Adaptation and validation of the quality of contraceptive counseling (QCC) scale for use in Ethiopia and India

Kelsey Holt; Ewenat Gebrehanna; Shashi Sarnaik; Lakhwani Kanchan; Reiley Reed; Aman Yesuf; Bella Vasant Uttekar

doi:10.1371/journal.pone.0283925

Peer Review History

Original SubmissionFebruary 22, 2022
20 Jul 2022 Decision Letter - Nguyen Toan Tran, Editor PONE-D-21-36673Adaptation and validation of the quality of contraceptive counseling (QCC) scale for use in Ethiopia and IndiaPLOS ONE Dear Dr. Holt, 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 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, Nguyen Toan Tran Academic Editor PLOS ONE Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. Please include a complete copy of PLOS’ questionnaire on inclusivity in global research in your revised manuscript. Our policy for research in this area aims to improve transparency in the reporting of research performed outside of researchers’ own country or community. The policy applies to researchers who have travelled to a different country to conduct research, research with Indigenous populations or their lands, and research on cultural artefacts. The questionnaire can also be requested at the journal’s discretion for any other submissions, even if these conditions are not met. Please find more information on the policy and a link to download a blank copy of the questionnaire here: https://journals.plos.org/plosone/s/best-practices-in-research-reporting. Please upload a completed version of your questionnaire as Supporting Information when you resubmit your manuscript. 3. In your Data Availability statement, you have not specified where the minimal data set underlying the results described in your manuscript can be found. PLOS defines a study's minimal data set as the underlying data used to reach the conclusions drawn in the manuscript and any additional data required to replicate the reported study findings in their entirety. All PLOS journals require that the minimal data set be made fully available. For more information about our data policy, please see http://journals.plos.org/plosone/s/data-availability. Upon re-submitting your revised manuscript, please upload your study’s minimal underlying data set as either Supporting Information files or to a stable, public repository and include the relevant URLs, DOIs, or accession numbers within your revised cover letter. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories. Any potentially identifying patient information must be fully anonymized. Important: If there are ethical or legal restrictions to sharing your data publicly, please explain these restrictions in detail. Please see our guidelines for more information on what we consider unacceptable restrictions to publicly sharing data: http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. Note that it is not acceptable for the authors to be the sole named individuals responsible for ensuring data access. We will update your Data Availability statement to reflect the information you provide in your cover letter. 4. We note that you have stated that you will provide repository information for your data at acceptance. Should your manuscript be accepted for publication, we will hold it until you provide the relevant accession numbers or DOIs necessary to access your data. If you wish to make changes to your Data Availability statement, please describe these changes in your cover letter and we will update your Data Availability statement to reflect the information you provide. 5. Please note that in order to use the direct billing option the corresponding author must be affiliated with the chosen institute. Please either amend your manuscript to change the affiliation or corresponding author, or email us at plosone@plos.org with a request to remove this option. 6. PLOS requires an ORCID iD for the corresponding author in Editorial Manager on papers submitted after December 6th, 2016. Please ensure that you have an ORCID iD and that it is validated in Editorial Manager. To do this, go to ‘Update my Information’ (in the upper left-hand corner of the main menu), and click on the Fetch/Validate link next to the ORCID field. This will take you to the ORCID site and allow you to create a new iD or authenticate a pre-existing iD in Editorial Manager. Please see the following video for instructions on linking an ORCID iD to your Editorial Manager account: https://www.youtube.com/watch?v=_xcclfuvtxQ 7. Please include your full ethics statement in the ‘Methods’ section of your manuscript file. In your statement, please include the full name of the IRB or ethics committee who approved or waived your study, as well as whether or not you obtained informed written or verbal consent. If consent was waived for your study, please include this information in your statement as well. 8. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The manuscript is an interesting piece of work. It is well written; however, I would like to forward the the following points to further refine the manuscript. 