectional design and self-reports should be acknowledged. Also, the study did not assess the actual behavior of CVD health checks among these participants. Therefore, it is hard to conclude whether the significant factors are really useful in promoting CVD health checks. 6. The footnote of Table 3 mentions “SE: standard error”. However, Table 3 does not report SE. ****** 6. 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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Revision 1
9 Sep 2020 Author Response Answer to reviewers’ comments Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf We have checked and complied to the requirements. 2.Please refer to any sample size calculations performed prior to participant recruitment. If these were not performed please justify the reasons. Please refer to our statistical reporting guidelines for assistance (https://journals.plos.org/plosone/s/submission-guidelines.#loc-statistical-reporting). Sample size calculation was added. (study design and data collection, page 6-7, line 161-168) For the regression model, the sample size needed was calculated based on the work of Peduzzi et al [23] using the following formula: N=10k/P Where k was the number of independent variables (9 factors were examined in this study) and P was the proportions of intention to undergo CVD health check. The P was estimated from the intention to undergo for CVD health check reported as 83.7% [20]. Thus, the estimated sample size required was 108 for men and women respectively. The larger study recruited 397 participants, providing adequate power for this analysis. Reviewer #1: Dear author(s), Many thanks for all efforts. Gender differences is one of the insurmountable issues not often dealt with. sexism is always questionable to specialists. your manuscript is overall reasonable and appreciable. However, there are some suggestion below: Thank you for the comments and suggestions. 1.In Abstract-Results part, please report coefficients with p-value and/or confidence interval. Revised. (abstract, results, page 2-3, line 47-59) 2.In Abstract-Methods part, please express further information about statistical analysis and present the method of inference. Revised. (abstract, method, page 2, line 42-44) 3.Abstract-Background is too short. please write a bit more about the previous studies before giving the aim of the study. Revision done. Due to word count limitation in abstract, we choose to focus on the methods and results. (abstract, background, page 2, line 31-34) Undergo a health check for cardiovascular disease (CVD) is an important strategy to improve cardiovascular (CV) health. Men are reported to be less likely to undergo cardiovascular disease (CVD) health check than women. Gender difference could be one of the factors influencing health seeking behaviour of men and women. 4.In Abstract- Results part, please follow the usual frame of writing integers, particularly,indexes. I mean SD. please write confidence intervals and p-value with them. Revised. (abstract, results, page 2-3, line 47-59) 5.In method part, why did not explicate the type of sampling? We have added the information. (method, page 5, line 136-138) This was a cross sectional survey using mall intercept interviews [21]. Malaysians aged >30 years who attended a hypermarket were invited to participate in the survey using convenient sampling. How did you achieve the number of sub-sample? As above. (study design and data collection, page 6-7, line 161-168) For the regression model, the sample size needed was calculated based on the work of Peduzzi et al [23] using the following formula: N=10k/P Where k was the number of independent variables (9 factors were examined in this study) and P was the proportions of intention to undergo CVD health check. The P was estimated from the intention to undergo for CVD health check reported as 83.7% [20]. Thus, the estimated sample size required was 108 for men and women respectively. The larger study recruited 397 participants, providing adequate power for this analysis. Is there any way to reach the original data? The original data can be requested from the author if needed. 6.why did you use hierarchical regression? Clarified. (data analysis, page 7-8, line 192-194) This hierarchical ordinal regression was chosen because we would like to know in addition to the internal factors, the effect of external factors on participants’ intention to undergo CVD health checks. Were the presumptions checked? Revised to add clarity. (data analysis, page 8, line 203-210) Model fitness was assessed using the Deviance goodness-of-fit measures [24]. The test of Parallel lines was used to assess the proportional odds assumption. Multicollinearity of the independent variables was examined using variance inflation factor (VIF). The VIFs for independent variables in the models were < 10, which indicated no multicollinearity existed between these variables. The summary results of the presumptions checked and model adequacy using Akaike Information Criterion (AIC) were shown in S1 Table. All final models have the lowest AIC values, indicating these were the optimal models. 7.How did you apply Pearson correlation while you did use ordinal regression and proportional odds? We used Pearson correlation to check collinearity between the 9 factors. We have now removed this and used VIF to check for multicollinearity of the independent variables. (data analysis, page 8, line 205-208) 8.If you would like to apply log-log function? you should use AIC or BIC for model adequacy checking? Thank you for the suggestions. We have revised as suggested (data analysis, page 8, line 208-210) and included the AIC results in S1 Table. 9.why was Pseudo-R2 used? We would like to know in addition to the internal factors, the effect of external factors by comparing the pseudo-R2. Revised as follows (data analysis, page 8, line 199-201). Nagelkerke R2 was used as an estimate of the variance explained by the model. The magnitude of difference in Nagelkerke R2 of the hierarchical model allowed us to compare the importance of these factors sequentially. 