*For a more proper view of our Response to reviewers, we kindly ask you to check the
Word document entitled Response to reviewers.
Dear Sir/Madam
With this cover letter we submit the revised manuscript, initially entitled” Challenges
in the communication process during the COVID-19 pandemic- a perspective of medical
staff”, and after complying with the suggestions of the reviewers, entitled “Misinformation
about medication during the COVID – 19 pandemic: a perspective of medical staff” by
Claudiu Coman, Maria Cristina Bularca, Angela Repanovici and Liliana Rogozea for publication
in PLOS ONE.
We revised the manuscript according to the suggestions and recommendation made by
the reviewers. We would like to thank the reviewers for taking time to review our
paper and for providing such useful suggestions. We also thank the academic editor
for reviewing our paper. We tried to comply with all the suggestions and recommendations
made by the reviewers, and in this letter, we describe the changes we made to the
text according to the recommendations of the reviewers.
Our manuscript needed major revisions. The changes were made while having active the
“Track changes” function from Microsoft Word and the lines where the text was changed
can be best viewed while having active the “All markup” option. Moreover, in order
for our changes to be best seen, we will also provide in this cover letter, the lines
from the revised manuscript with the “Track changes” function, and “All markup” option
active. With regards to our response to Reviewer 1, the reviewer made a series of
suggestions directly in the PDF version of our initial manuscript, but also provided
a summary of those suggestions in the e-mail which was sent by the journal to the
corresponding author. In this regard, we responded first to the comments highlighted
in the summary from the e-mail, and then we responded to each point made by Reviewer
1 in the PDF version of our initial manuscript. Next, we responded to each point raised
by Reviewer 2.
Our response to Reviewer 1:
We firstly thank the reviewer for taking time to review our manuscript and provide
suggestions in order to improve it. We addressed all the suggestions made by the reviewer.
When we describe how the text was changed, we also provide the lines where the text
can be found in the revised manuscript with the option “Track changes” active. In
this way, the changes can be viewed completely (the text we deleted, and the text
we inserted). Next, we will firstly describe our answers to the comments which were
summarized in the e-mail received by the corresponding author, and then we will present
our responses to the comments made by the reviewer in the PDF version of our manuscript.
Reviewer 1 comments- as summarized in the email received by the corresponding author
Reviewer 1 point 1: the review comments attached. The required modifications can be
summarized as following and the authors will find it in details in the attached file:
the authors should review the journal guidelines and abide by it in manuscript preparation.
Response 1: We are grateful to the reviewer for the suggestion. We reviewed the guidelines
of PLOS ONE journal again and we made sure our manuscript is prepared in accordance
to the author guidelines which can be found on the journal’s official website. We
also checked the pdf files entitled “Download sample title, author list, and affiliation
page” and “Download sample manuscript body”, in order to make sure our manuscript
is correctly formatted. Thus, we looked again at the guidelines for the sections which
have to be included in the manuscript, the font and sizes for headings, table captions,
referencing rules, etc., and we made sure our manuscript respects the guidelines of
the journal.
Reviewer 1 point 2: the introduction section is too long and need to be summarized.
Response 2: We thank the reviewer for the useful suggestion. In order to comply with
it, we tried to summarize our introduction. Thus, we would like to mention that we
also took into account the comments the reviewer made in the pdf version of the manuscript.
In this regard, there the reviewer recommended us to rephrase the first paragraph
of our paper because the paragraph was not about the communication process: “the introductory
paragraph is not related to communication process”. We rephrased the paragraph and
we added information in which we highlighted the fact that the COVID – 19 pandemic
negatively influenced the communication process. The changes we made, the text deleted,
added or rephrased can be best seen while having active the “Track changes” function
and the “All markup” option provided by Microsoft Word. Thus, in the Introduction
section of the paragraph, page 4 of the manuscript, lines 71-77, we made changes to
the text, and the new introductory paragraph also addresses the subject of communication:
“The COVID 19 pandemic generated multiple changes in the way today’s society members
carry out their daily activities. One of the processes which was mostly affected by
the pandemic was the communication process between institutions and the public, as
well as between individuals. In this regard, from this perspective, while many domains
were affected by the spread of the virus, such as the educational system or the cultural
sector, the health sector was the one that faced the most challenges [1].”
Next, in the pdf version of our manuscript, the reviewer suggested that the details
we gave regarding the virus could be summarized in one paragraph: “the history of
covid-19 can be summarized in a single paragraph”. In order to comply with the request,
in the Introduction section, at page 4 of the manuscript, we summarized the text indicated
by the reviewer.
The text the reviewer suggested us to summarize:
“Caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [2], the disease
was firstly detected in December 2019, in Wuhan, China [3], and it fastly spread all
over the world. The World Health Organization was informed about a pneumonia outbreak
in Wuhan on December 31 2019, the number of cases continued to increase, and on March
11 2020 the World Health Organization characterized COVID 19 as a pandemic [4]. Being
highly contagious, the virus affected a large number of people, and as of November
27 over 61 million cases were reported [5]. Even though many companies and institutions
are struggling to develop a vaccine, Pfizer, Gamaleya Research Institute, University
of Oxford, and a preliminary analysis of the vaccine proposed by Pfizer showed that
the vaccine is able to prevent more than 90% of people from getting infected with
COVID 19 [6], so far no vaccine was approved as a general and universal vaccine against
COVID 19 [7]. Ever since the pandemic was declared, finding the right treatment for
the virus has become a priority for researchers and doctors from all over the world.
In this regard, large number of trials started to be conducted, and in order to find
an efficient drug treatment against the virus, one method that was adopted was testing
and administrating to patients, drugs that were previously used for curing other viruses
[8]. Thus, on March 20 2020, The World Health Organization launched the SOLIDARITY
clinical trial, a trial that monitored the effects on patients infected with COVID
19, of specific drugs that proven to be effective in the treatment of other diseases:
remdesivir, interferon beta, chloroquine and hydroxychloroquine -previously used for
Malaria, as well as drugs used on HIV patients: lopinavir and ritonavir [9]. However,
according to the interim results published on October 15 2020 by WHO, even though
those drugs were taught to have positive effects on treating COVID 19, they had little
influence or no influence at all on mortality in general, on the need and initiation
of ventilation and on the recovery process [10].”
