PONE-D-21-23936Quality of life among patients with common chronic disease during COVID-19 Pandemic in Northwest Ethiopia; A Structural Equation ModelingPLOS ONE

Dear Dr. Alamneh,

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.

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We look forward to receiving your revised manuscript.

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Filipe Prazeres, MD, MSc, Ph.D.

Academic Editor

PLOS ONE

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Reviewers' comments:

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Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: Yes

Reviewer #3: Partly

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: No

Reviewer #3: Yes

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: This is a cross sectional study to understand the determinants that affects QOL in patients with chronic diseases during COVID pandemic in Ethiopia. My comments are as follows:

The study design:

Although the authors mentioned in both discussion and conclusion that the quality of life was compromised during COVID-19, this conclusion cannot be drawn from the existing data. This is a cross sectional study - unless the current data can be compared to similar data prior to the COVID-19 outbreak, we cannot know if the QOL actually worsened during COVID-19.

Furthermore, the determinants that may predict QOL appeared to be similar to pre-COVID19 era. i.e. poorer QOL is found in people with disease complications. What's the new information then?

Results:

1/ The age of the participants are relatively young (they were all supposed to have chronic diseases). Why is that so? Most of the patients with chronic diseases are usually eldery. (your IQR was 37-59).

2/ some of the results are difficult to read. for example, "age.... had direct posetive effect on QOL". Does this mean younger or older age? The same goes with the other presentations.

3/ "kinds of medication.... had direct negative effective on QOL". How do you put different kinds of medications into a statistical model? Furthermore, what are the medications that are associated with low QOL?

4/ I will be very careful to use the word "Causal factors" because this is a cross-sectional study, many causal relationships cannot be established. For example, it is likely that people with good drug compliance has less problems with their diseases and thereby a better QOL. However, it may also be true that people with good QOL are less troubled by their problems and thereby remember to take their medications. Actually this is one of the limitations that should be discussed.

Discussion:

1/ most of the discussion were concentrated to explain the results. But some of the results may not need very detailed discussion. For example, it is well understood why presence of co-morbidities is linked to poorer QOL. There should be multiple reasons behind. Rather, the discussion can point out how we can use the results. Any policies that need to be changed according to your results? Any more research that needs to be done?

2/ The authors correctly pointed out that the study population is heterogeneous - it included multiple chronic diseases. Then, the authors can see if the results are the same when analyzing only a subgroup of patients (e.g. only include patients with HIV or patients with hypertension). This will make your results more robust

3/ The findings may actually apply to pre-COVID era. Can the data be compared to other studies in the pre-COVID era to show that there is indeed a worsening of environmental QOL, for example?

Minor:

There are multiple spelling and grammar mistakes. The manuscript may benefit from language editing.

Reviewer #2: /// Overall ///

I don't have background on direct and indirect effects, the authors may want to clarify these to all readers. Overall, I understand the the direct effect was determined via univariate model(s) whilst the indirect one was from a mixed multivariate model(s), then, why you have to call it direct and indirect?

Typo are found in the text, please proofread carefully

//// Detail suggestions////

line 32: the range of mean score QOL seem to be large, author may consider to report both mean and median

line 161: the full term of CKD should be written before the abbreviation. Please check through all abbreviations.

line 171, 231: typo

line 205: reference of reliability thresholds should be cited properly.

line 262-266: also many literature have proved that QOL decrease by age (as their physicals health getting poorer), you may want to add some discussion on this phenomenon.

/// Tables and Figures ///

Figure 2 and 4: the author may want to add some notes to explain what are q1-q25, PHD, QOL, EHD, SRD, PSHD

Figure 3: typo

Reviewer #3: Abstract and Introduction- Need to rephrase and construct for better sentences

Line 54-58 Need to check the sentences, the facts are contradicting with each other.

