Regional differences in primary healthcare utilization in Java Region—Indonesia

Ratna Dwi Wulandari; Agung Dwi Laksono; Nikmatur Rohmah; Hadi Ashar

doi:10.1371/journal.pone.0283709

Peer Review History

Original SubmissionOctober 28, 2022
6 Jan 2023 Decision Letter - Retno Asti Werdhani, Editor PONE-D-22-29798 Regional Differences in Primary Health Care Utilization in Java Region - Indonesia PLOS ONE Dear Dr. Wulandari, 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 Feb 20 2023 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. 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If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references.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 If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.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: General comments: 1. Important issue to find the gap of health care utilization and may be factor related to health seeking behavior 2. Need further discussion to overcome the gap of health care utilization because there should not be any gap for health care utilization (health for all), example from another region/country/references so that it will in line with the recommendation mentioned in conclusion. Abstract 1. Need more information on why policymakers need to understand primary health care utilization disparity to minimize the gap, therefore … 2. It’s not common for use interpret OR 0.851 as 0.851 times less likely. Usually, we say 1-0.851 = 15 % less likely Background/Introduction 1. Please mention/explore more about the type/example of service provided for preventive, promotive, curative, and rehabilitative in Puskesmas. (5W1H Puskesmas) in background 2. The detail aim of the study hasn’t been mentioned yet. It’s important for the reader to see the aim of the study in the background so that they can see the redline between the aim and result. 3. Why only Java region, not the whole region in Indonesia Method: 1. Define utilization: for disease cure seeking behavior, preventive seeking behavior? 2. For data analysis, it’s better to mention relationship between which variables using which statistical tools and when we declare it’s statistically significant or not? Or relationship? 3. Outcome variables, divided into what category? Was it utilized or not, or outpatient or inpatient 4. Justification why 25% selected sample from the population 5. How did you select 30.000 cencus blocks? 6. Table 2 presentation: please mention what method did you use in binary logistic regression for multivariate analysis? Enter/stepwise/forward/backward? Which group is reference line? Result: 1. Interesting presentation using phc utilization map 2. Can the Colour of figure 1 not all purple? Can it change into more contrast colour like blue, red, yellow to divide the category? 3. “Based on marital status, married dominated all regions. Regarding education level, primary education leads all provinces, except Jakarta Provinces, which are led by secondary education. According to employment status, employed dominated all areas. The most prosperous lead in Jakarta, West Java, Yogyakarta, and Banten Province is based on wealth status. Regarding health insurance ownership, insured people dominated all regions.” � please write the reference table 4. 0.851 times less likely. It’s not common for use interpret OR 0.851 as 0.851 times less likely. Usually, we say 1-0.851 = 15 % less likely… 5. 0.805 times less likely. Same notes with the above feedback Discussion: 1. Why east java less likely and Jakarta and Yogyakarta are more likely? � east java healthier people, better health system? 2. “Regions in western Indonesia tend to have better utilization of Puskesmas in rural areas [8,20]. � can you explore more on this? The example/comparison between western and rural areas? Is there no rural area in western? Because you compare between western and rural area 3. “Rural people have more significant barriers to using primary health care than people in urban areas” � please explore more what do you mean by significant barriers? 4. “All age groups are more likely than ≤ 17 to utilize primary health care, and young adults and above mainly use primary health care” � is it typo? < 17 is part of age groups? 5. “Studies in the Chongqing or Guizhou areas also report that age is associated with knowledge, utilization of health education, and satisfaction in the primary health care sector” � can you explore more about this? Why age is associated with those factors? Was it supporting or obstacles? 6. “the employed are less likely to use primary health care than the unemployed” � author discussed about the income.” � How about geographical access? In conclusion: “ Efforts should focus on increasing interventions for those who live in rural areas, are younger, have never been in a union, are better educated, are employed, have better wealth status, and are uninsured “ � it would be better if there is an example of how to do it? [Note: HTML markup is below. Please do not edit.] [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. 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Revision 1