The way we summarized the text can be seen at lines 102-114- in the revised version
of our manuscript (The full change, the text deleted and the text summarizes is visible
at lines 78-114).
The text we summarized (lines 102 -114 with the “Track changes” and “All Markup” option
active:
“Caused by severe acute respiratory syndrome coronavirus 2 [2], the disease was firstly
detected in December 2019, in Wuhan, China [3]. Due to the evolution of the virus,
the World Health Organization declared the pandemic in March 2020 [4], and as of November
27 over 61 million cases were reported [5]. In this regard, although several companies
are struggling to develop a vaccine, and some of the proposed vaccines showed promising
results [6], so far no vaccine was approved in order to be administrated to the entire
population [7]. Ever since the pandemic was declared, many companies started to be
preoccupied with finding a treatment, and one method used that was adopted was administrating
to patients, drugs that were previously used for curing other viruses [8]. Thus, one
of the most well - known trials started was the SOLIDARITY trial, which focused on
using various drugs including chloroquine and hydroxychloroquine, lopinavir or ritonavir
[9]. However, even if those drugs were taught to have positive effects on treating
the virus, they did not have a significant influence on preventing mortality in general
[10]”.
Next, in order to reduce the information written in the Introduction section, as the
reviewer suggested, we also deleted the last paragraph of the Introduction section,
paragraph in which we provided details about the concepts that we addressed next in
the Literature review section. Thus, at lines 118 – 122 in the revised manuscript
with “Track changes” and “All Markup” option active, we deleted the following text:
“Hence, considering the purpose of our paper and the research questions, we believed
it was necessary to analyze the literature on the drugs used to treat COVID – 19,
on the role of social media platforms in spreading fake information about the virus
and potential treatments, and on the way the pandemic influenced the credibility of
doctors and their relationship with their patients.”
Reviewer 1 point 3: the section titles need to be reviewed and fixed.
Response 3: We thank the reviewer for the useful suggestion. We checked again the
author guidelines provided by the journal on its official website, regarding sections
of the manuscript. In this regard, we corrected the section which was entitled “Methods
and materials” in the initial version of our manuscript, with the correct form, which
is “Materials and methods”. The change can be seen in the revised manuscript at page
17, line 364, while having active the “Track changes” and “All markup” options from
Microsoft Word. We reviewed all of our section titles and made sure they are correct.
Reviewer 1 point 4: the resuklts section include too much tables need to be focusing
on the most significant tables and attach the other tablesas supplementary tables.
Response 4: We are grateful to the reviewer for such useful suggestion. We addressed
the suggestion, we looked at the tables included in the Results section and we integrated
in the section only the most significant tables. The other tables were deleted from
the text and added to supplementary information. Thus, we created Word documents with
supplementary information for each of our research questions. In this regard in S3_Tables
with results to the 1st research question we included Table 2 ; in S4_Tables with
results to the 2nd research question we included Table 5 and Table 6; in S5_Tables
with results to the 3rd research question we included Table 7 and Table 9; in S6_Tables
with results to the 4th research question we included Table 11 and Table 12; in S7_Tables
with results to the 5th research question we included Table 15 and Table 16.
Reviewer 1 point 5: the methods section is missing the research design, sampling method
and the calculation of the study sample and the validity and reliability section.
Response 5: We are very grateful to the reviewer for suggesting us to improve the
methods section of our paper. With regards to the research design section, we added
this section to our manuscript and we explained in detail the research design. Even
more, we deleted some information from the Sampling and data collection procedures
and we added it to the research design section because it was more suitable there.
In this regard, at pages 17-18 of the manuscript, between lines 365- 385 can be found
the Research design section of our paper, which comprises the following text:
“The present study was conducted on Romanian healthcare professionals including doctors,
nurses and medical students. The method used is quantitative. The questionnaire was
administrated online, the data was collected through the help of Google forms, and
was disseminated on groups of healthcare professionals and students on platforms such
as Facebook and WhatsApp, during the period April 2021– June 2021. The data we collected
was firstly exported to Microsoft Excel, and then it was analyzed with IBM Statistical
Package for the Social Sciences, version 20. The respondents were informed about the
purpose of the study, about the fact that they were allowed to withdraw at any time,
and they were asked to give their consent for participating in the study. The average
time needed to complete the questionnaire was 15 minutes. Considering the validity
of our research, we took into account the theoretical information from the literature
regarding the development of a questionnaire. Our team of researchers together with
health specialists have configured the dimensions, and operationalized the concepts
in accordance with the theoretical approaches identified at the current stage of the
research. Even more, we pre-tested the questionnaire before disseminating in order
to guarantee the validity of the instrument. Thus, the questionnaire was completed
by 50 respondents in the pre-testing stage. Considering the reliability of the research,
we used split half reliability method. We split our sample in half, and we checked
the variables in from our sub-samples in order to see if the variables provided convergent
results. The convergent results we obtained by applying the split half method showed
that we obtained a high fidelity measurement.
In order to create the research design section and to also improve the way our paper
is structured, we made changes to the section “Sampling and data collection procedures”.
In this regard, we deleted some text and we reformulated some phrases. The section
comprises the following text, which can be found at pages 17-18 of the revised manuscript
with “Track changes” and “All markup” option active, lines 419-427:
“In order to conduct the research we used a quantitative method while having as an
instrument a questionnaire. The responses were collected online, with the help of
Google forms, and the questionnaire was self – administrated. The research received
approval from The Council of the Faculty of Sociology and Communication, approval
request Nr.378/30.03.2021. Taking into account the sampling method and the calculation
of the study sample, we used random, probabilistic sampling method. We took into consideration
specialists, physicians, and medical students from Brasov, and we applied the snowballing
method in order to disseminate the questionnaire. The sample of our study comprises
536 respondents, and included doctors, nurses as well as medical students from Romania.”
