PONE-D-20-38452

Perceived stress and associated factors among health care professionals working during COVID-19 pandemic in public health institutions of southern Ethiopia 2020

PLOS ONE

Dear Dr. Getie,

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 outcome variable, PSS-10, does not have cut-off values. We expect the statistical analysis to be revised to one appropriate for continuous outcome variable. We also recommend that the PSS-10 distribution to be presented in graphs showing percentages of participants with specific scores if possible.

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We look forward to receiving your revised manuscript.

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Markos Tesfaye, M.D., Ph.D

Academic Editor

PLOS ONE

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3. We noticed you have some minor occurrence of overlapping text with the following previous publication(s), which needs to be addressed:

https://onlinelibrary.wiley.com/doi/10.1111/pcn.13128

https://www.dovepress.com/front_end/preparedness-and-responses-of-healthcare-providers-to-combat-the-sprea-peer-reviewed-fulltext-article-ID

In your revision ensure you cite all your sources (including your own works), and quote or rephrase any duplicated text outside the methods section. Further consideration is dependent on these concerns being addressed.

Additional Editor Comments:

The manuscript reports findings of a cross-sectional survey of perceived stress among health care providers working in southern Ethiopia. The authors have used PSS-10 to measure perceived stress and performed logistic regression to identify factors associated with perceived stress. While the area of research is relevant to the challenges faced during the COVID pandemic, there are issues that limit the reports scientific value.

1. The authors did not provide any cut-off value for perceived stress in their operational definitions making the interpretation of the data very difficult. It is not helpful to present a percentage of perceived stress when there are no established cut-offs.

2. Since perceived stress may not have established cut-off values, it is better to present the distribution of perceived stress in a histogram. Also, it would be more appropriate to present linear regression analysis with perceived stress as continuous outcome variable than as categorical 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: No

Reviewer #2: Partly

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

Reviewer #1: No

Reviewer #2: Yes

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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: Yes

Reviewer #2: Yes

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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: 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: Title:

1. The study is about perceived stress of healthcare workers in the context of COVID-19. May the authors include “in the context of…” instead of “during” in the title?

Abstract

2. There are editorial problems.

3. Why written consent was not obtained from the participants?

4. In the methods section of the abstract, it says: “The study participants were selected using simple random sampling technique after allocating a proportion to each health institute based on the size of HCPS. A pretested and structured interviewer-administered questionnaire using KOBO collect survey tool was used to collect data”. What are HCPS and KOBO? This should be fully spelled in first use.

5. The tools of data collection, at least for main outcomes, are not briefly stated in the abstract. May the authors also state the cut off of dichotomizing the outcome measures in this abstract section?

6. In the conclusion section of the abstract, the authors have repeated the findings than showing the readers about the implications of the findings. Indeed, the first couple of sentences look non-relevant to the conclusion.

Introduction

On page 4, line 83-84, it says: “There is a dearth of information regarding stress related to COVID-

7. 19 in Ethiopia”. What about similar study conducted in Dilla, southern Ethiopia? what about green literature in this area in Ethiopia?

Methods

8. The authors used simple random sampling. There is also a statement about multistage sampling? If multistage sampling was used, was it stratified by the types of institutions: hospital, HC or health posts?

9. KOBO” requires further description. The outcome measures and their psychometric properties including the issues of validity in the Ethiopian context is not given. Please, do it. The cut off values in the original tools and in the current manuscript are not given. Otherwise it is difficult to interpret the findings and there is no gauge.

10. With respect to the data quality, how the data was entered. Would you describe it?

Results

11. The Ethiopian population is more than 80% rural. But, the samples indicated that only 12% rural participants. This indicates non-random sampling??

12. Many sentences are not clear in the results. ex “From the total respondents more than half 409(51.3%) of health care professional’s responded that the community response to COVID -19 as somewhat followed by 247(31%) not at all”.

13. I could not follow what Table 2 is presenting? The use of language and given options for the items are not clear.

14. The following variables are not clear

a. Government support: government support is similar for similar healthcare institutions. so why it is included as variable? Moreover, how it was measured?

b. Valued by community: what does it mean? How was it assessed?

c. Response of community members: what is it? How has it been assessed?

d. What was the assessment tool for “confidence in coping”?

Conclusion

“Lack of line of commutation to providing up to date information, lack of confidence on coping stress and not getting along well with individuals are factors associated with developing perceived stress”. What does it mean?

Reviewer #2: Exclusion criteria needs to be clarified further

Who were your data collectors with their level of educational background? ( Numner of data collectors and and supervisors should be clarified)

For how many days training was given for data collectors?

Please rewrite your operational definitions

In the category of professions why you omitted professionals like mental health and environmental health workers?

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Reviewer #1: No

Reviewer #2: No

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Attachments

Attachment

Submitted filename: comments for author.docx

Perceived stress and associated factors among health care professionals working during COVID-19 pandemic in public health institutions of southern Ethiopia 2020

PONE-D-20-38452R1

Dear Dr. Getie,

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,

Jianguo Wang, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

I checked the responses and read through the revised manuscript. It can be acceptable technically.

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: All comments have been addressed

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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: Yes

**********

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

Reviewer #2: Yes

**********

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: Yes

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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: 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 #2: the author has addressed all comments, the manuscript is technically sound and all the data supports the conclusion.

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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

Attachments

Attachment

Submitted filename: comments.docx