Role of literacy, fear and hesitancy on acceptance of COVID-19 vaccine among village health volunteers in Thailand

Pallop Siewchaisakul; Pongdech Sarakarn; Sirinya Nanthanangkul; Jirapat Longkul; Waraporn Boonchieng; Jukkrit Wungrath

doi:10.1371/journal.pone.0270023

Peer Review History

Original SubmissionFebruary 9, 2022
8 Mar 2022 Decision Letter - Wenping Gong, Editor PONE-D-22-04125Role of Literacy, Fear, Hesitancy on Acceptance of COVID-19 Vaccine among Village Health Volunteer in ThailandPLOS ONE Dear Dr. Wungrath, 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 22 2022 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: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Wenping Gong, Ph.D. Academic Editor PLOS ONE 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 " ext-link-type="uri" xlink:type="simple">https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf" 2. Please provide additional details regarding participant consent. In the ethics statement in the Methods and online submission information, please ensure that you have specified what type you obtained (for instance, written or verbal, and if verbal, how it was documented and witnessed). If your study included minors, state whether you obtained consent from parents or guardians. If the need for consent was waived by the ethics committee, please include this information. Once you have amended this/these statement(s) in the Methods section of the manuscript, please add the same text to the “Ethics Statement” field of the submission form (via “Edit Submission”). For additional information about PLOS ONE ethical requirements for human subjects research, please refer to http://journals.plos.org/plosone/s/submission-guidelines#loc-human-subjects-research. 3. Thank you for stating the following in the Acknowledgments Section of your manuscript: "This research is supported by the Center of Excellence in Community Health Informatics, Chiang Mai University. The authors would like to acknowledge the village health volunteer network in Thailand for distributing the online survey. " We note that you have provided funding information that is not currently declared in your Funding Statement. However, funding information should not appear in the Acknowledgments section or other areas of your manuscript. We will only publish funding information present in the Funding Statement section of the online submission form. Please remove any funding-related text from the manuscript and let us know how you would like to update your Funding Statement. Currently, your Funding Statement reads as follows: "This study was granted by the Center of Excellence in Community Health Informatics, Chiang Mai University, Chiang Mai, Thailand." Please include your amended statements within your cover letter; we will change the online submission form on your behalf. 4. We note that you have indicated that data from this study are available upon request. PLOS only allows data to be available upon request if there are legal or ethical restrictions on sharing data publicly. For more information on unacceptable data access restrictions, please see http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. In your revised cover letter, please address the following prompts: a) If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially sensitive information, data are owned by a third-party organization, etc.) and who has imposed them (e.g., an ethics committee). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent. b) If there are no restrictions, please upload the minimal anonymized data set necessary to replicate your study findings as either Supporting Information files or to a stable, public repository and provide us with the relevant URLs, DOIs, or accession numbers. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories. We will update your Data Availability statement on your behalf to reflect the information you provide. 5. Your ethics statement should only appear in the Methods section of your manuscript. If your ethics statement is written in any section besides the Methods, please move it to the Methods section and delete it from any other section. Please ensure that your ethics statement is included in your manuscript, as the ethics statement entered into the online submission form will not be published alongside your manuscript. 6. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. [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: Partly ******** 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: No ****** 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: The authors use cross-sectional data collected from a large and diverse sample of Thai village health volunteers to determine what factors are associated with COVID vaccination intentions. Results indicate that vaccine hesitance and fear are both associated with lower likelihood of getting vaccinated. The theoretical contribution is small, but there is considerable value in studying health behaviors in non-WEIRD (western, educated, industrialized, rich and democratic) countries. However, the manuscript has important shortcomings. There are data limitations, analytic errors, and the writing is unacceptable (e.g., there are numerous grammatical errors). These problems appear to be fixable, though doing so will require considerable effort. Given the numerous opportunities for improvement, I organize my review in the order in which I first observed each problem. - The introduction is unfocused and often off topic. This