Line 96- suggest for ‘Facility based cross sectional study design’ to ‘A cross sectional study design’…

Methods- study setting

It is important to highlight during the study period, how many existing healthcare facilities are used for COVID-19, converted as hybrid healthcare facilities and healthcare facilities are not used for COVID-19. Not need to mention too detail about the burden of disease for COVID-19.

Can you explain about the semi-structured questionnaire used for your study?

What is the proportion of face-to-face interview before you switch to the electronic form?

Why were the validity and reliability not conducted for SRQ-20 tool and Morisky Medication Adherence Scale (MMAS-8)?

The chronic diseases are self-reported or confirmed with the medical records?

There are few typos error

How do you overcome information and recall bias in this study?

Should separate the categories able to read and write and the education level and re-analyze the data.

Can the patient the differentiate the symptoms of the disease and complications of the disease?

How did you ask the common mental disorders for this study? (This is a diagnosis)

What was measured for ‘Kind of medication’?

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

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Submitted filename: Comments.docx

PONE-D-21-23936R1Quality of life among patients with common chronic disease during COVID-19 Pandemic in Northwest Ethiopia; A Structural Equation ModelingPLOS ONE

Dear Dr. Alamneh,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Sep 29 2022 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Filipe Prazeres, MD, MSc, Ph.D.

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

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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 #3: 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 #3: Yes

**********

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

Reviewer #3: No

**********

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 #3: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #3: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #3: Refer to the attachment file.

1. Please put the Cronbach Alpha value for SRQ-20 tool and Morisky Medication Adherence Scale (MMAS-8), and cited the papers for tools validation conducted in Ethiopia(as references).

2. For descriptive analysis (table 1), ‘Unable to read and write’ and ‘Able to read and write’ should be put under new variable e.g ‘Literacy status’. The 2 categories mentioned above are not compatible with the existing categories in the variable ‘education status’

For SEM analysis, you need to decide how to make the 3 categories for education status into binary. (same with marital status that have more than 2 categories)

3.The words ‘common mental disorder’ in the narrative of the results, tables, discussion and conclusion are not appropriate, because SRQ-20 tool is a screening tool for depression, anxiety symptoms and psychosomatic complaints.

Please change ‘common mental disorder’ with ‘mental health problem’.

4.The use of ‘Kind of medication’ is not clear, unless you define it in the operational definition.

It is suggested the variable for ‘Kind of medication’ is change to ‘how many medication’.

**********

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.

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Reviewer #3: No

**********

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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: PLOS ONE_Reviewew new comments .docx

PONE-D-21-23936R2Quality of life among patients with common chronic disease during COVID-19 Pandemic in Northwest Ethiopia: A Structural Equation ModellingPLOS ONE

Dear Dr. Alamneh,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Nov 03 2022 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Filipe Prazeres, MD, MSc, Ph.D.

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

[Note: HTML markup is below. Please do not edit.]

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 #3: 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 #3: Yes

**********

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

Reviewer #3: No

**********

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 #3: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #3: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #3: 1. For descriptive analysis (table 1), you only changed the ‘education status’ to ‘Literacy status’ and the categories remained the same and also their frequency and percentage.

(i) for the new variable ‘Literacy status’, the 2 categories under it are ‘Unable to read and write’ and ‘Able to read and write’. The total percentage of these 2 categories is 100%. Do not include the categories under variable ‘education status’ in this variable ‘ literacy status’.

(ii) Please maintain the variable ‘education status’. The 3 categories in this variable are Primary education, Secondary education and Diploma. Please ensure the total percentage of these 3 categories is 100%.

2. Please address my comment in the previous revision:

For SEM analysis, you need to decide how to make the 3 categories for education status into binary. (same with marital status that have more than 2 categories)

**********

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 #3: No

**********

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Attachments

Attachment

Submitted filename: Plos One comments.docx

Quality of life among patients with common chronic disease during COVID-19 Pandemic in Northwest Ethiopia: A Structural Equation Modelling

PONE-D-21-23936R3

Dear Dr. Alamneh,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Filipe Prazeres, MD, MSc, Ph.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

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