Building capacity of primary health care workers and clients on COVID-19: Results from a web-based training

Olumuyiwa O. Odusanya; Adeyinka Adeniran; Omowunmi Q. Bakare; Babatunde A. Odugbemi; Oluwatoyin A. Enikuomehin; Olugbenja O. Jeje; Angela C. Emechebe

doi:10.1371/journal.pone.0274750

Peer Review History

Original SubmissionJune 7, 2022
22 Aug 2022 Decision Letter - Ogochukwu Chinedum Okoye, Editor PONE-D-22-16429The Editor-in-Chief PLoS One FULL TITLE Building capacity of Primary Health Care workers and Clients on COVID-19: Results from a web-based trainingPLOS ONE Dear Dr. Olumuyiwa Odusanya, 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. The topic is apt and the research question, clear. The manuscript is fairly well written but requires specific technical details in the methods and results to improve the quality of the paper. Kindly respond to all the issues raised by both reviewers. Please submit your revised manuscript within Oct 06 2022 11:59PM. 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We will update your Data Availability statement to reflect the information you provide in your cover letter. 5. 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 If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references.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 If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [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: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 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 ****** 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 ****** 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: 1. The manuscript is technically sound with regards to its research question of assessing the effect of web based training on health care workers and their clients on COVID 19. 2. The statistical analysis in general is appropriate and rigorous. However one is curious to know why an "independent t-test" was used to measure differences in knowledge, attitude and practice (KAP) pre- and post- intervention instead of a "paired t-test"? 3. The Journal editor will be in the best position to answer that, as this reviewer is not privy to the data. Based on PLOS ONE requirements i however assume a YES. 4.The manuscript is presented in an intelligible fashion and written in standard English. Reviewer #2: Title – Building capacity of Primary Health Care workers and Clients on COVID-19: Results 3 from a web-based training The topic appropriate for the study Abstract – Structured and well written Background – Detailed information on statement of problem as well as rational for the study clearly presented. Line 89 – 90: Almost 80% had positive - had positive what? 82% used face masks - desirable to know what use of face mask means in the study. Is it consistent use of face mask or ever use of face mask? Methods – Well described in details Line 127 – 128: The population is estimated to be over 20 million.- Provide reference The health care of its residents is overseen by the Lagos State Ministry of Health. - It is also true that the Federal Ministry of Health also play a role in the health of the residents. Please clarify what is meant by 'overseen' Line 134 – 135: Government-owned health facilities include 18 PHC centres and the Lagos State University Teaching Hospital (LASUTH). - Is there no secondary health facility in the LGA? Mention the presence or absence of secondary health facility in the LGA. Line 158 – 159: PHCs were selected based on having a high patient load and all eligible health workers in the selected facilities were recruited into the study - How many PHCs were selected in each LGA. The sampling method for selecting those PHCs not mentioned Line 191: …. their first visit ….. - Does this mean their first ever visit/contact to facility or first visit for that episode of illness. Please clarify Result – Analysis and Tables appropriate Line 263 – 264: The mean ages at the baseline and the end of the study were 40.8±9.6 and 39.2±9.9 years respectively. - What is the explanation for the change in age at baseline and at the end of the study? If it is the 63 that completed the study that were used then their ages shouldn't have changed remarkably. Indicate the duration of each phase of the study in the methods section. Line 270 – 271: …… level of knowledge was 270 high on symptoms, modes of transmission, and preventive measures - Provide the figure for the level of knowledge. It is not enough to state that it is high except in the discussion section. Line 278 – 279: Marital status and LGA of health workers were statistically significantly associated with knowledge scores - In what direction are the differences? Line 290: …….. interactions with trained PHC workers … - Provide information on the nature of their interactions (duration of interactions, mode of interaction - one - on - one or group health talk, etc) with PHC workers in the methods section. Line 298 – 299: The interaction with trained PHC workers led to an increase in all aspects of the knowledge enquired about: - Provide data showing the increase as provided for the baseline Well written in details with relevant tables and figures Discussion – Well discussed with study limitations provided. Line 326 - ….. cough. - delete - cough is repeated in this sentence Conclusion – Clearly written with appropriate recommendation. Study limitation - It is desirable to mention the limitation in the study design - The lack of control group ****** 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: Yes: Nyemike Simeon Awunor Reviewer #2: Yes: Prof. Tanimola Akande ******** [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: PONE-D-22-16429_reviewer.pdf https://doi.org/10.1371/journal.pone.0274750.r001