With regards to the sampling method, we would like to thank the reviewer for pointing
out that we should give more information about the sampling procedure. Even though
in the initial version of our manuscript we described the sample of our research,
how the questionnaire was distributed and to whom, we added more specific information
about the sampling method. Hence, at page 20 of the manuscript, lines 423 - 426, we
explained that we used a random, probabilistic sampling method:
“Taking into account the sampling method and the calculation of the study sample,
we used random, probabilistic sampling method. We took into consideration specialists,
physicians and medical students from Brasov, and we applied the snowballing method
in order to disseminate the questionnaire.”
Reviewer 1 point 6: the conclusion section need to be summarized and conclude the
main study findings and its significance.
Response 6: We are grateful to the reviewer for the suggestion. In order to comply
with it we tried to summarize our Conclusions section, to highlight again the main
findings of the research and the significance of our study. In this regard, the text
which was written in Conclusions in the initial version of our manuscript was improved.
In this regard, we deleted some of the redundant information which was written in
this section. The information we deleted:
“In this regard, besides fighting the pandemic, physician also had to fight the so
called infodemic. Fake news spread on social media about various alternative treatments
for the virus and the opinions of certain professionals about treatment methods which
later proven to be inaccurate negatively influenced the credibility of doctors.” (Lines
789-792)
“This results can suggest that while professionals were aware of the role of social
media in spreading medical misinformation and in affecting trust in doctors, due to
their knowledge, at personal level they were less affected by that type of information,
many of them believing that social media should also be used for sending official
information” (lines 803-807)
“Moreover, the medical staff was aware of the alternative treatments which were promoted
on social media, the method of drinking alcohol in order to prevent the infection
being the method that most of the respondents have heard about” (lines 811-813).
“Hence, on the basis of the findings and implications of the study, we further discuss
limitations and future research directions.” (Lines 838-839).
Next, we took into account the recommendation of the reviewer and we started the section
by presenting the main findings of our research. Since we had several research questions,
we presented our main findings in relation to those research questions. Next, the
reviewer recommended us to explain the significance of our study. Thus, in the paper
we had already written the theoretical and practical implication of our paper. In
this regard, we did not delete the implications because we consider that the implications
emphasize why the study conducted is important and how it can be further taken into
consideration. Next, we did not delete the limitations and future research directions
either, because we considered necessary to highlight how and why our study has limitations
but also how it could be further developed or extended.
Reviewer 1 point 7: the references are too much need to be filtered and summarized
to 30 or 40 refrences maximum. Regards
Response 7: We are very grateful to the reviewer for this recommendation and we appreciated
the interest in improving our paper. However, when we started to write the article,
we wanted to make sure our paper will be well documented and that it will address
all the theoretical concepts and aspects needed. In this regard, we made a thorough
research and literature review on the medication used in order to treat the virus,
on the way social media contributed to the spread of misinformation about the virus,
and on the way trust in doctors and the doctor- patient relation was affected during
the pandemic. Thus, we read many research paper because we wanted for our paper to
provide an overall view on the subject addressed. In this regard, we consider that
all the references we used are relevant for the subject approached and for the research
that we conducted, and therefore we could not delete more than half of them. In other
words, through the references cited we support and sustain our arguments, we show
how other researchers approached similar matters and thus we could not delete more
than half of our references because we considered that by deleting them we could no
longer have a strong and well consolidated theoretical background and we could not
properly explain how we wanted to address the matted of medical misinformation and
its effects from the perspective of medical staff. Even more, the journal does not
have a limitation regarding the length of the article or the number of references:
“Manuscripts can be any length. There are no restrictions on word count, number of
figures, or amount of supporting information”. In addition, we have seen articles
which addressed subjects related to health and the COVID – 19 pandemic, and which
were published in PLOS ONE, that have more than 40 references. For example, one article
entitled “Severity of infection with the SARS- CoV -2 B1.1.7 lineage among hospitalized
COVID – 19 patients in Belgium” (https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0269138), has 76 references, and another article, entitled “The coronavirus disease 2019
(COVID -19) vaccination psychological antecedent assessment using the ARABIC 5c validated
tool: An online survey in 13 Arab countries” (https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0260321) has 71 references.
Reviewer 1 comments- as pointed by the reviewer in the PDF version of our manuscript
Reviewer 1 point 1: A perspective of medical staff
Response 1: We thank the reviewer for the suggestion. We put “:” instead of “-“in
our title, before the phrase “a perspective of medical staff”. The change can be seen
at line 2 of the revised manuscript.
Reviewer 1 point 2: the abstract need to be summarized to 250 to 300 words by the
main important information in each part ....it is recommended to avoid long paragraphs
and to paraphraze and summarize the ideas in short paragraphs.
Response 2: We are grateful to the reviewer for the recommendation. In order to comply
with it we summarized our abstract to 219 words. In this regard, we deleted the text
which was written in the Abstract section, and instead, at page 3 of the revised manuscript
with “Track changes” and “All markup” option on, at lines 50 –68 we inserted the following
text:
“Background. Healthcare professionals had to face numerous challenges during the pandemic,
their professional activity being influenced not only by the virus, but also by the
spread of medical misinformation. In this regard, we aimed to analyze, from the perspective
of medical staff, the way medical and non - medical information about the virus was
communicated during the pandemic in order to raise awareness about the way misinformation
affected the medical staff.
Methods and findings. The study was conducted on Romanian healthcare professionals.
They were asked to answer to a questionnaire and the sample of the research includes
536 respondents. The findings revealed that most respondents stated that information
about alternative treatments against the virus affected the credibility of health
professionals, and that younger professionals believed to a greater extent that trust
in doctors was affected. The research also showed that respondents were well informed
about the drugs used in clinical trials in order to treat the virus.
Conclusions. Healthcare professionals declared that the spread of misinformation regarding
alternative treatments, affected their credibility and the relationship with their
patients. Healthcare professionals had knowledge about the drugs used in clinical
trials, and they acknowledged the role of social media in spreading medical misinformation.
However, younger professionals also believed that social media could be used to share
official information about the virus.”
Reviewer 1 point 3: the introductory paragraph is not related to communication process.
