PONE-D-23-05351Exploring barriers and facilitators to women's intention and behavior to seek treatment for distressing sexual problemsPLOS ONE

Dear Dr. Velten,

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.

The paper is really well written and exaustive. Please answer minor points risen by reviewers. According to me the method section is complete.

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Marta Panzeri, Ph.D.

Academic Editor

PLOS ONE

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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

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

Reviewer #1: Yes

Reviewer #2: Yes

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

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

Reviewer #1: Yes

Reviewer #2: Yes

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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

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5. Review Comments to the Author

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

Reviewer #1: The paper is rich and nicely written. It tackled the topic of help seeking for sexual problems from different perspectives and provided further understanding of the factors that affect women’s intention and behaviour.

I would suggest considering the following points:

Introduction:

Elaborate the impact of sexual problems on women’s life and wellbeing.

The context of the study should be elaborated highlighting the healthcare system and the facilities provided for sexual healthcare services. This was not mention knowing that the accessibility, availability, quality, and acceptability of care could be major facilitators or barriers to helpseeking for sexual problems. Another factor that impacts on women’s helpseeking behaviour is the husband attitude which also should be reflected on.

Methods:

The design is not mentioned.

Since data collection was done online, I wonder if data about the country of residence and nationality were collected as the culture may affect help seeking.

How did you ensure consistency of the definition of the sociodemographic and socioeconomic variables among participants coming from different countries?

Reviewer #2: Dear Editor and Authors:

This manuscript aims to identify barriers and facilitators that lead women to seek treatment for sexual problems.

It is a complete, complex and well elaborated work. In addition, the effort made by the authors to compose it can be observed, since they use a large number of variables and manage to defend them in a very adequate way. This study expands the knowledge about the behavioral intention to seek help that women present and can contribute both in clinical practice and as a starting point for future research and interventions.

Page 3 – Introduction: To complete the introduction, it is recommended to include some data on sexual difficulties worldwide.

Page 5 - Barriers and facilitators for help-seeking: This section is very complete. The first paragraph talks about structural and attitudinal characteristics. It is recommended to order the information in this section, e.g. following the content of the first paragraph, i.e. structural and attitudinal characteristics or according to the variables to be used in this study. In this line, it is recommended to mention these characteristics. For example, at the beginning of the paragraphs that are developed in this section, in order to order the information and make it easier to read for future users of the journal. In addition to socio-economic status, it is recommended that any further structural barriers be included or made clearer in the text.

It is considered necessary to include a justification for the inclusion of the variables under study and not others.

Page 8 Participants: Can the authors specify whether there were any exclusion criteria?

Pages 9-14 Measures: It is recommended to include examples of items from the scales used.

Page 11 – Line 145 “professional.”)”: Include a full stop at the end of the sentence.

Page 11 - Help-seeking intention: Can the authors explain why they only refer to mental health? Please include examples of items from the two additional versions indicated in the paragraph.

Page 12 Self-stigma of seeking help/ Attitudes towards and preferences for psychological online-interventions: Can the authors explain why no such questionnaire on physical health was included? This should be clear from the introduction.

Page 16, Lines 370-377: It is recommended to indicate in summary form what these data, these averages, mean. This makes it easier for the reader to understand quickly.

Table 3 “Other reasons”: Please indicate in brackets or at the bottom of the table what "other reasons" mean.

Lines 482-500: Today's society places a greater burden and responsibility on women, which can make it difficult for them to devote time to their own care. There may be a need for health education for the whole population, with a special emphasis on women. Perhaps those women who report having no time are working in and out of the home, taking care of the family, etc. In future studies it would be interesting to learn about these aspects that may act as barriers to general and sexual health care for these women.

Lines 521-522 “It is also conceivable that women who are in a particularly good socioeconomic 522 situation fear a loss of status to a greater extent if they initiate treatment for a sexual problem”: Please elaborate in the text on this conclusion reached by the authors (and cite).

Were people who indicated any sexual problems or sexual distress offered any help or benefits for participating in this study (other than those mentioned in the Method)?

Journal checklist:

1. The study presents the results of original research. X

2. Results reported have not been published elsewhere.

3. Experiments, statistics, and other analyses are performed to a high technical standard and are described in sufficient detail. X

4. Conclusions are presented in an appropriate fashion and are supported by the data.X

5. The article is presented in an intelligible fashion and is written in standard English.X

6. The research meets all applicable standards for the ethics of experimentation and research integrity. X

7. The article adheres to appropriate reporting guidelines and community standards for data availability.X

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Reviewer #1: Yes: Mathilde Azar

Reviewer #2: No

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Exploring barriers and facilitators to women's intention and behavior to seek treatment for distressing sexual problems

PONE-D-23-05351R1

Dear Dr. Velten,

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,

Marta Panzeri, Ph.D.

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 #1: All comments have been addressed

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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

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

Reviewer #1: 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

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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

**********

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 answered all the questions and addressed all the comments. The introduction is well elaborated with emphasis on the variables of the study. The rational is clearly highlighted considering the context and the gaps in the literature. The methods are presented and clearly explained. The data are rich and support the research questions. The discussion is rich and the conclusion is relevant.

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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: Mathilde Azar

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