Knowledge and practices of modern contraceptives among religious minority (Muslim) women: A cross-sectional study from Southern Nepal

Dipendra Singh Thakuri; Yamuna K. C. Singh; Rajendra Karkee; Resham B. Khatri

doi:10.1371/journal.pone.0278899

Peer Review History

Original SubmissionMarch 19, 2022
26 Apr 2022 Decision Letter - Ai Theng Cheong, Editor PONE-D-22-08164Knowledge and practices of modern contraceptive among religious minority (Muslim) women: A cross-sectional study from Southern NepalPLOS ONE Dear Dr. Thakuri, 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. ============================== ACADEMIC EDITOR: Results: Was the knowledge score normally distributed? What was the cut off score for the good and poor knowledge? Please provide the results of knowledge score in mean, median and the minimum and maximum score. Table 2 Kindly change the No and yes for knowledge contraceptive methods to poor (score <xx) and good (score >= xxx). Table 3 Title: kindly specify determinants of good or poor knowledge Pragmatic implications and conclusion The suggestion in implication need to base on the results. This study did not show any results of male engagement, thus might not appropriate to introduce this in the pragmatic implications and conclusion. Please submit your revised manuscript by Jun 10 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'. 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[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: Partly ******** 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: No Reviewer #2: No ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: 1. Abstract: Data were collected using face-to-face semi-structured interviews. Semi-structured is for qualitative. Remove semi. 2. In Nepal, modern contraceptive services are provided from different outlets ranging from community to tertiary level (Figure 1). If this is, what is the real gap in your study? 3. Your method part is shallow; try to address the study period, data analysis... 4. Page- 5: Method part, 1st paragraph “Muslims in Nepal”. This is unclear. What is its importance? This sensitive issue (religious-based). Better if it’s addressed in the statement of the problem as a gap by linking with your objectives. 5. Page 5: Your sample size is 417, i.e. p-0.44 + 10% non-response rate= 417. How you said 400? 6. Page 6: Conceptual framework of the study. What is the importance? i.e. its repetition you have already in the discussion part. If it has justifiable importance, take it at the end of the introduction rather than in the method part. 7. Page 6: “Study variables”. Minimize it- put the main list of the variables. 8. Page 6: Outcome variables. Similarly, minimize it- as good/poor knowledge of modern contraceptive methods is assessed from 10 items and then we considered a score of mean and above ‘Good Knowledge’ and a score of below mean ‘poor knowledge [7, 36]. Do not list everything. 9. Adopted–adaptation 10. Result part: add the descriptive finding of 10 sets of questions related to knowledge about modern contraceptives 11. It needs an English edition Reviewer #2: This article has potential for highlighting social, religion and cultural issue in family planning among the minority ethnic group of women. Introduction: The objectives are not clear. Investigating the status of knowledge and practice need clarification. The justification and problem gaps were not clearly laid down. Why still study the practice status when there have been studies that demonstrated the low CPR among Nepal minority group? Methods: Information regarding the venue not clear- work office? Was it done from the hospital base or the central office of MWRA community? Sample size calculation needs to demonstrate a recalculation that is based on the two dependant variables (not only practice base). I would also advise to use the two proportion sample size formula. Discussion/ conclusion: Since this study was done among a minority Muslim women; unfortunately there is very little said regarding the role of religion and culture in the family planning practice. Why would there be a low practice despite an acceptable percentage of women with good knowledge. The author earlier mentioned about the inaccessible family planning services and also being the minority ethnic group how does this influence the status of familkyplanning knowledge and practice but nothing was discussed on thesis. This article still need English editing ****** 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:** Alemu Guta Reviewer #2: 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: PONE-D-22-08164_review.pdf https://doi.org/10.1371/journal.pone.0278899.r001
Revision 1
