PONE-D-23-10564Episodic future thinking in type 2 diabetes: Further development and validation of the health information thinking control for clinical trialsPLOS ONE

Dear Dr. Stein,

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Brown: None.

Bickel: Although the following activities/relationships do not create a conflict of interest pertaining to this article, in the interest of full disclosure, Warren K. Bickel would like to report the following: Warren K. Bickel is a principal of HealthSim, LLC; BEAM Diagnostics, Inc.; and Red 5 Group, LLC. In addition, he serves on the scientific advisory board for Sober Grid, Inc.; and Ria Health; serves as a consultant for Boehringer Ingelheim International; and works on a project supported by Indivior, Inc.

Epstein: None.

Stein: None.”

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Reviewers' comments:

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Reviewer #1: Yes

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

Reviewer #1: Yes

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Reviewer #1: Yes

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Reviewer #1: Yes

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5. Review Comments to the Author

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Reviewer #1: I have reviewed the manuscript “Episodic future thinking in type 2 diabetes: Further development and validation of the health information thinking control for clinical trials” under consideration for publication in PLOS ONE. This manuscript explores Health Information Thinking (HIT) as a control condition for clinical trials examining the effect of Episodic Future Thinking (EFT) on delay discounting (DD) among adults with self-reported type 2 diabetes, which is likely to be of interest to a broader audience. Findings suggest that HIT could be a potential control condition for research examining the effects of EFT on DD, as individuals in the HIT condition had higher DD than individuals in the EFT condition. This manuscript addressed the limitation of previous studies on this topic that use general health information as HIT. I appreciate the fact that the authors utilized diabetes-specific HIT rather than general health information.

Below are some issues that I identified that could potentially improve a future manuscript (organized roughly by the appropriate section):

INTRODUCTION

1. Please provide brief explanations/definitions for technical terms (e.g., HbA1c, BMI) for readers who might not be familiar with these terms.

METHOD

2. I appreciate the authors providing a specific example of EFT Cue Generation, “In one month, I am celebrating my wife’s birthday. We are having a nice dinner with friends and family at a local restaurant. I am asking her about her year and what she is looking forward to this upcoming year. I am happy to be surrounded by friends and family,” on Page 9. I suggest the authors also provide a specific example of HIT Cue Generation to inform how the HIT cue generation might look like. Relatedly, readers might be interested in more details regarding each type of health information as HIT cues: aerobic physical activity, ultra-processed foods, self-monitoring, glycemic index, energy density, variety (of food), and strengthening exercises. I recognize additional information is provided in the supplemental materials, but if there is space, authors might provide an example generated cue for each HIT cue in the manuscript itself.

3. This may be better suited for the results section, but clearer presentation of the proportion of individuals who were considered valide responders (i.e., passed 3 of 4 attention checks) is needed. I recommend updating the flow chart (Figure 1) to reflect number of individuals who failed attention checks, as well as the final analyzed sample sizes as results presented are for those who both completed and passed attention checks (although the authors do mention similar results were observed for the full completer sample and provide those results in supplmental material).

4. I appreciate the authors conducting attrition analyses. I realize this may not be possible, but given the demographic items were administered at the start of the survey, are there data for enough individuals to allow for comparison of completers vs. non-completers to see if any baseline factors were associated with completion status?

5. Related to point 4, please indicate whether rates of valid responding (i.e., 3+ of 4 attention checks) differed by condition. Considering completers only, it appears to be 129/142 (90.8%) for HIT, 96/120 (80%) for EFT, 159/172 (92.4%) for NCC using info from the Delay Discounting Results section, but it is unclear whether these are meaningfully different rates. Please report this information and discuss as relevant. It could also be helpful to examine whether baseline factors were associated with responding status. Results could be helpful both in terms of: 1) establishing internal validity of the study and 2) worthy of discussion in terms of implications for intervention contexts (i.e., intervention adherence)

RESULTS/TABLES

6. The study asked participants to rate the EFT and HIT cues on four dimensions (i.e., enjoyment/likeliness, importance, excitement, vividness/usefulness). However, no data analyses were performed for these measurements. I recognize this is beyond the scope of the manuscript as currently written, but I am curious to learn if any dimension ratings are associated with DD rates, and imagine other readers might be interested as well. Or if there is any difference in enjoyment/likeliness, importance, and excitement observed across EFT and HIT conditions. If there are any differences (or similarly, limited differences) in these dimensions across conditions, this could provide further discussion of the suitability of HIT as a control condition for EFT studies.

7. This is a minor issue, but it could be helpful to report findings for the experimental conditions in the same order throughout the manuscript. For example, in the text, it is reported as EFT, HIT, NCC. Same for Figure 3. However, Figures 1 and 2 order as HIT, EFT, NCC.

DISCUSSION

8. This study measured DD once and then compared the group differences in DD, so no change in DD was measured. Thus, authors should be careful when using terms inferring change throughout the discussion (and also the abstract) to prevent inadvertently misleading readers. For example, in the abstract the authors indicate “that EFT, but not diabetes-specific HIT, reduces delay discounting in adults with type 2 diabetes and obesity”, but the results only indicated DD was lower in the EFT condition than in the HIT condition. Please revise as necessary accordingly

9. The first sentence of the discussion (i.e. that HIT does not result in lower DD relative to EFT) seems at odds with findings. Should this read “…does not significantly reduce delay discounting relative to either EFT or a NCC…”? Please clarify/correct as appropriate.

10. In the Limitations paragraph on page 17, the authors state there was greater attrition in the EFT group, but it is not clear from analyses reported whether this is accurate, only that there were differences among the 3 groups. Was attrition for EFT in fact different from HIT as a pairwise comparison?

11. In paragraph 4 of the Discussion session (page 16), the sentence “Thus, more work is required to explore demographic variables that may moderate the efficacy of EFT in regard to changing health behaviors” seems out of place in this paragraph. It seems more information is needed; for example are the authors referring to diabetes-related health status specifically? I suggest the authors elaborate more and provide examples of demographic variables they think might be potential moderators; otherwise, they could revise this paragraph and remove this sentence, as they did not discuss any potential moderators in the study analyses.

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Reviewer #1: No

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Episodic future thinking in type 2 diabetes: Further development and validation of the health information thinking control for clinical trials

PONE-D-23-10564R1

Dear Dr. Stein,

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.

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Kind regards,

Emily Lund

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

I have reviewed your revisions and believe that you have adequately addressed reviewer comments and strengthened the manuscript.

Reviewers' comments: