Assessment of preventive behavior and associated factors towards COVID-19 in Qellam Wallaga Zone, Oromia, Ethiopia: A community-based cross-sectional study

Birhanu Gutu; Genene Legese; Nigussie Fikadu; Birhanu Kumela; Firafan Shuma; Wakgari Mosisa; Zelalem Regassa; Yoseph Shiferaw; Lata Tesfaye; Buli Yohannes; Kogila Palanimuthu; Zewudie Birhanu; Desalegn Shiferaw

doi:10.1371/journal.pone.0251062

Peer Review History

Original SubmissionSeptember 7, 2020
11 Dec 2020 Decision Letter - Frank T. Spradley, Editor PONE-D-20-28112 ASSESSMENT OF PREVENTIVE BEHAVIOR AND ASSOCIATED FACTORS TOWARDS COVID-19 IN QELLEM WALLAGA ZONE OROMIA, ETHIOPIA: A COMMUNITY BASED CROSS-SECTIONAL STUDY PLOS ONE Dear Dr. Gutu, 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. An expert in the field handled your manuscript, and we are thankful for their time and contributions. Although interest was found in your study, several major concerns and comments arose during review. Notably, there are questions about the experimental design, statistical analysis, and data presentation. Please address ALL of the reviewer's comments in your revised manuscript. 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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 2. 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. 3. Thank you for stating the following in the Acknowledgments Section of your manuscript: "We would like to acknowledge Dambi Dollo University for financial aid." We note that you have provided funding information that is not currently declared in your Funding Statement. 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Reviewer #1: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: 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 ****** 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 ****** 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: 50 change term "binary" logistic regression for "binomial" logistic regression 169 use logistic regression "with binomial distribution and log link" 50 change Odds Ratio for Prevalence Ratio. reason: It is a cross-sectional, not a case control study. 48 change multistage "systematic" sampling for multistage sampling 51 change test statistical significance for "to express the associations and" 116 remove word "systematic" 171 suggestion: detail the multiple stepwise process. specify if it was forward or backward. add a table to see the in which order the variables enter into the final model. review format in the output of summary(step.model$finalModel)in http://www.sthda.com/english/articles/37-model-selection-essentials-in-r/154-stepwise-regression-essentials-in-r/ 165 observation: no details on how authors setup the survey sampling design prior to the logistic regression step. check: https://scialert.net/fulltext/?doi=ajms.2010.33.39 253 table 6 must specify the variables that were used to adjust the estimate. it also must show the unadjusted PR. put the outcome==1 in the right column (good prev behavior, in this case). 313 specify the reason of the restriction to make your data fully available 244 suggest to create figures to show the likert scale results as here https://www.r-graph-gallery.com/202-barplot-for-likert-type-items.html or here https://cran.r-project.org/web/packages/sjPlot/vignettes/plot_likert_scales.html ****** 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. 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 #1: 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/. 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Revision 1
22 Jan 2021 Author Response Response to academic editor’s comments 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. � Authors’ response: the manuscript revised according to PLOS ONE’s style requirements including the file naming 2. 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. � Authors’ response: we revised and put the detail of study tool and its preparation under the “Data collection tool” subtitle in the manuscript and included a copy of both the original language and English, as Supporting Information with the revised manuscript. 3. Financial disclosure statement Authors’ response: This study was funded by Dambi Dollo University. BG received the fund and used for the intended purposes. BG, GL, NF, BK, FS, WM, YS, LT, BY, KP and DS: received salary from Dambi Dollo University. The fund has no specific grant number. The university website is: http://www.dadu.edu.et.org. 4. Data availability � Authors’ response: We uploaded the data file as Supporting Information with the revised manuscript 5. Please amend either the title on the online submission form (via Edit Submission) or the title in the manuscript so that they are identical. � Authors’ response: the title in the manuscript as well as on the online submission form are amended and identical Response to reviewers' comments: Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? Reviewer #1: Yes � Authors’ response: thank you ________________________________________ 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: No � Authors’ response: thank you for all the comments on statistical analysis, and data presentation. We amended all of them as suggested by the reviewer in our revised manuscript. ________________________________________ 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 � Authors’ response: We uploaded our data as supporting information ________________________________________ 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 Authors’ response: Thank you ________________________________________ 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: 48 Change multistage "systematic" sampling for multistage sampling � Authors’ response: accepted and change made 50 Change term "binary" logistic regression for "binomial" logistic regression � Authors’ response: modified as per the comment 50 Change Odds Ratio for Prevalence Ratio. Reason: It is a cross-sectional, not a case control study. � Authors’ response: Prevalence Ratio replaced the Odds Ratio throughout the entire manuscript 51 Change test statistical significance for "to express the associations and" � Authors’ response: change made and "to express the associations and" is used instead of “test statistical significance for” 116 Remove word "systematic" primarily � Authors’ response: the word "systematic" is deleted 169 Use logistic regression "with binomial distribution and log link" � Authors’ response: change made as per the comment 165 Observation: no details on how authors setup the survey sampling design prior to the logistic regression step. Check: https://scialert.net/fulltext/?doi=ajms.2010.33.39 � Authors’ response: we accept the observation and thoroughly explained the sampling design in our manuscript as “sampling technique”; all the necessary steps we followed to reach the study unit (the households) and the respondents has discussed in the manuscript. 