22 Jun 2022 Author Response June 5, 2022 Dear Editors-in-Chief PLOS ONE Thank you very much for your email with the decision dated April 26, 2022. We found that reviewers' and editor feedbacks were insightful. We have addressed both reviewers’ and editors' comments point by point. We have uploaded the revised manuscript showing track changes so that you can see all revisions and modifications we have made. We believe that our revisions will satisfy you and both reviewers. We have included a clean copy and track change copy of the revised manuscript. Thank you for considering this manuscript for publication. Sincerely, Dipendra Singh Thakuri On behalf of Yamuna KC Singh, Rajendra Karkee, Resham Bahadur Khatri Editor 1. Was the knowledge score normally distributed? What was the cut off score for the good and poor knowledge? Please provide the results of knowledge score in mean, median and the minimum and maximum score. Authors response: Thank you so much for your insightful comments. The knowledge score was not normally distributed; therefore, we employed to run logistic regression to identify the factors associated with the outcome variables of this study. We dichotomised the knowledge and practices scores based on previous studies using mean cut-off point. Below the mean score, we consider as poor knowledge and mean and above as good knowledge. Additionally, we have added results of knowledge scores in mean, median and the maximum and minimum scores in the page no. 9 of revised manuscript. 2. Table 2 Kindly change the No and yes for knowledge contraceptive methods to poor (score <xx) and good (score >= xxx). Authors response: Thank you so much for your comments. We have changed it in the revised manuscript as suggested. 3. Table 3 Title: kindly specify determinants of good or poor knowledge Authors response: Thank you so much for your comments. We have revised it as suggested in the revised manuscript. “The good and poor knowledge was determined by using mean cut-off point. We considered below the mean score as poor knowledge and mean and above as good knowledge.” 4. The suggestion in implication need to base on the results. This study did not show any results of male engagement, thus might not appropriate to introduce this in the pragmatic implications and conclusion. Authors response: Thank you so much for your important feedback. We agree with you, and we have removed it? Reviewer #1 1. Abstract: Data were collected using face-to-face semi-structured interviews. Semi-structured is for qualitative. Remove semi. Authors response: Thank you for your suggestion. It was a typo error. We have corrected it. 2. In Nepal, modern contraceptive services are provided from different outlets ranging from community to tertiary level (Figure 1). If this is, what is the real gap in your study? Authors response: Thank you so much for your comment. Despite the availability of FP services, our study population does not go or is very reluctant to take services from local health posts and health centres. 3. Your method part is shallow; try to address the study period, data analysis... Authors response: Thank you so much for your comments. Our study period was between June and September 2019, described under the study design and setting section on page no. 6. Similarly, we have mentioned details about data analysis under the separate data analysis section on page no.8. 4. Page- 5: Method part, 1st paragraph “Muslims in Nepal”. This is unclear. What is its importance? This sensitive issue (religious-based). Better if it’s addressed in the statement of the problem as a gap by linking with your objectives. Authors response: Thank you so much for your important feedback. We have reviewed and moved the information to the Introduction part. 5. Page 5: Your sample size is 417, i.e., p-0.44 + 10% non-response rate= 417. How have you said 400? Authors response: Thank you so much for your important comment. Non-response rate has been reported to be very low by various studies in Nepal, so we take a 5% non-response rate. Considering a 5% non-response rate, we calculated a sample size of 398, So we collected 400 as our final sample size. We have taken the reference of past studies to consider the non-response rate of 5%. https://www.jnhrc.com.np/index.php/jnhrc/article/view/2244/939 6. Page 6: Conceptual framework of the study. What is the importance? i.e. its repetition you have already in the discussion part. If it has justifiable importance, take it at the end of the introduction rather than in the method part. Authors response: Thank you so much for your valuable comment. We have removed it as you suggested. 7. Page 6: “Study variables”. Minimize it- put the main list of the variables. Authors response: Thank you so much for your suggestions. We have revised it as suggested. 8. Page 6: Outcome variables. Similarly, minimize it- as good/poor knowledge of modern contraceptive methods is assessed from 10 items and then we considered a score of mean and above ‘Good Knowledge’ and a score of below mean ‘poor knowledge [7, 36]. Do not list everything. Authors response: Thank you so much for your important feedback. We have revised it as suggested. Please see it in the page no. 7 of revised manuscript. 9. Adopted–adaptation 10. Result part: add the descriptive finding of 10 sets of questions related to knowledge about modern contraceptives. Authors response: Thank you so much for your important comments. We have added descriptive findings of 10 sets of questions in the revised manuscript, see table 2 of the revised manuscript. 