manuscript promises to make a modest empirical contribution, documenting attitudes associated with vaccine acceptance in Thailand. The introduction should explain this succinctly, summarizing what is known about other part of the world and explaining why readers might expect Thailand to be different. - The description of the sample (page 4 line 100-) and of the procedures for collecting data (page 6 line 163-) do not appear entirely consistent. For example, the former implies that participants were registered users of a mobile app called “SMART VHV.” The latter says that participants were recruited using a form of snowball sampling via social media (Facebook and Line). I encourage the authors to combine these two sections and to carefully edit the content for clarity and consistency. - There are important details missing from the description of the sampling. For example, how many individuals were invited to participate? See the AAPOR guidelines for reporting survey data. - The authors imply that the sample is diverse and largely unbiased, but descriptive feature (page 7 line 195) suggest that it is highly skews (e.g., 84% female) - Figure 1 is missing - The description of the measures (starting on page 5) appears to contain many errors. For example, how can a 12-item scale include items numbered 11-15? And how can the same item numbers be used in several scales? - When describing a scale, the authors should also report the M, SD, and alpha. - What the authors describe as vaccine literacy appears to tap several different ideas, include efficacy. If this is an established scale, a cite would help. - What the authors describe as vaccine hesitancy includes questions about effectiveness and perceived importance. If this is an established scale, a cite would help. - The authors reject the use of a random effect based on the ICC (page 7 line 189). They should report the ICC. - In the text, the authors say that participants were asked to specify their preferred vaccine if they indicated willingness to be vaccinated (page 6 line 148). However, Table 1 reports vaccine preference among those who do not wish to be vaccinated. - The occupation categories in Table 1 are not mutually exclusive (e.g., employee and private employee). - If the authors want to demonstrate that the association between vaccine fear and acceptance is conditioned on the individual’s vaccine preference, it would be more appropriate to test whether preference moderates the influence of fear when estimating acceptance. - The discussion is too long and covers too many topics (including several that we not mentioned in the results section). As with the introduction, the manuscript would be more compelling if the authors restricted their comments to their most important contributions. === Potential PLOS policy violations === The authors checked the box indicating that the data will publicly available, but then write, “The datasets used and /or analyzed during the current study are available from the corresponding author on reasonable request.” Participants were not allowed to submit the questionnaire if they skipped questions (page 7 line 175). Every US-based IRB that I have worked with requires that participants be allowed to refuse to answer questions. ****** 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/. 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.0270023.r001
Revision 1
18 Apr 2022 Author Response Thank you very much for your fruitful comments. We have revised the manuscript following your suggestions and comments. We hope our revision would satisfy your expectation. Please find our point-by-point response below. Comments to the Author Reviewer #1: The authors use cross-sectional data collected from a large and diverse sample of Thai village health volunteers to determine what factors are associated with COVID vaccination intentions. Results indicate that vaccine hesitance and fear are both associated with lower likelihood of getting vaccinated. The theoretical contribution is small, but there is considerable value in studying health behaviors in non-WEIRD (western, educated, industrialized, rich and democratic) countries. However, the manuscript has important shortcomings. There are data limitations, analytic errors, and the writing is unacceptable (e.g., there are numerous grammatical errors). These problems appear to be fixable, though doing so will require considerable effort. Given the numerous opportunities for improvement, I organize my review in the order in which I first observed each problem. 1. The introduction is unfocused and often off topic. This manuscript promises to make a modest empirical contribution, documenting attitudes associated with vaccine acceptance in Thailand. The introduction should explain this succinctly, summarizing what is known about other part of the world and explaining why readers might expect Thailand to be different. Ans: We have re-written the whole introduction following your suggestions. (Page 3, line 51-91) 2. The description of the sample (page 4 line 100-) and of the procedures for collecting data (page 6 line 163-) do not appear entirely consistent. For example, the former implies that participants were registered users of a mobile app called “SMART VHV.” The latter says that participants were recruited using a form of snowball sampling via social media (Facebook and Line). I encourage the authors to combine these two sections and to carefully edit the content for clarity and consistency. Ans: We totally agreed. We have