Anticipated stigma and associated factors among chronic illness patients in Amhara Region Referral Hospitals, Ethiopia: A multicenter cross-sectional study

Mohammed Hassen Salih; Hussen Mekonnen; Lema Derseh; Helena Lindgren; Kerstin Erlandsson

doi:10.1371/journal.pone.0273734

Peer Review History

Original SubmissionJanuary 26, 2022
28 Jun 2022 Decision Letter - Tao (Alison) Wang, Editor PONE-D-22-00465Anticipated stigma and associated factors among chronic illness patients in Amhara Region Referral Hospitals, Ethiopia: a multi-center cross-sectional study.PLOS ONE Dear Dr. Mohammed, 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. ============================== Comments from academic editor: Abstract-conclusion/recommendation: the recommendation reads too general. It would be better if some specific recommendations can be made based on the study findings (the identified associated factors). Introduction: “In the current pandemic COVID-19, health-related stigma has increased”, please add reference(s) for this sentence. Introduction: “scholars have identified different types of stigma; enacted, anticipated and perceived stigmas are the most common.” Reference is needed. Introduction: “Anticipated stigma is an individual belief or perception that…..” Reference is needed. Materials and Methods- Study area and period: in this section, the monthly number of follow-up patients in each hospital was reported, please specify if these were patients with chronic diseases. Otherwise, please consider deleting this information. What is the sampling method for participant recruitment? Please specify. Sample size calculation: “S is the sample variance of anticipated stigma (0.75) determined from a previous pilot study”, please add the reference for the mentioned previous pilot study. “Twenty-one variables were used as the independent (Covariate) variables.” How did you determine those 21 variables? Based on previous studies or any theoretic framework, please specify. Data analysis: Were all the 21 independent variables directly included in the regression analysis? Any univariate analysis and/or correlation analysis was conducted prior to the regression analysis to identify the variables with statistical significance that can be included in the regression analysis? 10. Results and discussion: please separate the results and discussion into two sections. Reviewers' comments: 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: Manuscript comments When I review this paper, I have found some strength and some comments to be improved. The paper is well stated and the title is very crucial, very important and timely searched particularly in developing country. The model selection for analysis was appropriate for such type of continuous outcome variable. The result and discussion were described properly. However, I have some comments to be improved the manuscript which is listed below. 1. In abstract: methods part better to put first “A simple random sampling technique was used to select the three Referral Hospitals in the region and study subjects.” then “Data were collected using a pre-tested interview based questionnaire.” 2. In introduction: better to incorporate about definition of chronic illness and put the definition of stigma (from line 68-72) is in the first paragraph. 3. In materials and methods part: The information which is written from line 120 to 122 should be updated. In data collection procedure part in line 203 (each with an MSc –holder or higher) needs edition because the data was already collected. From where the pilot studies was done? Should be mention. Please submit your revised manuscript by Aug 12 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'. 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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: 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. Attachments Attachment Submitted filename: Manuscript comments.docx https://doi.org/10.1371/journal.pone.0273734.r001
Revision 1
12 Jul 2022 Author Response Dear reviewer/professor, I thank you for the critical comments you gave me. All the comments and suggestions were excellent and scientific view. It increased our paper quality. Dear Professor, we thank you for your valuable time and here we tried to respond line by line to each comment and suggestion. When I review this paper, I found some strengths and some comments to be improved. The paper is well stated and the title is very crucial, very important, and timely searched particularly in a developing country. The model selection for analysis was appropriate for such type of continuous outcome variable. The result and discussion were described properly. However, I have some comments to be improved on the manuscript which are listed below. Response – thank you professor for your excellent view of our paper and the suggestions. 