PONE-D-21-15410

Cross-national Study of Communal Attitudes toward Individuals with Intellectual Disabilities in sub-Saharan Africa: Cameroon vs. Ghana

PLOS ONE

Dear Dr. Opoku,

Thank you for submitting your manuscript to PLOS ONE. I have read your paper and I have received reviews from 2 experts. They agree that this paper is interesting, but also believe the paper may be improved through a revision. I concur with their views. The comments are straightforward and you should have no problems in addressing them. 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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Academic Editor

PLOS ONE

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Additional Editor Comments:

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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

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

Reviewer #1: Yes

Reviewer #2: I Don't Know

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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

Reviewer #2: 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: Yes

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: Very well done article: I have the following suggestions:

1. There has been some research about the CLAS-ID being mainly useful for university students, who it was developed for, and not lay people or health professionals. Maybe comment on the applicability of the study results to the general population and/or government stakeholders.

2. One limitation of the CLAS-ID is that there are conflicting findings about the purpose and value (positive or negative) of the sheltering subscale. Please comment: Ouellette-Kuntz et al. 2003 and Ouellette-Kuntz et al. 2012 comment on this, I believe.

3. In the introduction, provide stronger rationale for looking at differences by gender, as that was a key study hypothesis.

4. In the introduction, provide stronger rationale for the Theory of Planned Behaviour, and comment on its other constructs (subjective norms, perceived behavioural control) or omit.

5. What program or discipline were the students in? Different groups of students (e.g. law vs. social care students) have been shown to have different attitudes.

6. Comment on whether gathering data from students at the end of lecture could have influenced participation, and whether participation in the study was voluntary or for course credit.

Reviewer #2: I would like to thank the authors for exploring an interesting and important topic. The study explores the attitudes towards people with intellectual disability in the geographical context of Cameroon and Ghana while investigating psychometric properties of a questionnaire--the community living attitude scale for intellectual disability (CLAS-ID)--measuring the attitudes towards people with intellectual disability (CLAS-ID). The study recruits 741 university students from two public universities in Cameroon and Ghana, selected based on convenience. The study concluded the CLAS-ID is a sound instrument to measure attitudes towards people with ID in Cameroon and Ghana contexts, while attitudes towards people with intellectual disability among participants were found to be ambivalent. Additional findings were also reported in the manuscript. The authors provided elaborate background information and justification for this study, and I agree that covering the topic is important to better understand the situation of people with ID, especially in low and middle-income countries context, and to endorse the inclusion of the said people in society.

The followings are points that I would like to further discuss with the authors:

1. This study uses both CFA and PCA to explore the CLAS-ID underlying factors, however, both analyses yielded different results. The authors might want to discuss further the rationale of using both analyses in this study, and/or how the reader should interpret the results.

2. Page 11 [With respect to the Cameroonian data, the questionnaires were both in English and French since both languages are the medium of instruction and officially recognized languages]

Does this mean the Cameroonian participants receive two versions of the CLAS-ID, English and French? If yes, do the two versions are considered identical instruments? Please clarify.

3. Under the 'Predictors of Attitudes' subheading, there is a discussion about the association between the CLAS-ID sub-scales, which does not seems relevant with the sub-headings topic. Please clarify.

[page 19] 'the association between the sub-scales….

4. [page 2] From the perspectives of parents and individuals with IDs, empirical evidence suggests that they continue to suffer discrimination and rejection by other people in sub-Saharan African societies.

The authors might want to elaborate more on the examples of discrimination and rejection of people with ID in sub-Saharan societies. I think the information could help the readers to better understand the situation of people with ID in Ghana and Cameroon context.

5. [page 10] 'almost all the academics responded that the content was appropriate for data collection

Does this mean some academics disagree that the content of the instrument appropriate for data collection? If yes, then the author might want to provide more discussion about this.

6. The Author might want to add a reference for this statement:

[page 2] The onset of an ID is usually diagnosed before 18 years of age, with leading causes attributed to genetic factors and neurodevelopmental, neurological, and other medical conditions.

The finding regarding participants' ambivalent attitude towards people with ID, is not included in the abstract. The authors might want to consider adding the information in the abstract.

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Reviewer #1: No

Reviewer #2: No

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Cross-national Study of Communal Attitudes toward Individuals with Intellectual Disabilities in sub-Saharan Africa: Cameroon vs. Ghana

PONE-D-21-15410R1

Dear Dr. Opoku,

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,

Robert Didden

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

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

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 #1: Yes

Reviewer #2: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: 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

Reviewer #2: No

**********

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

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 #1: (No Response)

Reviewer #2: (No Response)

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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 #1: No

Reviewer #2: No