10.why did you cite some references in your result part??? We have rechecked the result section and did not cite any references in this section. 11.why does not exist any plot or related path-diagram? We did not test any path effects. Reviewer #2: The study entitled “Gender differences in factors influencing intention to undergo cardiovascular disease health checks: a cross-sectional survey” used a cross-sectional design on a conveniences sample to assess the factors influencing individuals’ intention to undergo cardiovascular disease (CVD) health checks. Below please see my comments. Thank you for the comments and suggestions. 1. The meanings of internal factor and external factor are unclear. The authors should provide clear definition for internal factor and external factor in both Abstract and the main text. We have added the definitions for internal and external factors in the abstract (abstract, method, page 2, line 40-42) and study design and data collection section (page 6, line 146-147). Seven were internal factors that were related to individuals’ attitude, perception and preparedness for CVD health checks and two external factors that were related to external resources [23]. 2. The regression model should include one more block to control the impacts of demographics. That is, age, educational level, marital status, working status, and morbidities should be controlled in all the regression models. Revised (data analysis, page 8, line 196-199) …, the internal factors were included in the first block of the regression followed by the external factors. The demographics (age group, education level, marital status, working status, morbidities) and history of regular health check were considered as confounding variables and were entered in the analysis last. The results were presented in table 3 and 4. 3. The comparisons between males and females are not based on inferential test. The authors should use inferential test to make the comparisons. Please refer to the following papers for more information. Wong, H. Y., Mo, H. Y., Potenza, M. N., Chan, M. N. M., Lau, W. M., Chui, T. K., Pakpour, A. H., Lin, C.-Y. (2020). Relationships Between Severity of Internet Gaming Disorder, Severity of Problematic Social Media Use, Sleep Quality and Psychological Distress. International Journal of Environmental Research and Public Health, 17, 1879. Ou, H.-t., Su, C.-T., Luh, W.-M., & Lin, C.-Y. (2017). Knowing is half the battle: The association between leisure-time physical activity and quality of life among four groups with different self-perceived health status in Taiwan. Applied Research in Quality of Life, 12(4), 799-812. Thank you for the suggestion. However, our objective was to identify significant factors affecting men and women in undergoing health checks, and to compare the differences in the factors identified between men and women. Inferential test to compare the coefficients across men and women was not conducted because we did not intend to compare the magnitude differences between these coefficients. 4. Some languages are not academic (e.g., “This was a subgroup analysis of a bigger study”), I would recommend the authors finding assistance from a professional English editor. We have edited according to formal language as much as we can. Revision done (page 5, line 131-133) This was a sub-analysis of a larger study that examined factors influencing individuals’ intention to undergo CVD health checks. 5. The limitations of cross-sectional design and self-reports should be acknowledged. Also, the study did not assess the actual behavior of CVD health checks among these participants. Therefore, it is hard to conclude whether the significant factors are really useful in promoting CVD health checks. We have added the limitations in the section of strength and limitations (page 16, line 347-354) We were unable to determine the cause and effect relationship due to the cross-sectional study design. Several biases could have occurred due to self-report data such as the socially desirable effect and recall bias from participants. We acknowledged measurement of participants’ actual participation in health checks would be the desired outcome but due to resource constraints, we used intention to undergo health checks as a surrogate for action in this preliminary work. Future study can examine the effectiveness of interventions targeting these factors separately for men and women. 6. The footnote of Table 3 mentions “SE: standard error”. However, Table 3 does not report SE. We have added SE values in Table 3 and 4. Attachments Attachment Submitted filename: Response to reviewers.docx https://doi.org/10.1371/journal.pone.0239679.r002
11 Sep 2020 Decision Letter - Amir H. Pakpour, Editor Gender differences in factors influencing intention to undergo cardiovascular disease health checks: a cross-sectional survey PONE-D-20-17378R1 Dear Dr. Cheong, 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. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. 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 help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- 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. Kind regards, Amir H. Pakpour, Ph.D. Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0239679.r003
Formally Accepted
16 Sep 2020 Acceptance Letter - Amir H. Pakpour, Editor PONE-D-20-17378R1 Gender differences in factors influencing intention to undergo cardiovascular disease health checks: a cross-sectional survey Dear Dr. Cheong: I'm 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 let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, 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. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Amir H. Pakpour Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0239679.r004

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