combined the two sections. We first described about the registered SMART VHV, for these user group use social media (Line and Facebook). After that we described how we inform and distribute our online questionnaire. (page 4, line: 91-112) 3. There are important details missing from the description of the sampling. For example, how many individuals were invited to participate? See the AAPOR guidelines for reporting survey data. Ans: We have revised the manuscript stated that “A nonprobability sampling so called the snowball sampling was adopted based on the 137,782 registered SMART VHV in our study through the social platform (Line and Facebook) in that these two social media are the most popular in Thailand and numbers of VHV use it to communicate and coordinate with each other.” (Page 4, line: 100-102) 4. The authors imply that the sample is diverse and largely unbiased, but descriptive feature (page 7 line 195) suggest that it is highly skews (e.g., 84% female) Ans: This research is online data collection, and we did not specify the respondent. We understand that it will cause the data to be skewed. We therefore consider it a limitation of the present studies. (page 15, line 318-323). Moreover, Thai society men need to be the main income earner of the family and have to work outside while women are at home or working at home. Therefore, it is more likely that women will apply for VHV, which is obliged to perform community health care duties, which work mostly during the day. 5. Figure 1 is missing Ans: We have submitted the Fig 1 (separate file). 6. The description of the measures (starting on page 5) appears to contain many errors. For example, how can a 12-item scale include items numbered 11-15? And how can the same item numbers be used in several scales? Ans: We sincerely apologize for misunderstood in the use of characters. We explain that we planned to utilize the letter l (lowercase l) for the questions in the Vaccine Literacy (VL), which resembles the number 1. So, for the questions in this category, we've changed it to capital L for clarification. (page 5, line 127, 129 and 131-132). 7.When describing a scale, the authors should also report the M, SD, and alpha. Ans: Thank you for your suggestions, we have reported the mean, SD and alpha as written in page 8 line 184-187. “Based on the present study, the mean score and standard deviation (SD) of VL was 33.83 (SD: 7.55), VF was 11.35 (SD: 4.58), and VH was 24.72 (SD:7.45). Cronbach’alpha coeffiecnt for VL, VH and VF were 0.89, 0.91 and 0.90, respectively.” (Page 6, line: 164-166) 8. What the authors describe as vaccine literacy appears to tap several different ideas, include efficacy. If this is an established scale, a cite would help. Ans: The VL questionnaire was adapted from Vaccine Literacy Questionnaire-Italy (HlVa-IT) of Biasio LR. et al. (2020). We have added this reference in the Methods section. (Page 5, line 125-126) 9. What the authors describe as vaccine hesitancy includes questions about effectiveness and perceived importance. If this is an established scale, a cite would help. Ans: The VH questionnaire was adapted from Hesitancy Scale (aVHS) of Akel HT. et al. (2021). We have added this reference in the Methods section. (Page 6 line: 144-145) 10. The authors reject the use of a random effect based on the ICC (page 7 line 189). They should report the ICC. Ans: We have reported the ICC which was 0.053570. (page 7, line 186) 11. In the text, the authors say that participants were asked to specify their preferred vaccine if they indicated willingness to be vaccinated (page 6 line 148). However, Table 1 reports vaccine preference among those who do not wish to be vaccinated. Ans: We have noted and corrected our mistaken of reporting number in table 1. (Page 9) PS: we also re-checked our results and have corrected the number report in Table 2 and Table 3 of adjusted OR. 12. The occupation categories in Table 1 are not mutually exclusive (e.g., employee and private employee). Ans: Thank you very much for your comments. We have changed the word from employee to freelancer in all Tables. 13. If the authors want to demonstrate that the association between vaccine fear and acceptance is conditioned on the individual’s vaccine preference, it would be more appropriate to test whether preference moderates the influence of fear when estimating acceptance. Ans: Thank you very much for your idea about testing of whether preference moderates the influence of fear when estimating acceptance. We did try to analyze but it is impossible to do so, since our questionnaire design was that for those who only chose accepted to get vaccine can later choose the preference types. Therefore, it cannot take the preference type as a covariate in the logistic model. Accept to get shot Preference type of vaccine No Yes No 2,200 0 Inactivated 0 503 Adenovirus 0 665 mRNA 0 1,759 Cocktail 0 59 Any 0 126 Total 2,200 3,112 As a result, we decided to analyze the association between VL, VF, VH, and AV in different model based on each preference type of vaccine, adjusted by other variables. We have showed in our univariate, the effect of fear itself on acceptance by vaccine types were not different according to the Odd ratio in the univariate analysis. 