6 Feb 2023 Author Response RESPONSES Dear Dr. Wulandari, We've checked your submission and before we can proceed, we need you to address the following issues: 1. We note that Figure 1 in your submission contain [map/satellite] images which may be copyrighted. All PLOS content is published under the Creative Commons Attribution License (CC BY 4.0), which means that the manuscript, images, and Supporting Information files will be freely available online, and any third party is permitted to access, download, copy, distribute, and use these materials in any way, even commercially, with proper attribution. For these reasons, we cannot publish previously copyrighted maps or satellite images created using proprietary data, such as Google software (Google Maps, Street View, and Earth). For more information, see our copyright guidelines: http://journals.plos.org/plosone/s/licenses-and-copyright. We require you to either (1) present written permission from the copyright holder to publish these figures specifically under the CC BY 4.0 license, or (2) remove the figures from your submission: a. You may seek permission from the original copyright holder of Figure 1 to publish the content specifically under the CC BY 4.0 license. We recommend that you contact the original copyright holder with the Content Permission Form (http://journals.plos.org/plosone/s/file?id=7c09/content-permission-form.pdf) and the following text: “I request permission for the open-access journal PLOS ONE to publish XXX under the Creative Commons Attribution License (CCAL) CC BY 4.0 (http://creativecommons.org/licenses/by/4.0/). Please be aware that this license allows unrestricted use and distribution, even commercially, by third parties. Please reply and provide explicit written permission to publish XXX under a CC BY license and complete the attached form.” Please upload the completed Content Permission Form or other proof of granted permissions as an "Other" file with your submission. In the figure caption of the copyrighted figure, please include the following text: “Reprinted from [ref] under a CC BY license, with permission from [name of publisher], original copyright [original copyright year].” b. If you are unable to obtain permission from the original copyright holder to publish these figures under the CC BY 4.0 license or if the copyright holder’s requirements are incompatible with the CC BY 4.0 license, please either i) remove the figure or ii) supply a replacement figure that complies with the CC BY 4.0 license. Please check copyright information on all replacement figures and update the figure caption with source information. If applicable, please specify in the figure caption text when a figure is similar but not identical to the original image and is therefore for illustrative purposes only. Response: we decided to deletes the figure in the manuscript. Additional Editor Comments: General comments: 1. Important issue to find the gap of health care utilization and may be factor related to health seeking behavior 2. Need further discussion to overcome the gap of health care utilization because there should not be any gap for health care utilization (health for all), example from another region/country/references so that it will in line with the recommendation mentioned in conclusion. Response: the narration suggested was added to the discussion. Abstract 1. Need more information on why policymakers need to understand primary health care utilization disparity to minimize the gap, therefore … 2. It’s not common for use interpret OR 0.851 as 0.851 times less likely. Usually, we say 1-0.851 = 15 % less likely Response: the abstract was revised as suggested. Background/Introduction 1. Please mention/explore more about the type/example of service provided for preventive, promotive, curative, and rehabilitative in Puskesmas. (5W1H Puskesmas) in background Response: the narration was added in the introduction as suggested. 2. The detail aim of the study hasn’t been mentioned yet. It’s important for the reader to see the aim of the study in the background so that they can see the redline between the aim and result. Response: The purpose of the study is at the end of the introduction. According to the research background, the study analyzes regional differences in primary health care utilization in Java Region in Indonesia. 3. Why only Java region, not the whole region in Indonesia Response: The Java region is a benchmark for success for other areas in Indonesia, including models for policies addressing gaps in primary healthcare utilization. Method: 1. Define utilization: for disease cure seeking behavior, preventive seeking behavior? Response: We define utilization as access to primary healthcare; whatever the reason for the need for such access. 2. For data analysis, it’s better to mention relationship between which variables using which statistical tools and when we declare it’s statistically significant or not? Or relationship? Response: the data analysis was revised as suggested. 