1.) If you have an interest of comparing an underlying factor structures in the two countries, the manuscript didn't serve its purpose as multigroup CFA is missing from the manuscript. If otherwise, what is the point of separately reporting findings of the two countries without making an objective assessment (statistical comparison)? 2.) In line 125 to 126, it is indicated that clinic staffs are engaged in the process of sample selection and are aware of the study objective and its process in the study from Ethiopia. This more likely would have an impact on the result of the study (introducing bias) as providers may get to be at their best behavior during the study period. 3.) In line 244-45, the authors mentioned that scores were skewed to higher quality and yet they used arithmetic mean as a summary measure which is highly influenced by skewed observation. Besides, the measurement is an ordinal scale and the use of arithmetic mean is not advisable in this scale of measurement. 4.) In line 252, the authors mentioned that they used MLVM command to run the factor analysis in STATA. MLVM is not a command; rather an option within the SEM command of STATA. 5.) In the reliability and validity analysis, the item "prov_insist" was kept as part of the third domain in Ethiopia and "opportunity" and "info_private" as part of the second domain. The reliability of these factors would have been improved if this items were removed. In addition, the items load poorly to their respective domains. This suggests that the authors should respecify the model and test a an alternative four or five factor CFA model (eg. pressure as a fourth domain) than retain then as part of the second or third. 6.) The result section has a component that should have been taken to the discussion section (Lines 278 to 303). Reviewer #2: The authors present a pertinent and well-founded justification for carrying out the investigation. With regard to the structure of the article, it has a careful presentation, is written in English, easy to read, with a logical sequence and interconnection between the contents. Contains all mandatory elements for publications in PLOS ONE. The methodology used fits the type of study developed. It presents all the steps that it integrates in a very detailed, clear and robust way. The inclusion and exclusion criteria of the participants, the type of and its calculation are explained. The tests used for the adaptation and validation of the Quality of Contraceptive Counseling (QCC) Scale for use in Ethiopia and India are adjusted and appropriate. The authors justify the robust way and, based on the statistical analysis performed, the inclusion of items on the scale (even those with a low factor), as well as the exclusion of others. They present results of an original research and with high methodological rigor. The discussion is well founded, supported by the data obtained through the results. Conclusions lead us to the importance and relevance of using a valid and reliable scale as an instrument to be used in quality contraceptive counseling. Most references are from the last 5 years. The study respected the ethical principles required for studies with human beings: the authorizations of the University of California and the respective countries (Ethiopia and Egypt), as well as the informed consent given by the study participants. I consider the article relevant for publication, due to the importance of dissemination, use of the scale and the methodological robustness presented. ****** 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: No Reviewer #2: Yes: Sara Elisabete Cavaco Palma ******** [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.0283925.r001
Revision 1
3 Oct 2022 Author Response Reviewer #1: The manuscript is an interesting piece of work. It is well written; however, I would like to forward the the following points to further refine the manuscript. 1.) If you have an interest of comparing an underlying factor structures in the two countries, the manuscript didn't serve its purpose as multigroup CFA is missing from the manuscript. If otherwise, what is the point of separately reporting findings of the two countries without making an objective assessment (statistical comparison)? • Thank you for this clarifying question which helps us to refine the language we use in the manuscript to describe the QCC Scale versions. Our intention was not to compare the underlying factor structures between countries, but rather to assess independently the degree to which the two new scales replicated the factor structure and scale/item properties of the original QCC-Mexico scale. To make this more clear, we have made edits to the language throughout the entire manuscript to make clear that the QCC-Ethiopia and QCC-India scales were independently evaluated and that we consider these two separate, independently-assessed scales. 2.) In line 125 to 126, it is indicated that clinic staffs are engaged in the process of sample selection and are aware of the study objective and its process in the study from Ethiopia. This more likely would have an impact on the result of the study (introducing bias) as providers may get to be at their best behavior during the study period. • Thank you for this point. We have added in line 414 an additional sentence to the Limitations: “We also note that because providers in the study sites were aware the study was taking place, it is possible that they adjusted their behavior to provide better counseling; this could have inflated QCC scores.” 3.) In line 244-45, the authors mentioned that scores were skewed to higher quality and yet they used arithmetic mean as a summary measure which is highly influenced by skewed observation. Besides, the measurement is an ordinal scale and the use of arithmetic mean is not advisable in this scale of measurement. • Thank you for this helpful point. We have added information on the skew of scale and subscale scores to the Results and Table 3. Because D&A subscale scores were highly skewed, we re-ran the correlation analyses to use a dichotomous (top-scored) measure, as we had previously done in the validation study in Mexico (and updated Table 4 accordingly). We clarified in the Discussion that because of the skew of the D&A scores we recommend they be dichotomized when used as a standalone measure. • Re: to the original line pointed out by this reviewer, in line 256 we have changed the word “skewed” to “tended” to more precisely represent the point, since we did not find evidence of skew other than that related to the D&A subscale. • We have otherwise retained use of mean scoring per our understanding of the literature supporting use of mean scores for Likert scale data; see for example: o Sullivan GM, Artino AR Jr. Analyzing and interpreting data from likert-type scales. J Grad Med Educ. 2013 Dec;5(4):541-2. doi: 10.4300/JGME-5-4-18. PMID: 24454995; PMCID: PMC3886444. o Norman G. Likert scales, levels of measurement and the "laws" of statistics. Adv Health Sci Educ Theory Pract. 2010 Dec;15(5):625-32. doi: 10.1007/s10459-010-9222-y. Epub 2010 Feb 10. PMID: 20146096. 4.) In line 252, the authors mentioned that they used MLVM command to run the factor analysis in STATA. MLVM is not a command; rather an option within the SEM command of STATA. • Thank you for this point; we have changed the word “command” to “option” accordingly. 5.) In the reliability and validity analysis, the item "prov_insist" was kept as part of the third domain in Ethiopia and "opportunity" and "info_private" as part of the second domain. The reliability of these factors would have been improved if this items were removed. In addition, the items load poorly to their respective domains. This suggests that the authors should respecify the model and test a an alternative four or five factor CFA model (eg. pressure as a fourth domain) than retain then as part of the second or third. • Thank you for this suggestion. Per this reviewer’s first point, we have modified language to make more clear that our goal with this analysis was to examine the extent to which the QCC-Ethiopia and QCC-India Scales replicated the factor structure and scale/item properties of the original QCC-Mexico scale (rather than using exploratory factor analysis to determine the underlying factor structure of each). Because the QCC-Ethiopia and QCC-India scales contained only minor item modifications compared to the original QCC-Mexico Scale, we feel this approach is justified and that the utility of these adapted versions of the QCC Scale is higher with a consistent factor structure between countries such that the three QCC subscales can be applied in different settings. 6.) The result section has a component that should have been taken to the discussion section (Lines 278 to 303). • Thank you for this helpful suggestion. We have moved this text to the discussion section –integrated into paragraphs 2-4—accordingly (with the exception of the sentence reporting findings from the model fit exercise which we deemed appropriate to retain in Results). Reviewer #2: The authors present a pertinent and well-founded justification for carrying out the investigation. With regard to the structure of the article, it has a careful presentation, is written in English, easy to read, with a logical sequence and interconnection between the contents. Contains all mandatory elements for publications in PLOS ONE. The methodology used fits the type of study developed. It presents all the steps that it integrates in a very detailed, clear and robust way. The inclusion and exclusion criteria of the participants, the type of and its calculation are explained. The tests used for the adaptation and validation of the Quality of Contraceptive Counseling (QCC) Scale for use in Ethiopia and India are adjusted and appropriate. The authors justify the robust way and, based on the statistical analysis performed, the inclusion of items on the scale (even those with a low factor), as well as the exclusion of others. They present results of an original research and with high methodological rigor. The discussion is well