PONE-D-23-09721Workplace violence and its associated factors among health care workers of a tertiary hospital in Kathmandu, NepalPLOS ONE

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Reviewers' comments:

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Comments to the Author

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

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

Reviewer #1: Yes

Reviewer #2: Yes

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

Reviewer #1: No

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?

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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 aims of the study must be presented in a clearer way.

- in the paragraph describing the Outcome variables, verbal violence is not clearly reported

- as far as concerns the selection of independent variables, the authors stated they "were selected through an extensive literature review of similar articles". Give relevant bibliometric references.

- In Table 5 the Authors presented the Factors associated with workplace violence, using all the type of violence toghether. I suggest to add also the analyses for the single type of violence, excluding the non-adjusted analysis.

- concerning the comparison with other countries, the authors mentioned Italy, including data of Ielapi et al, involving 203 HCWs. I suggest to use also these references 10.23749/mdl.v110i2.7807; 10.3390/ijerph19116938; 10.1016/j.puhe.2022.04.008

Reviewer #2: This is an interesting paper, looking at the prevalence and factors associated with workplace violence among doctors and nurses in a tertiary hospital in Nepal. The manuscript is well written. However, there are several limitations in terms of methodology and results, making the paper limited of use for public health.

1. Study setting: As this study selected Tribhuvan University Teaching Hospital, which is a large tertiary hospital as the study setting, the representativeness of study sample to all healthcare workers is thus limited. Work atmosphere, types and size of patients and services delivered and staff are different by level of healthcare setting. This can also be associated with workplace violence and confound with the relationship between exposure and outcome. Actually, it would be better if other levels of hospitals were selected as well. The authors should discuss this point as a limitation, including how it affects the study findings.

2. Sampling method: Please describe if the sampling was stratified by ward or hospital department or not. Different ward settings make different types of patients, relatives and services. This can be differently related to violence as well.

3. Outcome variable: I wonder if the frequency, intensity and recency of violence and how it affects functions, health and social well-being of the victims and indirectly affects their patient service were asked. It would be more useful for prevention of workplace violence and provision of help to those victims if such information was included in the questionnaire.

4. Exposure variables: It is well documented that alcohol and substance use (e.g., cannabis, methamphetamine) and psychiatric disorders are related with violence. The most common sources of violence in this study were from patients and their relatives. It would be more useful if we have data on their alcohol and substance use and psychiatric problems. Did the authors collect data relating to type of patients involved in the violence act? I don't see in the table if psychiatric ward and outpatient department were included in the sampling frame. Is there no such department in Tribhunyan Hospital?

5. Results: Tables 1 and 2 could be combined, of which data could be displayed by type of workers. Tables 3 and 4 should also be displayed by type of workers. It would be useful to see the cross-tabulation between types and sources of violence as interventions given to victims would be different by types and sources of violence. (For example, if violence is caused by patients, the intervention would be different to that caused by his/her colleagues or supervisor.) The results of factors associated with violence are not much of use for prevention and supportive interventions to the victims. Apart from posted department, other factors are hardly modified. If there were more details on the characteristics of violence and sources and the impacts on the affected healthcare workers, more specific interventions could be offered.

6. Discussion. The Recommendations suggested by the authors were too general. It is not needed to do this study to provide such recommendations.

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Reviewer #1: No

Reviewer #2: No

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Workplace violence and its associated factors among health care workers of a tertiary hospital in Kathmandu, Nepal

PONE-D-23-09721R1

Dear Dr. Anupama Bhusal,

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

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

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Kind regards,

Kshitij Karki, MPH, MA

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

**********

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 made the requested changes according to the reviewer's suggestion. According to me the manuscript is suitable for publication.

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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: No

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