Revision 1
31 Aug 2022 Author Response A. Response to Journal requirements 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. Response. This has been done. The two files are labelled appropriately as well as the response to reviewers 2. PLOS ONE does not copy edit accepted manuscripts Response. This has been done. The submission is free of typos and grammatical errors. 3. Please include your full ethics statement in the ‘Methods’ section of your manuscript file. In your statement, please include the full name of the IRB or ethics committee who approved or waived your study, as well as whether or not you obtained informed written or verbal consent. If consent was waived for your study, please include this information in your statement as well Response. Ethical approval was obtained from the Health Research Ethics Committee of the Lagos State University Teaching Hospital (REFERENCE NO: LREC/06/10/1501). Written informed consent was obtained from all the participants after explaining the study's aim and objectives. (This was in the initial submission, lines 258-260) 4. In your Data Availability statement, you have not specified where the minimal data set underlying the results described in your manuscript can be found. PLOS defines a study's minimal data set as the underlying data used to reach the conclusions drawn in the manuscript and any additional data required to replicate the reported study findings in their entirety. All PLOS journals require that the minimal data set be made fully available. For more information about our data policy, please see http://journals.plos.org/plosone/s/data-availability. Upon re-submitting your revised manuscript, please upload your study’s minimal underlying data set as either Supporting Information files or to a stable, public repository and include the relevant URLs, DOIs, or accession numbers within your revised cover letter. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories Response. Data set is now uploaded as an Excel sheet 5. 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. Response. Two new references have been added (no 16 and 21) making 24. B. Responses to Reviewers (Line numbers in red are as on the tracked changes document) 1. The statistical analysis in general is appropriate and rigorous. However one is curious to know why an "independent t-test" was used to measure differences in knowledge, attitude and practice (KAP) pre- and post- intervention instead of a "paired t-test"? Response. Line 269-272.The independent T test was used when we compared post training scores only for analysis of statistical association (Tables 4 and 5) but when we compared as on Table 3, the paired T test was used. This we believe is appropriate. “Associations between the socio-demographic characteristics of respondents and their post-intervention COVID-19 knowledge, attitude, and preventive practices were assessed using an independent sample t-test and one-way analysis of variance (ANOVA) when data were normally distributed or Wilcoxon signed-rank and Kruskal-Wallis equality-of-populations rank test as appropriate when the data were not normally distributed” This was as in the first submission. 2. Line 89 – 90: Almost 80% had positive - had positive what? 82% used face masks - desirable to know what use of face mask means in the study. Is it consistent use of face mask or ever use of face mask? Response. Line 86. Positive attitudes (80%) Line 87. Face masks use was consistent 3. Line 127 – 128: The population is estimated to be over 20 million.- Provide reference Response. Line 124. Reference 16 now included. 4. The health care of its residents is overseen by the Lagos State Ministry of Health. - It is also true that the Federal Ministry of Health also play a role in the health of the residents. Please clarify what is meant by 'overseen' Response. The Statement has now been re-written Line 125-127 “Health services for the citizens are available through both public and private facilities. The larger numbers of publicly owned facilities in Lagos State belong to the Lagos State Government although there are a few owned by the Federal Government” 5. Line 134 – 135: Government-owned health facilities include 18 PHC centres and the Lagos State University Teaching Hospital (LASUTH). - Is there no secondary health facility in the LGA? Mention the presence or absence of secondary health facility in the LGA. Response. Line 135-136. There is no secondary health care facility in Ikeja LGA as the existing one was upgraded to become the teaching hospital (LASUTH). 