Response 3: We thank the reviewer for pointing this out. We explained how we addressed
this point above in this Cover letter, in point 2 raised by the reviewer in the summary
which was written in the e-mail sent to the corresponding author. However, we will
present again the way we changed the introductory paragraph in order for it to be
related to communication process. In this regards, in the Introduction section of
the paragraph, page 4 of the manuscript with “Track changes” and “All markup active”,
lines 71-77, we made changes to the text, and the new introductory paragraph also
addresses the subject of communication:
“The COVID 19 pandemic generated multiple changes in the way today’s society members
carry out their daily activities. One of the processes which was mostly affected by
the pandemic was the communication process between institutions and the public, as
well as between individuals. In this regard, from this perspective, while many domains
were affected by the spread of the virus, such as the educational system or the cultural
sector, the health sector was the one that faced the most challenges [1].”
Reviewer 1 point 4: the history of covid-19 can be summarized in a single paragraph.
Response 4: We are very grateful to the reviewer for the recommendation. We tried
to comply with it and we summarized the history of COVID -19. Earlier in this cover
letter we explained how we addressed this point because the reviewer also mentioned
it in the summary which was written in the e-mail sent to the corresponding author.
In this regard, we summarized the indicated text, and at page 5 of the manuscript
with “Track changes” and “All markup” option active, lines 102- 114 we added the following
text:
“Caused by severe acute respiratory syndrome coronavirus 2 [2], the disease was firstly
detected in December 2019, in Wuhan, China [3]. Due to the evolution of the virus,
the World Health Organization declared the pandemic in March 2020 [4], and as of November
27 over 61 million cases were reported [5]. In this regard, although several companies
are struggling to develop a vaccine, and some of the proposed vaccines showed promising
results [6], so far no vaccine was approved in order to be administrated to the entire
population [7]. Ever since the pandemic was declared, many companies started to be
preoccupied with finding a treatment, and one method used that was adopted was administrating
to patients, drugs that were previously used for curing other viruses [8]. Thus, one
of the most well - known trials started was the SOLIDARITY trial, which focused on
using various drugs including chloroquine and hydroxychloroquine, lopinavir or ritonavir
[9]. However, even if those drugs were taught to have positive effects on treating
the virus, they did not have a significant influence on preventing mortality in general
[10]”.
Reviewer 1 point 5: the stydy aim is to assess the perception and this other aim is
not included as an intervention, so it is better to rephrased as to recommend future
researches or interventions to raise......
Response 5: We thank the reviewer for the useful suggestion. We tried our best in
addressing the recommendation. In this regard, we rephrased the part of the purpose
indicated by the reviewer. In other words, the reviewer suggested us to rephrase the
last part of our purpose, to rephrase the expression “in order to raise awareness
about the way misinformation affected medical staff”. Hence, at page 6 of the manuscript
with “Track changes” and “All Markup” option active, lines 129 –133 we rephrased the
purpose and added the following text:
“The purpose of the paper is to analyze, from the perspective of medical staff, the
way medical and non - medical information about the virus was communicated during
the pandemic to encourage the development of future research or interventions in order
to raise awareness about the way misinformation affected medical staff.”
Due to the suggestion of the reviewer, we had to change the way we described the purpose
of our paper in other sections of our manuscript too. Thus, the purpose of the paper
was changed in the way recommended by the reviewer, also at lines: 52 -55 (in the
Abstract section).
Reviewer 1 point 6: please to consider the restructuring of the manuscript as per
the journal guidelines and the title of each section. Also, the literature review
section is very long and it should be fixed to bo not more than 2 to 2 and half pages
summarizing the main ideas.
Response 6: We are very grateful to the reviewer for suggesting us to check again
the guidelines of the journal. As we previously explained in this Cover letter, (due
to the fact that the same point was also highlighted by the reviewer in the summary
which was written in the e-mail sent to the corresponding author), we checked again
the guidelines and made sure our manuscript is formatted according to the guidelines.
We also checked again the titles of the section which should be included in the manuscript,
and at page 17 of the revised manuscript with “Track changes” and “All markup” option
active, line 364 we changed “Methods and materials” to “Materials and methods”.
With regards to summarizing our Literature review and deleting references from our
paper, we present again the explanation we gave earlier in the Cover letter, at point
7 made by the reviewer in the e-mail sent to the corresponding author:
We are very grateful to the reviewer for this recommendation and we appreciated the
interest in improving our paper. However, when we started to write the article, we
wanted to make sure our paper will be well documented and that it will address all
the theoretical concepts and aspects needed. In this regard, we made a thorough research
and literature review on the medication used in order to treat the virus, on the way
social media contributed to the spread of misinformation about the virus, and on the
way trust in doctors and the doctor- patient relation was affected during the pandemic.
Thus, we read many research paper because we wanted for our paper to provide an overall
view on the subject addressed. In this regard, we consider that all the references
we used are relevant for the subject approached and for the research that we conducted,
and therefore we could not delete more than half of them. In other words, through
the references cited we support and sustain our arguments, we show how other researchers
approached similar matters and thus we could not delete more than half of our references
because we considered that by deleting them we could no longer have a strong and well
consolidated theoretical background and we could not properly explain how we wanted
to address the matted of medical misinformation and its effects from the perspective
of medical staff. Even more, the journal does not have a limitation regarding the
length of the article or the number of references: “Manuscripts can be any length.
There are no restrictions on word count, number of figures, or amount of supporting
information”. In addition, we have seen articles which addressed subjects related
to health and the COVID – 19 pandemic, and which were published in PLOS ONE, that
have more than 40 references. For example, one article entitled “Severity of infection
with the SARS- CoV -2 B1.1.7 lineage among hospitalized COVID – 19 patients in Belgium”
(https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0269138), has 76 references, and another article, entitled “The coronavirus disease 2019
(COVID -19) vaccination psychological antecedent assessment using the ARABIC 5c validated
tool: An online survey in 13 Arab countries” (https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0260321) has 71 references.