founded, supported by the data obtained through the results. Conclusions lead us to the importance and relevance of using a valid and reliable scale as an instrument to be used in quality contraceptive counseling. Most references are from the last 5 years. The study respected the ethical principles required for studies with human beings: the authorizations of the University of California and the respective countries (Ethiopia and Egypt), as well as the informed consent given by the study participants. I consider the article relevant for publication, due to the importance of dissemination, use of the scale and the methodological robustness presented. • Thank you for this assessment of our paper; we appreciate your review and feedback. Attachments Attachment Submitted filename: Response to reviewer feedback 15Sep22.docx https://doi.org/10.1371/journal.pone.0283925.r002
9 Nov 2022 Decision Letter - Wen-Jun Tu, Editor PONE-D-21-36673R1Adaptation and validation of the quality of contraceptive counseling (QCC) scale for use in Ethiopia and IndiaPLOS ONE Dear Dr. Holt, 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 Dec 24 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, Wen-Jun Tu 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 #1: All comments have been addressed Reviewer #2: (No Response) Reviewer #3: (No Response) ******** 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: Yes Reviewer #3: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: 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 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 #1: Yes Reviewer #2: Yes 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 #1: The authors confused the use of exploratory factor analysis with confirmatory factor analysis. In one hand, they report that the aim of their work is tool validation which was supposed to be done via confirmatory analysis. Yet, the strategy utilized during their analysis was a typical characteristics of an exploratory analysis. Reviewer #2: (No Response) Reviewer #3: This is a thorough, well-done study. The reporting is clear. The inclusion of two different countries in the survey offers added value. I have the following questions/comments: 1. Is there any information available about the response rate? 2. The factor analysis reveals that the QCC consists of 3 subscales. Does it make sense to calculate an overall QCC score (and an overall Cronbach's alpha)? 3. The item prov_insist is clearly measuring slightly differently from the other items in the "disrespect and abuse" subscale. I suggest to remove this item from the subscale. Since this item is considered important for the content validity, this item can still be included in the questionnaire, but it should not be used to calculate the score for “the disrespect and abuse” subscale. ****** 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: No Reviewer #2: Yes: Sara Elisabete Cavaco Palma Reviewer #3: Yes: Wim Peersman ******** [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.0283925.r003
Revision 2
3 Mar 2023 Author Response Reviewer #1: The authors confused the use of exploratory factor analysis with confirmatory factor analysis. In one hand, they report that the aim of their work is tool validation which was supposed to be done via confirmatory analysis. Yet, the strategy utilized during their analysis was a typical characteristics of an exploratory analysis. Thank you for this comment. We have in fact conducted a confirmatory analysis, as detailed in the Analysis section beginning line 169. Reviewer #2: (No Response) Reviewer #3: This is a thorough, well-done study. The reporting is clear. The inclusion of two different countries in the survey offers added value. I have the following questions/comments: 1. Is there any information available about the response rate? No, we do not have response rates available. Sampling was done by convenience sampling, as detailed in the “Sample, recruitment, and data collection” section starting on line 117. 2. The factor analysis reveals that the QCC consists of 3 subscales. Does it make sense to calculate an overall QCC score (and an overall Cronbach's alpha)? Thank you for this question. We argue that the Pearson correlation coefficients between subscale scores are high enough to suggest a single unifying latent QCC construct—as was similarly observed in the published Mexico version of the scale. The paragraph beginning line 308 provides the following detail: “Examination of the Pearson correlations coefficients between the subscale scores showed that the relationships observed in Mexico largely remained the same in Ethiopia, providing evidence for a single unifying latent QCC construct in this setting; specifically, the Information Exchange subscale and Interpersonal Relationship subscales were highly correlated (0.8 in Ethiopia, similar to the 0.7 observed in Mexico) and the Disrespect and Abuse subscale correlated 0.3 with both Information Exchange and Interpersonal Relationship in Ethiopia compared to the 0.3 and 0.4, respectively, observed