171 Suggestions: detail the multiple stepwise processes. Specify if it was forward or backward. add a table to see the in which order the variables enter into the final model. review format in the output of summary(step.model$finalModel)in http://www.sthda.com/english/articles/37-model-selection-essentials-in-r/154-stepwise-regression-essentials-in-r/ � Authors’ response: Of course we planned to use multiple stepwise processes that would create the model that best fit our data based on the reality that we have large number of variables from our study. However, in our actual analysis all the methods produce similar model with similar Hosmer and Limshow’s model adequacy test result and as a reason we randomly used forward (conditional) method for variable entry in to the analysis. We also add a table titled “Variables in the Equation” from the output to see the in which order the variables enter into the final model as “supporting information” in our revised manuscript. 244 suggest to create figures to show the likert scale results as here https://www.r-graph-gallery.com/202-barplot-for-likert-type-items.html or here https://cran.r-project.org/web/packages/sjPlot/vignettes/plot_likert_scales.html � Authors’ response: figures to show the likert scale results created as suggested 253 table 6 must specify the variables that were used to adjust the estimate. it also must show the unadjusted PR. put the outcome==1 in the right column (good prev behavior, in this case). � Authors’ response: From the unadjusted analysis, we found only four variables which have a statistically significant association with the outcome variable namely residence, comprehensive knowledge, social media as trusted source of information, and traditional healers as trusted source of information. First, we used all these variables to determine the adjusted estimate. While the residence, knowledge and social media show statistically significant association in the model, traditional healers as trusted source has no statistically significant association with the outcome variable but still in the final model. Then we decided to use only the three variables to develop the model removing traditional healers as trusted source to compare the models’ adequacy in fitting the data. Excluding traditional healers as trusted source resulted in improved adequacy of the model from 0.126 to 0.282, according to Hosmer and Lemeshow Test of model adequacy. Therefore, because the variable (traditional healer as trusted source of information) has no statistically significant association adjusted to other variables in the model and removing the variable increases the model adequacy, we used only the three variables (residence, comprehensive knowledge, social media as trusted source) to adjust the estimate and generate the final model. And all the three variables remained in the model as you can see from table 6. We also revised table 6 to show the unadjusted PR, and put the outcome==1 in the right column (good prev behavior, in this case) as per the suggestions. 313 specify the reason of the restriction to make your data fully available � Authors’ response: we submitted the data file as supporting information with the revised manuscript https://doi.org/10.1371/journal.pone.0251062.r002
23 Feb 2021 Decision Letter - Frank T. Spradley, Editor PONE-D-20-28112R1 Assessment of preventive behavior and associated factors towards COVID-19 in Qellam Wallaga Zone, Oromia, Ethiopia: A community-based cross-sectional study PLOS ONE Dear Dr. Gutu, 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 Apr 09 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, Frank T. Spradley Academic Editor PLOS ONE 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 #1: All comments have been addressed ******** 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 #1: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: I Don't Know ****** 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 #1: Yes ****** 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 #1: Yes ****** 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 #1: Thank you for accepting the recommendations and congratulation for your efforts. First, about the statistical analysis, I wonder if in your original procedures you applied a binomial logit regression (to estimate odds ratios) instead of a binomial log (to estimate prevalence ratios). My initial suggestion according to your study design was to update your analysis in case if it is required. Also, I suggest to detail if you applied weights for survey analysis as explained here: https://dev.stats.idre.ucla.edu/stata/faq/can-i-use-working-weights-for-survey-analyses-in-spss/ Additionally, even though your statistical analysis followed a predictive procedure, have you evaluate how other covariates could affect the associations that you found? For example, the association between residence-behavior and knowledge-behavior could depend or be confounded by age, education or occupation. In case any of those apply as confounders, the reported estimates should be adjusted for this set of variables. This would not require to add more rows to the table 5, but specifing it as a caption or note at the end. Related to this last point, I suggest to evaluate the consistency of the term "predictor" (as in subtitle 4.5) if you already applied "associated factor". Predictive modelling involve different objectives and procedures. Review Shmueli, Galit. "To explain or to predict?." Statistical science 25.3 (2010): 289-310. (https://doi.org/10.1214/10-STS330) and Chen, Lingxiao. "Overview of clinical prediction models." Annals of translational medicine 8.4 (2020). (https://doi.org/10.1214/10-STS330). Furthermore, I recommend to add a limitation paragraph in the discussion section. There you could detail how your results may be affected by the validity or biases of the scale that you applied to define the outcome (preventive behavior), including references of previous experiences, if it apply. Also about the sampling procedure or the absence of sampling weighting procedure. Lastly, I recommend to fix some writing typos like in lines 193, 194 or 223 from the "clean" copy of the manuscript. At line 188, it should end as "log link function". At table 4, you could add N(%) at the heading as in previous tables. At table 5, change the number "1" with "Ref." to detail the category of reference. ****** 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 #1: 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. https://doi.org/10.1371/journal.pone.0251062.r003
Revision 2
10 Apr 2021 Author Response Comments accepted, amended and explained Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0251062.r004
20 Apr 2021 Decision Letter - Frank T. Spradley, Editor Assessment of preventive behavior and associated factors towards COVID-19 in Qellam Wallaga Zone, Oromia, Ethiopia: A community-based cross-sectional study PONE-D-20-28112R2 Dear Dr. Gutu, 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, Frank T. Spradley Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0251062.r005
Formally Accepted
22 Apr 2021 Acceptance Letter - Frank T. Spradley, Editor PONE-D-20-28112R2 Assessment of preventive behavior and associated factors towards COVID-19 in Qellam Wallaga Zone, Oromia, Ethiopia: A community-based cross-sectional study Dear Dr. Gutu: 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. Frank T. Spradley Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0251062.r006

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