Reviewer 1 point 7: Research Design (please to review examples of the journal manuscript
preparation)
Response 7: We thank the reviewer for pointing out that we should described more thoroughly
the Research design of our paper. We explained how we addressed this suggestion earlier
in this Cover letter, because the reviewer highlighted the suggestion in the summary
from the e-mail sent to the corresponding author too. However, we will present again
the way we complied with the suggestion. We did review examples of the journal manuscript
preparation, and after we had done so, we deleted some text from the section “Sampling
and data collection procedures” and moved it to the new section created. In this regard,
at pages 17-18 of the revised manuscript with “Track changes” and “All markup” option
active, lines 365-385, we inserted a sub-section entitled “Research design” which
comprises the following text:
“The present study was conducted on Romanian healthcare professionals including doctors,
nurses and medical students. The method used is quantitative. The questionnaire was
administrated online, the data was collected through the help of Google forms, and
was disseminated on groups of healthcare professionals and students on platforms such
as Facebook and WhatsApp, during the period April 2021– June 2021. The data we collected
was firstly exported to Microsoft Excel, and then it was analyzed with IBM Statistical
Package for the Social Sciences, version 20. The respondents were informed about the
purpose of the study, about the fact that they were allowed to withdraw at any time,
and they were asked to give their consent for participating in the study. The average
time needed to complete the questionnaire was 15 minutes. Considering the validity
of our research, we took into account the theoretical information from the literature
regarding the development of a questionnaire. Our team of researchers together with
health specialists have configured the dimensions, and operationalized the concepts
in accordance with the theoretical approaches identified at the current stage of the
research. Even more, we pre-tested the questionnaire before disseminating in order
to guarantee the validity of the instrument. Thus, the questionnaire was completed
by 50 respondents in the pre-testing stage. Considering the reliability of the research,
we used split half reliability method. We split our sample in half, and we checked
the variables in from our sub-samples in order to see if the variables provided similar
results. The convergent results we obtained by applying the split half method showed
that we obtained a high fidelity measurement.”
Reviewer 1 point 8: methods and data (please to review the journal authors guideline).Also
the reserch design is missed, please to clarify the research design used.
Response 8: We thank the reviewer for the suggestion. We reviewed again the journal
author guidelines. Also, we added a research design section and the text contained
in the section can be found at lines 365-385 of the manuscript with the “Track changes”
and “All markup” option active.
Reviewer 1 point 9: start new sentence (line 333) in the PDF version of our manuscript
Response 9: We thank the reviewer for the recommendation. We complied with it and
we started a new sentence, at page 17 of the manuscript with “Track changes” and “All
markup” option active, lines 372 we deleted the words “At the beginning of the questionnaire”,
and we started a new sentence with “The respondents were informed…”.
Reviewer 1 point 10: Also this section should not include the data interpretation
or analysis. it should include only description.
Response 10: The reviewer referred to the “Sample and data collection procedure” section.
We are grateful to the reviewer for the suggestion and in order to comply with it
we made some changes to the text which was written in this section. In this regard,
the data interpretation and analysis was removed from the section, and was moved to
the “Results” section of our paper. The deleted text together with the table can be
seen at lines 427 –444 of the revised manuscript with “Track changes” and “All markup”
option active. The text we inserted in the “Results” section can be seen at lines
486-501 of the manuscript:
“Out of the 536 respondents, 460 (85.8%) were female and 76 (14.2%) were male. A total
of 411 respondents live in the urban area (76.7%), while 125 (23.3%) live in the rural
area. Most respondents (286, 53.4%) are between 18 and 35 years of age, 142 respondents
(26.5%) are between 36 and 50 years of age, 102 respondents (19.0%) are between 51
and 65 years of age, and 6 of them (1.1) are over 65 years of age. When it comes to
the professional degree of the respondents, most of them are students at a university
nursing program (122, 22.8%), and medical students (120, 22.4%). However, a total
of 102 respondents (19.0%) are senior specialists medical – doctors, and 70 (13.1%)
are nurses who have a higher education diploma. When it comes to the respondents field
of specialization, most of them (70.5%) operate in the field of general medicine,
while others are family doctors (10.4%), pediatricians (3%), dentists or oncologists
(1.9%), surgeons of doctors who are specialized in internal medicine (1.5%), or infectious
disease doctors, radiologists or cardiologists (1.1%). Furthermore, most of the respondents
(77.2%) stated that they did not work a unit with COVID – 19 patients while few of
them (22.8%) stated that they worked in such a unit at the time the research was conducted.
Thus, all the characteristics of the sample are presented in Table 1.
Table 1. Sample characteristics (n = 536).
Category Count Percentage
Gender Female 460 88.8%
Male 76 14.2%
Living environment Urban 411 76.7%
Rural 125 23.3%
Age 18-35 years old 286 53.4%
36-50 years old 142 26.5%
51 -65 years old 102 19.0%
Over 65 years old 6 1.1%
Professional degree Senior specialist medical - doctor 102 19.0%
Specialist medical - doctor 46 8.6%
Resident 28 5.2%
Nurse with higher education diploma 70 13.1%
Nurse with other studies than higher education 48 9.0%
Medical student 120 22.4%
Student at university nursing program
122 22.8%
Field of specialization General medicine 378 70.5%
Family doctor 56 10.4%
Pediatrics 16 3%
Stomatology 10 1.9%
Oncology 10 1.9%
Surgery 8 1.5%
Internal medicine 8 1.5%
Virology/ infectious disease doctor 6 1.1%
Cardiology 6 1.1%
Radiology 6 1.1%
Other 32 6%
Works in a unit with COVID – 19 patients Yes 122 22.8%
No 414 77.2%
”
Reviewer 1 point 11: please to explain how you calculated the sample size and the
type of sampling that you used.
Response 11: We thank the reviewer for the suggestion. We offered an explanation for
this point, which was also mentioned by the reviewer in the summary provided in the
e-mail sent to the corresponding author. However, we will present again the explanation,
which can be found at lines 413-416 of the manuscript with “Track changes” and “All
markup” option active:
“Taking into account the sampling method and the calculation of the study sample,
we used random, probabilistic sampling method. We took into consideration specialists,
physicians and medical students from Brasov, and we applied the snowballing method
in order to disseminate the questionnaire.”
