PONE-D-20-24316

Perspectives of compounding pharmacists on alcohol-based hand sanitizer production and utilization for COVID-19 prevention in Addis Ababa, Ethiopia: A descriptive phenomenology study

PLOS ONE

Dear Dr. Baye,

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.

Your article has benefited from three excellent reviews. I found each comment by the reviewers worthy of careful consideration. The reviewers point out several areas to improve the introduction and context of the paper. In addition to that context, it is very important at PLOS ONE to provide clear and transparent information about the methodology and so I recommend focusing on the comments by the reviewers regarding the methodology.  

Please submit your revised manuscript by Jan 15 2021 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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We look forward to receiving your revised manuscript.

Kind regards,

Jim P Stimpson, PhD

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: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: N/A

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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: Yes

Reviewer #2: Yes

Reviewer #3: 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

Reviewer #3: 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: General comments

This is an interesting and informative manuscript looking closely about perspectives of compounding pharmacist on alcohol-based hand sanitizer production and utilization for COVID-19 prevention. The area is worthy of investigation; as relatively little exploration addresses this specific topic. Thus, this would be of interest to readers.

While navigating through the manuscript, there are some punctuation, capitalization and grammar errors that need to be corrected. And I would recommend the manuscript to be proofread again.

Specific comments to each section of the manuscript

Abstract

1. Would authors give explanation about the intent of using two different technical terms “descriptive” phenomenology study in the title of the manuscript and “exploratory” qualitative study in the abstract section?

2. Better to use “in-depth interviews of key-informants for phenomenological study”

3. It is better to use “Findings” instead of “Results” in the qualitative study.

4. It would be good to mention who are the participants or the key informants at least in the beginning of the paragraphs in the results and conclusion section of the abstract. Just like, “The compounding pharmacists in this study had a mean age of 30.6 (±3.1).”

Introduction

1. Every word should be in non-abbreviated form at its first appearance/ mention like COVID-19 and COREQ) (S2_File) etc.

2. Page 4, Line # 63, authors should delete “is” and rewrite it as “As ABHR has low irritation to hands….”

3. Page 4, Line # 81, authors justified the relevance of the study using evidences. One of the evidence is emergence of microorganisms resistance to the alcohol in hand sanitizers. Would authors support this with additional literatures?

Methods

1. Page 5, Line # 103: the type of sampling for the selection of participants in this qualitative study should be explained.

2. Page6, Line # 108 and 109, Setting section: It is appropriate to mention the total number of public hospitals in Addis Ababa in the setting part. “The recruitment of key informants was continued until the saturation point was reached at 13th interview and no new information was obtained from the subsequent interviews [17].” ….. this implies there are other possible interviewees.

3. Page 5, Line 111 : Interview tool …. Pls mention here about the use of conducting pilot test in the standardization of the interview tool.

4. Reflexivity –the positionality and perspectives of the researchers is missed in the manuscript. So it is good to incorporate it as it will affect or shape the whole research findings in quality study.

5. Page 7, Line # 138-142, so long as you use thematic content analysis, it is quite clear to follow and adhere to the steps in the thematic analysis. Do you feel it is important list down the steps here?

Results …. Findings

1. Page 9, Line 167, Table 1: Sociodemographic characteristics of the participants (N = 13). Authors should limit the number of vertical and horizontal lines as minimum as possible.

2. It is more advisable for qualitative researcher to have more narration of themes followed by peculiar quotes/ excerpts that underpin it.

3. On the other hand, the phrase “…illustrated by the following excerpts.” is recurrently appears in this section. So, better to reword it to enhance the palatability of the manuscript to the reader.

Discussion and discussion

It is well narrated section. However, I would recommend couple of points for authors.

1. The authors should argue strongly through comparing their findings with findings and experiences of other studies in other settings. So, the discussion should be anchored deeply in literatures.

2. The authors should distill recommendations for policy input and present them in the discussion well.

Reviewer #2: Dear Authors,

Thank you very much for allowing me to review this manuscript. Compounding of sanitizers was an essential extended role of pharmacist during COVID 19 pandemic around the globe.

Your article is very interesting and reflects to the necessity of implementing a good compounding practice and adequate pharmacist training. To make a bigger impression on the stakeholders in your country, I would refer and point out how practice has expanded in developed countries to show the example:

https://www.sciencedirect.com/science/article/pii/S1551741120306628?via%3Dihub .

Please refer also to FIP guidelines: https://www.fip.org/files/content/priority-areas/coronavirus/COVID-19-Guidelines-for-pharmacists-and-the-pharmacy-workforce.pdf

In many pharmacy practices, compounding of sanitizers was one the first privilege’s for our profession at the beginning of SARS-COV-2 pandemic. I would refer to that in the article in the introduction.

The compounding standard was implemented in many EU states as a chapter in Pharmacopeia and urgently submitted by drug registrations office due to sanitizers deficit.

Since the role of compounding pharmacists is now more and more limited, pandemic is a very good chance to promote pharmacist professional skills.