11. It needs an English edition Authors response: Thank you so much for your comment. We have reviewed and edited the English language in the revised manuscript. Reviewer #2: This article has potential for highlighting social, religion and cultural issue in family planning among the minority ethnic group of women. Introduction: The objectives are not clear. Investigating the status of knowledge and practice need clarification. The justification and problem gaps were not clearly laid down. Why still study the practice status when there have been studies that demonstrated the low CPR among Nepal minority group? Authors response: Thank you so much for your comment. We have revised objectives and added information about problem gaps and justification in the introduction section. Methods: Information regarding the venue not clear- work office? Was it done from the hospital base or the central office of MWRA community? Authors response: Thank you so much for your comment. It was a community based study, and data were collected at a community level. A face to face interview was carried out in the respondent’s household. We have described it in the methodology part on page no.8 of the revised manuscript. Sample size calculation needs to demonstrate a recalculation that is based on the two dependent variables (not only practice base). I would also advise to use the two proportion sample size formula. Authors response: Thank you so much for your insightful comments /suggestions. We appreciate your important suggestion. We considered practice as our main outcome variable, so we only considered sample size calculation using practice prevalence. We have taken the reference of past studies where a sample was calculated based on the one dependent variable (Practice). https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-018-3643-3 http://pubs.sciepub.com/ajphr/5/1/1/ Why is the salary cut off at 20000? Why were the occupations divided as such? Authors response: Thank you so much for your comment. We have taken reference of previously published literature for salary cut off and dividing occupations. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6510098/ http://www.aimspress.com/article/10.3934/publichealth.2019.3.291 Why doesn’t the "ever visit to hospital" not included inside the regression? Authors response: Thank you so much for your comment. We have one variable regarding “ever visited a health facility for FP counselling” that we included inside the regression. Besides that, we didn’t have variables like ever visited hospital in this study, so we couldn’t include it. Discussion/ conclusion: Since this study was done among a minority Muslim woman; unfortunately, there is very little said regarding the role of religion and culture in the family planning practice. Authors response: Thank you so much for your comments. We have added details regarding the role of religion and culture in the revised manuscript (see the introduction, pages 3 and 4). Why would there be a low practice despite an acceptable percentage of women with good knowledge. The author earlier mentioned about the inaccessible family planning services and also being the minority ethnic group how does this influence the status of family planning knowledge and practice, but nothing was discussed on thesis. Authors response: Thank you so much for your comment. This mismatch between knowledge and practice shows knowledge always does not translate to practice because of other barriers, for example, cultural and economic reasons. We have discussed it in “Discussion”. Any different characteristics between ref 31, 40, 41, 42 and this study? Authors response: Thank you. These are studies from different settings, i.e., Nepal, India, Bangladesh, and other countries. Ref. 31 is a study conducted among Muslim women from eastern Nepal. Furthermore, Ref. 40-42, similar studies from abroad (India, Bangladesh, and other countries), so the context of these studies differs from this study. This article still needs English editing Authors response: thank you so much for your suggestion. We have reviewed and edited English. We would like to thank editor and both the reviewers for their insightful comments and feedback. Thank you so much for inviting us to revision of this manuscript. Dipendra Singh Thakuri, on behalf of all co-authors Attachments Attachment Submitted filename: Response to Reviewers.doc https://doi.org/10.1371/journal.pone.0278899.r002