14 The discussion is too long and covers too many topics (including several that we not mentioned in the results section). As with the introduction, the manuscript would be more compelling if the authors restricted their comments to their most important contributions. Ans: Thank you very much for your suggestions. We have revised our discussion follow our main aim and results. We arranged the discussion to follow first the result of factors associated with overall acceptance (Table 2) then factors associated with preferences types of vaccine (Table 3). Implication limitation and conclusion. (Page 12-15, line 234-330) === Potential PLOS policy violations === The authors checked the box indicating that the data will publicly available, but then write, “The datasets used and /or analyzed during the current study are available from the corresponding author on reasonable request.” Ans: All relevant data are within the paper and its Supporting Information files. Participants were not allowed to submit the questionnaire if they skipped questions (page 7 line 175). Every US-based IRB that I have worked with requires that participants be allowed to refuse to answer questions. Ans: We would like to extend our meaning of the sentence “Participants were not allowed to submit the questionnaire if they skipped questions” and make it clearer that is participants can allow to refuse to answer the question, or don’t participate, or stop doing the questionnaire at any time. There is a function of google form that you need to answer all question before submitting. We select this function, for we can protect an incomplete missing data. However, there are still have some variable or questions (We did not set up the function) that were incomplete as show in Figure 1. Attachments Attachment Submitted filename: Response to reviewer.docx https://doi.org/10.1371/journal.pone.0270023.r002
1 May 2022 Decision Letter - Wenping Gong, Editor PONE-D-22-04125R1Role of Literacy, Fear, Hesitancy on Acceptance of COVID-19 Vaccine among Village Health Volunteer in ThailandPLOS ONE Dear Dr. Wungrath, 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 Jun 15 2022 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: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-emailutm_source=authorlettersutm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Wenping Gong, Ph.D. Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. 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 Reviewer #3: (No Response) ******** 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 Reviewer #3: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #2: Yes Reviewer #3: 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 Reviewer #3: 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 #2: Yes Reviewer #3: 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 authors have done a thorough revision of the manuscript based on previous comments. However, there are some parts still need to be revised further to make the manuscript better. Please find below a few comments for your consideration. Introduction Authors presented the vaccination coverage in Thailand as of October 2021. It would be better if the figures for the current vaccination coverage in the country is presented. In the introduction, the authors presented the COVID-19 acceptance rates around the world. To make this information complete, the status in Africa could be added. For instance: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0260575 The introduction still needs to be revised further for grammatical and presentation errors. Authors should include the month in 2021 when the first batch of the COVID-19 vaccines arrived Thailand. Methods “Questionnaires” should be rewritten as “questionnaire” all through the manuscript. The authors have not stated the exclusion criteria used in the selection of the participants. Authors should provide the citations/references of the extensive literature used in this study. Authors did not explain how the literacy, fear, and hesitancy scores were calculated before being used in the univariate and regression analysis. Ideally, this explanation should appear under the statistical analysis section. Results In Table 1, the heading of the first row should be: Vaccinated n (%) Unvaccinated n (%) Discussion Has been improved upon. Reviewer #3: Paper by Dr. Wungrath et al. treated social and psychological factors associated with acceptance of COVID-19 vaccine in Thailand. I would like to present comments to improve the manuscript. [Major] 1. Introduction section may be relatively lengthy. To introduce readers to Methods and Results, shorter introduction may be effective. 2. As a reader, I would like the authors to explain vaccine literacy score, vaccine fear score, and vaccine hesitancy score, briefly. 3. Table 3: I am interested in the results of pooled analysis of varied types of vaccines. 4. Table 3: Showing the results of the results of non-adjusted analysis may increase the understanding of this study results. [Minor] 5. Many abbreviations may interrupt readers to smoothly read the manuscript. Key abbreviations could be spelled out. Overall, something is missing in this paper. It lacks impact. But it is well written and deserves to be published. ****** 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: Yes:** Ismail A. Odetokun (Ph.D.) Reviewer #3: 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.0270023.r003
Revision 2