Reviewer 1 point 12: this section should be trasfered before data presentation and
analysis with the methods part before data analysis
Response 12: The reviewer was referring to “The research instrument” section. We thank
the reviewer for the suggestion. Since the section was already written before the
“Data analysis” section, we moved the section before “Sampling and data collection
procedures”. The deleted text can be seen at lines 446-465 in the revised the manuscript
with “Track changes” and “All markup” option active. The section was moved and so,
the following text can be found in the revised manuscript at lines 387-406:
“In order to conduct the research we used a quantitative method while having a questionnaire
as an instrument. In this regard, we developed a questionnaire which comprises four
sections: A. Influence of the pandemic on the professional activity of medical staff
(items A1 to A4), B. Perception about the authorities’ communication process (items
B1 to B11), C. Perception about the communication of non- validated treatments (items
C1 to C20), and D. Sociodemographic questions (items D1 – D9), such as: gender, age,
living environment, professional degree, field of specialization. The sociodemographic
questions were used in order to identify different or similar attitudes between specific
groups. The questionnaire can be found in “S1.Appendix English version of the questionnaire”,
and in “S2. Appendix Romanian version of the questionnaire.” Before disseminating
the questionnaire, the instrument was tested on 30 doctors who work in the field of
cardiology and general medicine. The respondents understood clearly the questions
and did not report any issue in the process of answering them. Hence, the questionnaire
comprises close ended and open ended questions (Items A1, A4, B3, B11, C19, C20, D2,
D5, D6,) dihotomic questions as well as questions whose answers were measured on a
7 point Likert scale. For example, item A2 measured the extent to which the respondents
considered that the pandemic influenced the way they carried out their professional
activity (1- “to an extremely little extent, 7 “to an extremely great extent”), or
item B2 measure the respondents’ level of agreement with statements regarding the
way authorities communicated during the pandemic (1 – “strongly disagree, 7-“strongly
agree”).”
Reviewer 1 point 13: the validity and reliabity section is missed , please to discuss
it clearly Response 13: We thank the reviewer for the recommendation. In order to
address the recommendation, we inserted into our manuscript information about the
validity and reliability of our research in the “Research design” section. In this
regard, at page 18 of the manuscript with “Track changes” and “All markup” option
active, lines 376 – 385, we inserted the following explanation:
“Considering the validity of our research, we took into account the theoretical information
from the literature regarding the development of a questionnaire. Our team of researchers
together with health specialists have configured the dimensions, and operationalized
the concepts in accordance with the theoretical approaches identified at the current
stage of the research. Even more, we pre-tested the questionnaire before disseminating
in order to guarantee the validity of the instrument. Thus, the questionnaire was
completed by 50 respondents in the pre-testing stage.
Considering the reliability of the research, we used split half reliability method.
We split our sample in half, and we checked the variables in from our sub-samples
in order to see if the variables provided similar results. The convergent results
we obtained by applying the split half method showed that we obtained a high fidelity
measurement.”
Reviewer 1 point 14: you have two tables number by number 1 two times. please to review
the tables numbering and indexing in the maneuscript.
Response 14: We are very grateful to the reviewer for pointing this out. We checked
again all the numbers of the tables and corrected all the mistakes. Now in the revised
manuscript, all the tables are correctly numbered.
Reviewer 1 point 15: these codes need to be interpretted ( to give its full interpretaion
under each table)
Response 15: We thank the reviewer for the suggestion. The reviewer was referring
to the numbers of the questions which appear in the tables with correlations and t
tests. Those numbers represent the number of the questions from the questionnaires
which were included in the t tests or in the correlations. In other words, the numbers
refer to the variables used in order to make the tests and the correlations. For example,
in Table 3, C14 means, the question 14 from the questionnaire, which belongs to section
C. Section C refers to Perception about the communication of non- validated treatments.
So, under each table from our manuscript (including the tables which we put in supplementary
information) we added an explanation of the codes (numbers).
We would like to mention that the numbers of our tables changed, because in the initial
manuscript we had two tables numbered 1, so now we corrected the mistake. Thus, we
further present the explanation we gave in the revised manuscript with “Track changes”
and “All markup” option active, under each table:
Table 3 (which was table 2 in the initial manuscript). The following explanation was
added under the table: “1 1 C14 – refers to the question 14 from the section C of
the manuscript (The extent to which information about alternative treatments affected
trust in physicians), section which refers to Perception about the communication of
non- validated treatments; 2D2 - refers to question 2 from the D section of the manuscript
(age), which refers to Sociodemographic characteristics of the respondents
Table 8 (which was Table 7 in the initial manuscript). The following explanation was
added under the table “1 B10- refers to the question 10 from the section B of the
manuscript (Satisfaction with the way information about drugs used to treat the virus
was communicated) section which refers to Perception about the authorities’ communication
process; 2D2 - refers to question 2 from the D section of the manuscript (age), which
refers to Sociodemographic characteristics of the respondents.”
Table 13 (which was Table 12 in the initial manuscript). The following explanation
was added under the table “1 C1 – refers to question 1 from the section C of the manuscript
(The extent to which social media represents an appropriate environment for sharing
official COVID – 19 info), section which refers to Perception about the communication
of non- validated treatments; 2D2 - refers to question 2 from the D section of the
manuscript (age), which refers to Sociodemographic characteristics of the respondents.
Table 16 (which was Table 15 in the initial manuscript and which is in Supplementary
information - S7 Tables with results to the 5th research question). The following
explanation was added under the table “2A3 – refers to question 3 from the section
A of the manuscript (Main aspect of professional life influenced by the pandemic),
section which refers to Influence of the pandemic on the professional activity of
medical staff; The explanation for 1 professional degree was already written under
the table in the initial version of our manuscript.