6. Line 158 – 159: PHCs were selected based on having a high patient load and all eligible health workers in the selected facilities were recruited into the study - How many PHCs were selected in each LGA. The sampling method for selecting those PHCs not mentioned Response. Line 163-165. PHCs were selected based on having a high patient load (four facilities in Ikeja LGA and five facilities in Alimosho LGA) and all eligible health workers in the selected facilities were recruited into the study. These PHC were selected by simple random sampling. 7. Line 191: …. their first visit ….. - Does this mean their first ever visit/contact to facility or first visit for that episode of illness. Please clarify Response. Line 201 First visit for childcare during the study 8. Line 263 – 264: The mean ages at the baseline and the end of the study were 40.8±9.6 and 39.2±9.9 years respectively. - What is the explanation for the change in age at baseline and at the end of the study? If it is the 63 that completed the study that were used then their ages shouldn't have changed remarkably. Indicate the duration of each phase of the study in the methods section. Response. Line 281. The observation by the reviewers was correct but we have now effected the appropriate changes. Only the 63 that completed had their menage computed. The baseline mean age initially used was for all the recruited participants, but this has now been removed see Table 1 Line 203,214,229-231.The duration of the phase of the study: baseline -four weeks; intervention four weeks. Post intervention data collection.one week. Now indicated in the methods section 9. Line 270 – 271: …… level of knowledge was 270 high on symptoms, modes of transmission, and preventive measures - Provide the figure for the level of knowledge. It is not enough to state that it is high except in the discussion section. Response. Line 290-291.The details are now provided The level of knowledge was high on symptoms (< 90%), modes of transmission (<80%), and preventive measures (<93%). 10. Line 278 – 279: Marital status and LGA of health workers were statistically significantly associated with knowledge scores - In what direction are the differences? Response. Line 298-300. The direction has now been shown Married PHC workers had higher mean knowledge scores compared with the single. PHC workers in Alimosho LGA had higher mean knowledge scores than those in Ikeja LGA. 11. Line 290: …….. interactions with trained PHC workers … - Provide information on the nature of their interactions (duration of interactions, mode of interaction - one - on - one or group health talk, etc) with PHC workers in the methods section. Response. Line 230-233. This has been done in the methods section After the training, the same set of clients were exposed to the trained PHC workers for one-on one counselling on invitation to the PHC. Each session lasted for about ten minutes. 12. Line 298 – 299: The interaction with trained PHC workers led to an increase in all aspects of the knowledge enquired about: - Provide data showing the increase as provided for the baseline. Response. Line 321-329. The data was provided as before on Table 7 The interaction with trained PHC workers led to an increase in clients’ knowledge of symptoms (<80%), modes of transmission (<80%) and preventive measures (<90%). Single clients had significantly higher mean knowledge scores than the married but clients in Ikeja LGA had significantly higher knowledge scores than those in Alimosho LGA 13. Line 326 - ….. cough. - delete - cough is repeated in this sentence Response. Line 336. The repeated word “Cough” is now deleted. 14. Study limitation - It is desirable to mention the limitation in the study design - The lack of control group Response. Line 439-440. Now done The lack of a control group is another limitation of the study. Professor Olumuyiwa Odusanya (signed) Lead and Corresponding Author Attachments Attachment Submitted filename: Response to Reviewers_August29_2022.docx https://doi.org/10.1371/journal.pone.0274750.r002
6 Sep 2022 Decision Letter - Kehinde Kazeem Kanmodi, Editor Building capacity of Primary Health Care workers and Clients on COVID-19: Results from a web-based training. PONE-D-22-16429R1 Dear Prof Odusanya, 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, Kehinde Kazeem Kanmodi, BDS 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 #2: 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 #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 ****** 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: Suggested correction in the original manuscript has been corrected satisfactorily by the authors. The corrections requested in the various sections particularly in the Methods and Results section have been done. The areas requiring clarification have been clarified. ****** 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: Tanimola Makanjuola Akande ******** Attachments Attachment Submitted filename: PONE-D-22-16429_R1_reviewer.pdf https://doi.org/10.1371/journal.pone.0274750.r003
Formally Accepted
27 Sep 2022 Acceptance Letter - Kehinde Kazeem Kanmodi, Editor PONE-D-22-16429R1 Building capacity of Primary Health Care workers and Clients on COVID-19: Results from a web-based training. Dear Dr. Odusanya: 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. Kehinde Kazeem Kanmodi Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0274750.r004

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