3 May 2022 Author Response Thank you very much for your fruitful comments. We have revised the manuscript following your suggestions and comments. We hope our revision would satisfy your expectation. Please find our point-by-point response below. Review Comments to the Author Reviewer #2: The authors have done a thorough revision of the manuscript based on previous comments. However, there are some parts still need to be revised further to make the manuscript better. Please find below a few comments for your consideration. Introduction 1. Authors presented the vaccination coverage in Thailand as of October 2021. It would be better if the figures for the current vaccination coverage in the country is presented. Ans: We have stated the current vaccination coverage in May 2022 is 70.3%. (Page 3; line: 58-59) 2. In the introduction, the authors presented the COVID-19 acceptance rates around the world. To make this information complete, the status in Africa could be added. For instance: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0260575 Ans: We have added the recommended reference as in the sentence “Vaccine acceptance rate was 37.40% in Jordan, 61.16% in Bangladesh, 56.90% in the EU, 80.00% in the USA and 63% in Africa [10-14]”. (Page 3; line: 62) 3. The introduction still needs to be revised further for grammatical and presentation errors. Authors should include the month in 2021 when the first batch of the COVID-19 vaccines arrived Thailand. Ans: The first COVID-19 vaccine arrived in Thailand in February 2021 and the Thai Prime Minister encouraged VHVs to boost public confidence in this vaccine. Later, novel variants of COVID-19 and new vaccines arrived in Thailand (Page 4; line: 81) Methods 4. “Questionnaires” should be rewritten as “questionnaire” all through the manuscript. Ans: We have rewritten from questionnaires to questionnaire. 5. The authors have not stated the exclusion criteria used in the selection of the participants. Ans: SMART VHVs who lack of address information and incomplete filling questionnaire were excluded. (Page 4-5; line 110-111) 6. Authors should provide the citations/references of the extensive literature used in this study. Ans: We have provided citations/references of literature as recommendation. 7. Authors did not explain how the literacy, fear, and hesitancy scores were calculated before being used in the univariate and regression analysis. Ideally, this explanation should appear under the statistical analysis section. Ans: VL, VF, and VH score were summed up individually and treated in models as a continuous independent variable. (Page 7, line: 181-182) Results 8. In Table 1, the heading of the first row should be: Vaccinated n (%) Unvaccinated n (%) Ans: We have revised accordingly. Discussion Has been improved upon. Reviewer #3: Paper by Dr. Wungrath et al. treated social and psychological factors associated with acceptance of COVID-19 vaccine in Thailand. I would like to present comments to improve the manuscript. [Major] 1. Introduction section may be relatively lengthy. To introduce readers to Methods and Results, shorter introduction may be effective. Ans: We shorten the introduction part as recommend. 2. As a reader, I would like the authors to explain vaccine literacy score, vaccine fear score, and vaccine hesitancy score, briefly. Ans: We have briefly explained all scores as mentioned in the methods part. (Page 5-6; line: 124-150) 3. Table 3: I am interested in the results of pooled analysis of varied types of vaccines. Ans: The pooled analysis result (all type of vaccines) have been shown in Table 2. 4. Table 3: Showing the results of the results of non-adjusted analysis may increase the understanding of this study results. Ans: Thank you very much for your suggestions. We totally agree. However, we also concern about containing too many tables. Therefore, we put the overall results, showing both non-adjusted and adjusted results in the manuscript (Table 2). We provide the non-adjusted and adjusted full results varied by vaccine types in supporting information (S1 Table). [Minor] 5. Many abbreviations may interrupt readers to smoothly read the manuscript. Key abbreviations could be spelled out. Ans: We have reduced some abbreviations. However, according to the journal regulation about abbreviations stated that “Do not use non-standard abbreviations unless they appear at least three times in the text”. Therefore, we keep other key abbreviations in the manuscript. Attachments Attachment Submitted filename: Reponse to Reviewers.docx https://doi.org/10.1371/journal.pone.0270023.r004
2 Jun 2022 Decision Letter - Wenping Gong, Editor Role of Literacy, Fear and Hesitancy on Acceptance of COVID-19 Vaccine among Village Health Volunteers in Thailand PONE-D-22-04125R2 Dear Dr. Jukkrit Wungrath, 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, Wenping Gong, Ph.D. Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0270023.r005
Formally Accepted
14 Jun 2022 Acceptance Letter - Wenping Gong, Editor PONE-D-22-04125R2 Role of Literacy, Fear and Hesitancy on Acceptance of COVID-19 Vaccine among Village Health Volunteers in Thailand Dear Dr. Wungrath: 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. Wenping Gong Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0270023.r006

Open letter on the publication of peer review reports

PLOS recognizes the benefits of transparency in the peer review process. Therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. Reviewers remain anonymous, unless they choose to reveal their names.

We encourage other journals to join us in this initiative. We hope that our action inspires the community, including researchers, research funders, and research institutions, to recognize the benefits of published peer review reports for all parts of the research system.

Learn more at ASAPbio .