Reviewer 1 point 16: the variables need to be clear on the table
Response 16: We thank the reviewer for pointing this out. The reviewer was referring
to the variables from the table which had the number 3 in the initial version of our
manuscript. The table now has the number 4, because we corrected the way we numbered
the tables. Hence, in order to be clear which the variables in the table are, we put
the word “variables” in front of the variables which were tested. The changes to the
table can be seen in the revised version of our manuscript with “Track changes” and
“All markup” option active at page 29:
“Table 4. Significant t-test results: comparisons between variables
t-test for Equality of Means
Group N Mean S. D. t df p Mean Difference Std. Error Difference CI4
Lower Upper
Variables: Information about alternative treatments _ Professional degree1 Medical
staff 294 5.33 1.54 -2.04 534 .04 -.27 .13 -.52 -.01
Student 242 5.60 1.49
Variables: Information about alternative treatments _working unit Unit with COVID
-19 patients 122 5.19 1.61 -2.13 534 .03 -.33 .15 -.64 -.02
Unit without COVID 19 patients 414 5.53 1.49
Variables: Information about alternative treatments _gender Male 76 5.10 1.70 -2.16
534 .03 -.40 .18 -.77 -.03
Female 460 5.51 1.48
1Index variable from the professional degrees of respondents. Student: medical student
and student at university nursing program, Medical Staff: Senior specialist medical
– doctor, Specialist medical – doctor, Resident, Nurse with higher education diploma,
Nurse with other studies than higher education”
Reviewer 1 point 17: there keys need to be written in full interpretaion under each
table.
Response 17: We thank the reviewer for the recommendation. We complied with it, and
as we explained at one of the previous points of the reviewer, the keys (or codes)
refer to the number of the question from the questionnaire, and the letter refers
to the section of the questionnaire. Hence, the reviewer referred to the table which
had the number 7 in the initial version of our manuscript. The table has the number
8 in the revised version of our manuscript with “Track changes” and “All markup” option
active, because we corrected the way we numbered the tables. Under table 8, at page
33 of the manuscript we added the following explanation:
“1 B10- refers to the question 10 from the section B of the manuscript (Satisfaction
with the way information about drugs used to treat the virus was communicated) section
which refers to Perception about the authorities’ communication process; 2D2 - refers
to question 2 from the D section of the manuscript (age), which refers to Sociodemographic
characteristics of the respondents.”
Reviewer 1 point 18: the tables are too much, please to focus on the highly significant
tables and add the others as a supplementary tables. it is recommended to reduce the
number of tables to 5 or 6 tables
Response 18: We are very grateful to the reviewer for the useful suggestion. We complied
with the suggestion and we deleted some tables from the manuscript and added them
as supplementary information. Early in this Cover letter we provided an explanation
for the tables, because this point was also included in the summary provided by the
reviewer in the e-mail sent to the corresponding author. We let in the manuscript
only the important tables: the tables with correlations and t tests, and the table
with sociodemographic characteristics of the respondents. Thus, we presented again
the explanation for the way we included the tables in supplementary information:
We created Word documents with supplementary information for each of our research
questions. In this regard in S3_Tables with results to the 1st research question we
included Table 1; in S4_Tables with results to the 2nd research question we included
Table 4 and Table 5; in S5_Tables with results to the 3rd research question we included
Table 6 and Table 8; in S6_Tables with results to the 4th research question we included
Table 10 and Table 11; in S7_Tables with results to the 5th research question we included
Table 14 and Table 15.
Reviewer 1 point 19: the conclusion section should be summarized to one paragraph
summarize your important results and its significance and the future related researches
Response 19: We thank the reviewer very much for the recommendation. We answered to
this point previously in this Cover letter, because the same point was also mentioned
in the summary provided by the reviewer in the e-mail sent to the corresponding author
by the journal (“the conclusion section need to be summarized and conclude the main
study findings and its significance.”). In this regard, we present again the redundant
information we deleted from the Conclusions section, the way we highlighted the main
results, their significance as well as the future research directions.
The information we deleted from the Conclusions section:
“In this regard, besides fighting the pandemic, physician also had to fight the so
called infodemic. Fake news spread on social media about various alternative treatments
for the virus and the opinions of certain professionals about treatment methods which
later proven to be inaccurate negatively influenced the credibility of doctors.” (Lines
789-792)
“This results can suggest that while professionals were aware of the role of social
media in spreading medical misinformation and in affecting trust in doctors, due to
their knowledge, at personal level they were less affected by that type of information,
many of them believing that social media should also be used for sending official
information” (lines 803-807)
“Moreover, the medical staff was aware of the alternative treatments which were promoted
on social media, the method of drinking alcohol in order to prevent the infection
being the method that most of the respondents have heard about” (lines 811-813).
“Hence, on the basis of the findings and implications of the study, we further discuss
limitations and future research directions.” (Lines 838-839).
Next, we took into account the recommendation of the reviewer and we started the section
by presenting the main findings of our research. Since we had several research questions,
we presented our main findings in relation to those research questions. Next, the
reviewer recommended us to explain the significance of our study. Thus, in the paper
we had already written the theoretical and practical implication of our paper. In
this regard, we did not delete the implications because we consider that the implications
emphasize why the study conducted is important and how it can be further taken into
consideration. Next, we did not delete the limitations and future research directions
either, because we considered necessary to highlight how and why our study has limitations
but also how it could be further developed or extended.
Reviewer 1 point 20: please to review your refrences and filter it to 30 to 40 refrences
as 83 refrences are too much refrences
Response 20: We are very grateful to the reviewer for the suggestion and we understand
the perspective of the reviewer. We would like to mention that we gave an explanation
to this point early in this Cover letter, because the point was included in the summary
which was sent by e-mail to the corresponding author. However, we insert again below
the explanation for this point, explanations in which we show why we were unable to
fully comply with the suggestion of the reviewer and delete more than half of our
references:
We are very grateful to the reviewer for this recommendation and we appreciated the
interest in improving our paper. However, when we started to write the article, we
wanted to make sure our paper will be well documented and that it will address all
the theoretical concepts and aspects needed. In this regard, we made a thorough research
and literature review on the medication used in order to treat the virus, on the way
social media contributed to the spread of misinformation about the virus, on the way
misinformation influenced people’s confidence in the opinion of doctors and on the
way the doctor- patient relation was affected during the pandemic. Thus, we searched
and found many research papers and we reviewed all of them because we wanted for our
paper to provide an overall view on the subject addressed. In this regard, all the
references we used are relevant for the subject approached and for the research that
we conducted. In other words, through the references cited we support and sustain
our arguments, we show how other researchers approached similar matters and thus we
could not afford to reduce them. By reducing them we could no longer have a strong
and well consolidated theoretical background and we could not properly explain how
we wanted to address the matter of medical misinformation and its effects from the
perspective of medical staff. Even more, the journal does not have a limitation regarding
the length of the article or the number of references: “Manuscripts can be any length.