1. In the abstract: methods part better to put first “A simple random sampling technique was used to select the three Referral Hospitals in the region and study subjects.” then “Data were collected using a pre-tested interview-based questionnaire.” Response – Thank you professor and we correct it based on your excellent view. 2. In the introduction: better to incorporate about the definition of chronic illness and put the definition of stigma (from line 68-72) is in the first paragraph. Response – yes professor, we incorporated your suggestion in the first paragraph. Thank you. 3. In materials and methods part: The information which is written from line 120 to 122 should be updated. In data collection procedure part in line 203 (each with an MSc –holder or higher) needs edition because the data was already collected. From where the pilot studies was done? Should be mention Response- Dear Professor, I thank you for your critical review and comments. When we come to the population number of the Amhara Region we tried to get valuable data but not as much as the Ethiopian Statistical Agency. So, we agreed to use this one. In the Data collection procedure we correct based on your comment. Thank you so much Dear journal academic editor Thank you for your important and scientific-based comments raised for my manuscript. Here I tried to respond to each comment line by line. Thank you. 1. Abstract-conclusion/recommendation: the recommendation reads too general. It would be better if some specific recommendations can be made based on the study findings (the identified associated factors). Response - Dear professor, thank you for the comment. Incorporated the suggested point in the abstract. 2. Introduction: “In the current pandemic COVID-19, health-related stigma has increased”, please add a reference(s) for this sentence. Response - I thank you and attached the reference in the specified sentence. 3. Introduction: “scholars have identified different types of stigma; enacted, anticipated and perceived stigmas are the most common.” Reference is needed. Response - I thank you and attached the reference in the specified sentence. 4. Introduction: “Anticipated stigma is an individual belief or perception that …....” Reference is needed. Response - Thank you and revised the incorporated the reference. 5. Materials and Methods- Study area and period: in this section, the monthly number of follow-up patients in each hospital was reported, please specify if these were patients with chronic diseases. Otherwise, please consider deleting this information. Response - Delete it and accept your suggestion. 6. What is the sampling method for participant recruitment? Please specify. Response - Thank you, professor, to reach the study subject we used a simple random sampling method and it was stated line………. 7. Sample size calculation: “S is the sample variance of anticipated stigma (0.75) determined from a previous pilot study”, please add the reference for the mentioned previous pilot study. Response - I thank you, professor, for our “S” for the sample size taken from the previous project entitled Translation and psychometric evaluation of chronic illness anticipated stigma scale (CIASS) among patients in Ethiopia. Which was published in the same journal. We attach the reference based on the comment. 8. “Twenty-one variables were used as the independent (Covariate) variables.” How did you determine those 21 variables? Based on previous studies or any theoretic framework, please specify. Response - Dear Professor, thank you and we select those variables from previous papers and different literature. We accept your comment and add a sentence to clearly stated how 21 variables were selected. 9. Data analysis: Were all the 21 independent variables directly included in the regression analysis? Any univariate analysis and/or correlation analysis conducted before the regression analysis to identify the variables with statistical significance that can be included in the regression analysis? Response - Before we directly going to analyze our independent variables against the dependent variable, we did the basic assumption related to linear model regression. After the assumption was fulfilled, we directly included all those variables which were full filled the assumption. For our discussion section, we only discussed those variables that have a real association with the outcome variable. Thank you for your important insight and gave a much time to increase the validity of my manuscript. 10. Results and discussion: please separate the results and discussion into two sections. Thank you and I was trying to decrease the volume of our paper and make it short. But when we see your comment it was important to separate the result and discussion section. Accept and separated into result and discussion sections. Response - Thank you for your time and have a good day. https://doi.org/10.1371/journal.pone.0273734.r002
15 Aug 2022 Decision Letter - Tao (Alison) Wang, Editor Anticipated stigma and associated factors among chronic illness patients in Amhara Region Referral Hospitals, Ethiopia: a multi-center cross-sectional study. PONE-D-22-00465R1 Dear Dr. Mohammed Hassen, 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, Alison Wang Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0273734.r003
Formally Accepted
19 Aug 2022 Acceptance Letter - Tao (Alison) Wang, Editor PONE-D-22-00465R1 Anticipated stigma and associated factors among chronic illness patients in Amhara Region Referral Hospitals, Ethiopia: a multicenter cross-sectional study. Dear Dr. Salih: 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. Tao (Alison) Wang Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0273734.r004

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