11 Aug 2022 Decision Letter - Ai Theng Cheong, Editor PONE-D-22-08164R1Knowledge and practices of modern contraceptive among religious minority (Muslim) women: A cross-sectional study from Southern NepalPLOS ONE Dear Dr. Thakuri, 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 ensure that your decision is justified on PLOS ONE’s publication criteria and not, for example, on novelty or perceived impact. For Lab, Study and Registered Report Protocols: These article types are not expected to include results but may include pilot data. ============================== Please submit your revised manuscript by Sep 25 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, Ai Theng Cheong 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. Additional Editor Comments (if provided): Abstract Conclusion Suggest remove ‘Such interventions include mobilisation of health workers (HWs) from their community, and awareness of contraceptive methods embedding with values and culture of the Muslim religion.’ This would be more appropriate in discussion section. Methodology You have mentioned that the knowledge score is not normally distributed, if it is so, it might be more appropriate to use the median as the cut-off point. I can see that the mean and median are close i.e 6.9 vs 7, it is likely to be normally distributed, could you please check. Table 3: Title: From your explanation and interpretation of the results, it looks like your interest group for your knowledge outcome is ‘good knowledge’. If it so, the title should be determinants of good knowledge….., so the aOR less than 1 is considered as having poorer knowledge. Please check your interpretation and your analysis. For value that <0.00, please change to <0.001. Kindly check through all values Discussion First paragraph: Please check the interpretation and the facts for those lived in nuclear family in terms of their knowledge and practice. It is worth to add in a paragraph to discuss about those who lived in nuclear family regarding their poor knowledge but higher practice of FP. Pragmatic implications Could you please focus your intervention based on your results i.e. targeted the factors that could improve your practice based on your results (which is how to increase the knowledge in Muslim women, and intervention that could address this factor ‘ever visited a HF for HP counselling’). The following facts need to be reorganised and relate it to the factors that you have found to influence your practice. “These women groups require accessible quality of contraceptive choices. The concept of roving midwives service providers can be adopted and implemented to offer counselling and FP services at doorsteps. Second, some targeted Social Behaviour Change Communication (SBCC) can improve the awareness of contraceptives, and practices include mass media mobilisation programs coherent with their religious values and promote them for FP services. Third, contraceptive practices can be improved through several demand and supply-side strategies. Supply-side approaches could be the recruitment of local HWs and FCHVs from the Muslim community. The local health workforce of the Muslim community can encourage them to practice contraceptives. Fourth, demand-side approaches could raise awareness and develop education materials in Urdu for Muslim women and work to extend support for smaller family norms, providing counselling and advice about the contraceptive practice from the community and religious leaders. Other approaches such as mobile camps, satellite camps, and home visits could be essential to promote the contraceptive practice. Lastly, this study suggests that the Ministry of Health and Population (MOHP) should design targeted program strategies for Muslim women based on a deeper understanding of needs, including religious and cultural recognition” Conclusion The following would need to reorganise or rephrase after you have tidied up the discussion on the section of pragmatic implications : ‘To improve FP practices among Muslims in Nepal needs integrated and focused health interventions. Such program interventions include health education and information dissemination, SBCC interventions, mobilisation and home visits using local midwives, advice and supplies, and male mobilisers to reach out to Muslim men. In addition, the provision of FP services in mobile and satellite health camps could improve the practices of FP services among Muslims in Nepal.’ [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 #1: All comments have been addressed 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 #1: Yes Reviewer #2: Partly ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes 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 #1: Yes 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 #1: Yes Reviewer #2: No ****** 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 #1: Thank you, the author, for your effort. The previously raised comments are addressed well. On the methods and all via out the manuscript. Reviewer #2: Hi; The Manuscript is much improved. However there are still a few sentences that have typo error and grammatically not correct. Some of the sentences are hanging. SO still need some work on English editing 2. There are 2 tables 3; need to redefine 3. Table 3 is cute crowded; suggest to separate the factors associated with knowledge and factors associated with practice. The narrative part can be improved by this separation. 4. The interpretation of table 4 regarding nuclear family predicting contraceptive use is inaccurate. The discussion; sentence 4: The practice of modern contraception is poor among women who lived in a nuclear family. But the OR for nuclear family in practising FP is 4.4 5.I feel that there is a lot to look at on how we can target women coming from nuclear family that can be elaborated. 6. Conclusion: some of the conclusions do not come from the data. such as the male mobiliser or cultural factors. ****** 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 #1: Yes: Alemu Guta Reviewer #2: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0278899.r003