There are no restrictions on word count, number of figures, or amount of supporting
information”. In addition, we have seen articles which addressed subjects related
to health and the COVID – 19 pandemic, and which were published in PLOS ONE, that
have more than 40 references. For example, one article entitled “Severity of infection
with the SARS- CoV -2 B1.1.7 lineage among hospitalized COVID – 19 patients in Belgium”
(https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0269138), has 76 references, and another article, entitled “The coronavirus disease 2019
(COVID -19) vaccination psychological antecedent assessment using the ARABIC 5c validated
tool: An online survey in 13 Arab countries” (https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0260321) has 71 references.
We would like to mention again that we did our best in trying to address all the suggestions
of the reviewer and that we are thankful to the reviewer for all the points raised,
for the time spent on analyzing our paper and for providing us very useful recommendations!
Response to reviewer 2
Reviewer 2 comment: The study is interesting and shows the point of view of health
professionals, misinformation affected trustwith the patient. Another fact is that
even among professionals, there are different perceptions about the spread of fakenews,
according to age and occupation.
Response from authors: We are very grateful to the reviewer for his/hers kind words,
and we appreciate the time the reviewer spent on reviewing our paper. We addressed
all the recommendations of the reviewer and we will present each of the changes we
made to the text. Before describing the way we addressed all the comments, we would
like to mention that the changes can be best seen in the revised version of our manuscript,
which has the “Track changes” and “All markup” options active.
Reviewer 2 comment 1: Thus, I suggest adequacy in the title, as it is not expressing
exactly what the study observed.
Response 1: We thank the reviewer for the very useful suggestion. In order to comply
with it, we changed the title of our manuscript in order for it to be more appropriate
and more in line with the aim and the results of our study. In this regard, the new
title of the manuscript is “Misinformation about medication during the COVID – 19
pandemic – a perspective of medical staff” (Lines 2-3). The title now highlights the
fact that the study focused on misinformation about medication during the pandemic,
and on the effects that misinformation had on doctors, from the perspective of specialists
(doctors, nurses, medical students).
Reviewer 2 comment 2: The survey instrument was validated by a sufficient number of
professionals; however, I did not find the attached instrument to be evaluated and
to verify that the questions supported the statistical data that was generated. It
is important to send supplementary material S1 so that the reviewer can evaluate the
work impartially.
Response 2: We are very grateful to the reviewer for pointing this out. However, when
we submitted the manuscript, we did upload the questionnaire as supplementary information,
both in Romanian language and in English (S1_Appendix English version of the questionnaire;
S2_Appendix Romanian version of the questionnaire).| In order to comply with the recommendation
of the reviewer, we will try to upload again the questionnaire, and we will also insert
it at the end of this document, so that the reviewer can have access to it. In this
regard, the reviewer can find below the English and Romanian version of our questionnaire.
Reviewer 2 comment 3: The Information on drugs used to treat COVID 19 topic of the
Literature review covers the year 2020 and serves to locatethe context that health
professionals were in at the time of answering the questionnaire, however, there is
a lack ofinformation on the drugs that were being recommended by the WHO in the period
of application of the questionnaire,which was from April to June 2021. Contextualizing
how the data were in the period when the instrument was applied can directly impact
the conclusion:“Healthcare professionals knew about the drugs used in clinical trials”.
Response 3: We thank the reviewer for the useful suggestion. We searched for sources
which contained information regarding the types of drugs available and approved in
the period in which we conducted our research (April – June 2021) and we saw that
among the drugs approved were also the drugs about which the respondents to our research
had knowledge. Besides drugs, the news regarding the virus started to focus also on
information about possible vaccines, so the information about antiviral drugs started
to be published more rarely. Hence, our conclusion regarding the fact that “Healthcare
professionals knew about the drugs used in clinical trials” is still true. Thus, we
researched the literature and added an explanation in our Discussion section, but
we did not insert the references into our paper, because Reviewer 1 mentioned that
we have many references in our paper and that we should reduce them. However, Reviewer
2 can consult the references because we will insert them here after we provide the
explanation. Hence, in the Discussion section of our manuscript, page 43, lines 753-760
we added the following explanation:
“Moreover, during the period in which we conducted our research, (April – June 2021),
among the drugs which were approved were Remdesivir Tocilizumab – which was authorized
first in June 2021, drug which were also acknowledged by the respondents of our research”
[Reference 84, Reference 85)].”
Even more, one of the authors of the article (L.R.) is a doctor and was directly involved
in the process of taking care of COVID – 19 patients, so the author can confirm that
among the drugs which were in trial, or which were approved for administration against
COVID-19 were also the drugs which were acknowledged by the respondents of our research.
Reference 84: Food and drug administration. Coronavirus (COVID-19) Drugs [Internet].
Food and Drug Administration. [cited 2022 June 20] Available from: https://www.fda.gov/drugs/emergency-preparedness-drugs/coronavirus-covid-19-drugs
Reference 85: Murdock, J. The Latest Updates on COVID-19 Treatments and Medications
in the Pipeline. [Internet]. 23 May 2022 [cited 2022 June 20] Available from: https://www.goodrx.com/conditions/covid-19/coronavirus-treatments-on-the-way
Reviewer 2 comment 4: Minor revisions: When reading, there are differences in font
size/type. E.g. lines 206 and. 534
Response 4: We thank the reviewer for pointing this out. We would firstly like to
mention that line 206 has the number 245 in the revised version of the manuscript
with “Track changes” and “All markup” option active, and line 534 has the number 645.
In order to make sure there will no differences in font/size type, we checked again
our manuscript and we corrected the mistakes. In this regard, we made sure the text
from our manuscript is all formatted with Calibri, size 12.
We thank again the reviewer for spending time on reviewing our paper and for providing
us very useful suggestions!
We are very grateful to the reviewers and the academic editor for all the suggestions,
comments and points raised in order to improve our paper!
Sincerely,
Prof. Dr. Claudiu Coman
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https://orcid.org/0000-0001-6272-7414