in Mexico [11]. In India, the Information Exchange and Interpersonal Relationship subscales were correlated similarly to the other two countries (0.7); however, the Disrespect and Abuse subscale was less correlated with the other subscales (0.1 with Information Exchange and 0.05 with Interpersonal Relationship).” In the Discussion, we provide further guidance, noting the caveat that in India the D&A subscale was less correlated with the other subscales: “It is also worth noting that the Disrespect and Abuse subscale was less correlated with other subscales in our India sample compared to the Ethiopia sample and what had previously been observed in the QCC-Mexico validation study. This suggests that in the Vadodara context, the experience of Disrespect and Abuse is more weakly tied to the overall QCC construct; in other words, a person’s experience of extreme negative provider behaviors is less correlated with how they perceived counseling overall compared to other settings. Nonetheless, noting this limitation, composite scores can still be computed and applied to capture the full range of the QCC construct.” Further, the individual subscale alphas are also provided in Table 3. 3. The item prov_insist is clearly measuring slightly differently from the other items in the "disrespect and abuse" subscale. I suggest to remove this item from the subscale. Since this item is considered important for the content validity, this item can still be included in the questionnaire, but it should not be used to calculate the score for “the disrespect and abuse” subscale. Thank you very much for this observation. It has motivated us to modify the analysis and move this item to the IR subscale where it performs much better. Because disrespect and abuse is highly related to the interpersonal relationship between provider and client, this change is justified conceptually. Line 276- footnote to Table 3-now reads: “This item [prov_insist] loaded as part of the Disrespect and Abuse subscale in the original scale development in Mexico [11]. In our CFA modeling it performed very poorly on that subscale (subscale alphas were 0.4 and 0.6 and the item loaded 0.02 and 0.14 in Ethiopia and India, respectively) and thus was moved to the conceptually-related Interpersonal Relationship subscale, as shown here” Including the item in the IR subscale greatly improved the alphas for the D&A subscale in both countries and the loading of the item in India (though not Ethiopia, where it was nonetheless retained due to the critical importance of capturing potential pressure from providers from a content validity perspective). This change did not qualitatively change interpretation of findings related to goodness of fit or correlational validity, though the values were updated in the Results (Tables 3 & 4, respectively). Other changes made: • We caught a typo on line 100 about the length of the cognitive interviews in Ethiopia and updated to indicate that they were, on average, 30 minutes • The QCC Website containing the item wording has been updated; accordingly, we replaced the old url with the new one in the text of the manuscript: https://qccscale.ucsf.edu/qcc-scale-versions • In the Discussion, we referenced the short version of the QCC scale (the QCC-10); two new articles have been published so we added those citations to the reference section (19-20) Attachments Attachment Submitted filename: Response to reviewer comments March 3 2023.docx https://doi.org/10.1371/journal.pone.0283925.r004
22 Mar 2023 Decision Letter - Wen-Jun Tu, Editor Adaptation and validation of the quality of contraceptive counseling (QCC) scale for use in Ethiopia and India PONE-D-21-36673R2 Dear Dr. Holt, 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, Wen-Jun Tu 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 #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: 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 #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: The authors have adequately addressed my comments. ****** 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: Yes: Wim Peersman ******** https://doi.org/10.1371/journal.pone.0283925.r005
Formally Accepted
24 Mar 2023 Acceptance Letter - Wen-Jun Tu, Editor PONE-D-21-36673R2 Adaptation and validation of the quality of contraceptive counseling (QCC) scale for use in Ethiopia and India Dear Dr. Holt: 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. Wen-Jun Tu Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0283925.r006

Open letter on the publication of peer review reports

PLOS recognizes the benefits of transparency in the peer review process. Therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. Reviewers remain anonymous, unless they choose to reveal their names.

We encourage other journals to join us in this initiative. We hope that our action inspires the community, including researchers, research funders, and research institutions, to recognize the benefits of published peer review reports for all parts of the research system.

Learn more at ASAPbio .