Revision 2
14 Oct 2022 Author Response October 14, 2022 Dear Editors-in-Chief PLOS ONE Thank you very much for your email with the decision dated Aug 12, 2022. We found the reviewers' and editor's feedback and comments insightful. We have carefully addressed both reviewers’ and editor’s comments point by point. To facilitate your review, we have uploaded the revised manuscript in track change and clean versions so that you can see all revisions and modifications we have made. We believe that our revisions will satisfy you and both reviewers. Thank you in advance for considering this manuscript for publication. Sincerely, Dipendra Singh Thakuri On behalf of all co-authors Additional Editor Comments: Abstract Conclusion Suggest remove ‘Such interventions include mobilisation of health workers (HWs) from their community, and awareness of contraceptive methods embedding with values and culture of the Muslim religion.’ This would be more appropriate in discussion section. Authors' response: Thank you so much for your insightful suggestions. We've moved it from the conclusion section to the discussion section. (Page # 19) Methodology You have mentioned that the knowledge score is not normally distributed, if it is so, it might be more appropriate to use the median as the cut-off point. I can see that the mean and median are close i.e 6.9 vs 7, it is likely to be normally distributed, could you please check. Authors response: Thank you so much for your important suggestion. We have used median as the cut-off point as advised. Table 3: Title: From your explanation and interpretation of the results, it looks like your interest group for your knowledge outcome is ‘good knowledge’. If it so, the title should be determinants of good knowledge…., so the aOR less than 1 is considered as having poorer knowledge. Please check your interpretation and your analysis. For value that <0.00, please change to <0.001. Kindly check through all values Authors response: Thank you so much for your great comments. We have reviewed and revised it as advised. For a value that <0.00, we have changed it in the revised manuscript. Discussion First paragraph: Please check the interpretation and the facts for those lived in nuclear family in terms of their knowledge and practice. It is worth to add in a paragraph to discuss about those who lived in nuclear family regarding their poor knowledge but higher practice of FP. Authors response: Many thanks for your suggestions. We have addressed this in the discussion part of the revised manuscript. (Page # 18-19) Pragmatic implications Could you please focus your intervention based on your results i.e. targeted the factors that could improve your practice based on your results (which is how to increase the knowledge in Muslim women, and intervention that could address this factor ‘ever visited a HF for HP counselling’). The following facts need to be reorganised and relate it to the factors that you have found to influence your practice. “These women groups require accessible quality of contraceptive choices. The concept of roving midwives service providers can be adopted and implemented to offer counselling and FP services at doorsteps. Second, some targeted Social Behaviour Change Communication (SBCC) can improve the awareness of contraceptives, and practices include mass media mobilisation programs coherent with their religious values and promote them for FP services. Third, contraceptive practices can be improved through several demand and supply-side strategies. Supply-side approaches could be the recruitment of local HWs and FCHVs from the Muslim community. The local health workforce of the Muslim community can encourage them to practice contraceptives. Fourth, demand-side approaches could raise awareness and develop education materials in Urdu for Muslim women and work to extend support for smaller family norms, providing counselling and advice about the contraceptive practice from the community and religious leaders. Other approaches such as mobile camps, satellite camps, and home visits could be essential to promote the contraceptive practice. Lastly, this study suggests that the Ministry of Health and Population (MOHP) should design targeted program strategies for Muslim women based on a deeper understanding of needs, including religious and cultural recognition” Authors' response: Thank you so much for your valuable comments. We have reviewed and revised this section based on our study findings. (Page# 19) Conclusion The following would need to reorganise or rephrase after you have tidied up the discussion on the section of pragmatic implications: ‘To improve FP practices among Muslims in Nepal needs integrated and focused health interventions. Such program interventions include health education and information dissemination, SBCC interventions, mobilisation and home visits using local midwives, advice and supplies, and male mobilisers to reach out to Muslim men. In addition, the provision of FP services in mobile and satellite health camps could improve the practices of FP services among Muslims in Nepal.’ Authors response: Thank you for your comment. We have revised it based on the revision made in the discussion on the section on pragmatic implications. (Page# 20) Reviewer #1: Thank you, the author, for your effort. The previously raised comments are addressed well. On the methods and all via out the manuscript. Authors response: We thank the reviewer for their great comments. Reviewer #2: Hi; The Manuscript is much improved. However, there are still a few sentences that have typo error and grammatically not correct. Some of the sentences are hanging. SO still need some work on English editing Authors response: Thank you so much for your comments. We have checked the typo error and grammar throughout the manuscript and edited English. 2. There are 2 tables 3; need to redefine 3. Table 3 is cute crowded; suggest separating the factors associated with knowledge and factors associated with practice. The narrative part can be improved by this separation. Authors response: Thank you so much for pointing this out. We have addressed this in the revised manuscript. Also, we have separated the knowledge and practice table as suggested, and the narrative part was revised accordingly (Page# 14-16) 4. The interpretation of table 4 regarding nuclear family predicting contraceptive use is inaccurate. Authors response: Thank you for your comment. We have rechecked the interpretation of table 4 regarding nuclear family and contraceptive use, and it seems fine. The discussion; sentence 4: The practice of modern contraception is poor among women who lived in a nuclear family. But the OR for nuclear family in practising FP is 4.4 Authors response: Thank you so much for your important comment. It was a typo error. The women who lived in a nuclear family had good FP practice. We have corrected it in the revised manuscript. (Page #17) 5.I feel that there is a lot to look at on how we can target women coming from nuclear family that can be elaborated. Authors' response: We have added some recommendations regarding this in the programmatic implication section of the revised manuscript. 6. Conclusion: some of the conclusions do not come from the data. such as the male mobiliser or cultural factors. Authors response: Thank you so much for your comments. We have revised the conclusion as advised. Page #20) We want to thank the editor and both reviewers for their insightful comments and feedback. Thank you so much for inviting us to revise this manuscript. Dipendra Singh Thakuri, on behalf of all co-authors Attachments Attachment Submitted filename: Response to reviewers.docx https://doi.org/10.1371/journal.pone.0278899.r004
28 Nov 2022 Decision Letter - Ai Theng Cheong, Editor Knowledge and practices of modern contraceptive among religious minority (Muslim) women: A cross-sectional study from Southern Nepal PONE-D-22-08164R2 Dear Dr. Thakuri, 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, Ai Theng Cheong Academic Editor PLOS ONE Additional Editor Comments (optional): 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: Dear authors, You have addressed all my comments. The introduction puts the issue into correct perspective. The results are arranged systematically and coherently narrated. Nevertheless, I have a few suggestions that may make this article more meaningful. Strength: Please add that this study received help from the Muslim community as the interviewers and approval from the religiousleaders. This ensure higher participation from the respondents. This also could reflect in the conclusion that what these women (especially ones from the socially and economically disadvantaged group) require to practice contraception, may not be solely about having to increase knowledge but more of the support of various parties including the Muslim community and the religious leaders. The higher practices of contraception use among women from nuclear family and those who have had visits to the healthcare reflect the empowerment these women have regarding decision making. Hence, further research is needed how they made the decisions to use contraception. A qualitative approach would be fitting to address this. ****** 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: No ******** https://doi.org/10.1371/journal.pone.0278899.r005
Formally Accepted
2 Dec 2022 Acceptance Letter - Ai Theng Cheong, Editor PONE-D-22-08164R2 Knowledge and practices of modern contraceptives among religious minority (Muslim) women: A cross-sectional study from Southern Nepal Dear Dr. Thakuri: 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. Ai Theng Cheong Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0278899.r006

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