3. Outcome variables, divided into what category? Was it utilized or not, or outpatient or inpatient Response: Primary healthcare utilization comprises unutilized and utilized. 4. Justification why 25% selected sample from the population Response: This amount is to meet the minimum number of samples that must be met. 5. How did you select 30.000 cencus blocks? Response: The survey chose the method of probability proportional to size systematically. 6. Table 2 presentation: please mention what method did you use in binary logistic regression for multivariate analysis? Enter/stepwise/forward/backward? Which group is reference line? Response: The binary logistic regression used enter method. We used “unutilized primary healthcare” as a reference. Result: 1. Interesting presentation using phc utilization map Response: Thank you 2. Can the Colour of figure 1 not all purple? Can it change into more contrast colour like blue, red, yellow to divide the category? Response: The author decided to delete the map due to copyright issue. 3. “Based on marital status, married dominated all regions. Regarding education level, primary education leads all provinces, except Jakarta Provinces, which are led by secondary education. According to employment status, employed dominated all areas. The most prosperous lead in Jakarta, West Java, Yogyakarta, and Banten Province is based on wealth status. Regarding health insurance ownership, insured people dominated all regions.” � please write the reference table Response: The reference table was added as suggested. 4. 0.851 times less likely. It’s not common for use interpret OR 0.851 as 0.851 times less likely. Usually, we say 1-0.851 = 15 % less likely… Response: The results were revised as suggested. 5. 0.805 times less likely. Same notes with the above feedback Response: The results were revised as suggested. Discussion: 1. Why east java less likely and Jakarta and Yogyakarta are more likely? � east java healthier people, better health system? Response: The author cannot further analyze health status or health system. This study uses secondary data, so the analysis is limited to the data that has been received. 2. “Regions in western Indonesia tend to have better utilization of Puskesmas in rural areas [8,20]. � can you explore more on this? The example/comparison between western and rural areas? Is there no rural area in western? Because you compare between western and rural area Response: The cited studies limit the analysis to only rural areas in Indonesia, and the results show that western has better utilization of Puskesmas. 3. “Rural people have more significant barriers to using primary health care than people in urban areas” � please explore more what do you mean by significant barriers. Response: Those who live in rural areas have slightly lower utilization of the Puskesmas than those in urban areas. 4. “All age groups are more likely than ≤ 17 to utilize primary health care, and young adults and above mainly use primary health care” � is it typo? < 17 is part of age groups? Response: The ≤ 17 is the reference line in the age group. In the sentence, “all age groups” means all groups except the ≤ 17. 5. “Studies in the Chongqing or Guizhou areas also report that age is associated with knowledge, utilization of health education, and satisfaction in the primary health care sector” � can you explore more about this? Why age is associated with those factors? Was it supporting or obstacles? Response: The narration was added as suggested. The situation is related to previous treatment experience and degenerative disease factors. 6. “the employed are less likely to use primary health care than the unemployed” � author discussed about the income.” � How about geographical access? Response: In conclusion: “ Efforts should focus on increasing interventions for those who live in rural areas, are younger, have never been in a union, are better educated, are employed, have better wealth status, and are uninsured “ � it would be better if there is an example of how to do it? Response: The study limits recommendations by only providing the characteristics of policy targets according to the study's results. Further studies are needed to determine the right policy by involving stakeholders interested in this situation. Attachments Attachment Submitted filename: Responses.docx https://doi.org/10.1371/journal.pone.0283709.r002
14 Mar 2023 Decision Letter - Retno Asti Werdhani, Editor Regional Differences in Primary Health Care Utilization in Java Region - Indonesia PONE-D-22-29798R1 Dear Dr. Wulandari, 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, Retno Asti Werdhani, M.Epid, Ph.D Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0283709.r003
Formally Accepted
20 Mar 2023 Acceptance Letter - Retno Asti Werdhani, Editor PONE-D-22-29798R1 Regional Differences in Primary Healthcare Utilization in Java Region - Indonesia Dear Dr. Wulandari: 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. Retno Asti Werdhani Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0283709.r004

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