The study was performed in 13 hospitals in the capital city. A very small sample of staff members took part in the project to make a larger impact.

Additionally, you mentioned about the role of compounding pharmacists but it seems they had different education levels.

Please explain, why there are different levels of education and mention this in the text please and if education may inflence anwsers. Older pharmacist are much better train in compounding than young ones.

I would like a clear information on that point please.

Do you have an up to date numbers from Ethiopian Statistical Office? The 2007 population and housing census of Ethiopia is very old, and I am sure that many things has changed. What is an average number of produced sanitizers in all this 13 hospitals? Please calculate the volume.

My final question, why did you decided to use this methodology, if this kind methodology is commonly used in nursing and midwifery research mainly?

I am missing the study limitation. I would not make my decision based on such a small number of participants, this was rather to show the problem, not to make an embracing change.

Please kindly update your manuscript references and answer my quires.

Thank you.

Reviewer #3: Concerns:

1. How do you evaluate the content validity of the interview guide? It has to be clearly described

2. While the topic and objective of the manuscript is to explore the perspective and experience of compounding pharmacists on production and utilization of ABHR solution, the interview guide consists of question #15 and 16. For example, Participants were asked to reflect on their believe on how they are duly recognized and reimbursed for their public health services to combat COVID-19 in Ethiopia

3. How many pharmacies were there in Addis Ababa? how many of them were producing ABHR at the time of data collection? how do you select study participants (sampling technique if any) .....need to be clarified so that the readers may evaluate the representativeness of the sample used

4. better to use most recent data on population of AA

5. …."The recruitment of key-informant was continued until the saturation point was reached at 13th interview and no new information was obtained from the subsequent interviews…." VS “ ….When no addition information was found from participants the content of the interviews was deemed to be saturated”......clarify the two different statements. What do we mean saturation point in qualitative study?

6. The statement "On the reverse, few did not perceive that pharmacists are information experts regarding sanitizers use" does not support the excerpt which follows it...needs modification

7. The language used while translating the Amharic tape record or note to English (excerpts) needs revision for grammatic errors

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

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Attachments

Attachment

Submitted filename: Birhanu_Reviewer Comments Nov , 2020.docx

PONE-D-20-24316R1

Perspectives of compounding pharmacists on alcohol-based hand sanitizer production and utilization for COVID-19 prevention in Addis Ababa, Ethiopia: A descriptive phenomenology study

PLOS ONE

Dear Dr. Baye,

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.

This article does not meet publication criteria #5 https://journals.plos.org/plosone/s/criteria-for-publication. PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. I recommend that authors seek independent editorial help before submitting a revision. These services can be found on the web using search terms like “scientific editing service” or “manuscript editing service.”

Please submit your revised manuscript by Mar 27 2021 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,

Jim P Stimpson, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (if provided):

This manuscript needs another round of revisions to clarify the writing. Be as specific as possible and provide the data.

I will illustrate from the Abstract given how important this part of the manuscript is for indexing and dissemination, but this comment extends beyond the abstract to the entire paper.

Page 2 Line 34: Add more details about the methods. For example, how were the pharmacists selected?

Page 2 Line 36-37: “The compounding pharmacists in this study had a mean age of 30.6 (±3.1) years and men were the dominant one.”

Instead, of “men were the dominant one,” you should provide the descriptive stats for what proportion were male.

Lines 37-38: “Most participants believed that the compounding practice with

their respective sites followed the principles of good compounding practice.” Define what “most participants” means. Provide the data.

Lines 41-43: “Study participants demand incentive mechanisms and reimbursements for experts involved in compounding of ABHR solutions.” Did they “demand” incentives or is there a better word choice like “suggested” or “recommended.”

Lines 45-47: “Few of participants the compounding pharmacists indicated that the compounding practice lack compliance of good compounding practice due to lack of convenient compounding room, quality control tests, sufficient manpower and equipment.” This is an awkward sentence that needs significant revision. What does “few of the participants” mean? The word “lack” is used twice which confuses the meaning in the sentence.

Here are more examples from the Methods section, which is also critical for readers to understand the study. Again, this is not an exhaustive list, but illustrates the need for greater attention to the writing quality.

Page 6 Lines 110-111: “The compounding pharmacists who had agreed to participate in the study were approached.” Approached by whom? In what way were they approached? This sentence either needs to be clarified or deleted.

Lines 111-113: “The recruitment of key- informants was continued until the saturation point was reached at 13th interview and as no new information was obtained from the subsequent interviews.” 13th should be spelled out as thirteenth. The word “the” should proceed 13th. This sentence is unclear as it suggests that 13 interviews were conducted but infers that more were conducted but that the subsequent interviews did not yield new information. Therefore, 13 interviews were used for the analysis but how many interviews were conducted?

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Perspectives of compounding pharmacists on alcohol-based hand sanitizer production and utilization for COVID-19 prevention in Addis Ababa, Ethiopia: A descriptive phenomenology study

PONE-D-20-24316R2

Dear Dr. Baye,

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.

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Kind regards,

Jim P Stimpson, PhD

Academic Editor

PLOS ONE

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