PONE-D-23-29407Predictors of non-adherence to antihypertensive medications: A cross-sectional study from a regional hospital in AfghanistanPLOS 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?

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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?

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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: Cut off points for assessing depression status is not mentioned in methodology.

Cut-off points for assessing physical activity are not mentioned in methodology.

Class interval for age in Table (1) is not equal.

In Table (4), why 40 is used as cut off point for age.

Where is the p value for table (4)

Reviewer #2: Methodology

The authors should have explained the reliability and validity of the questionnaires used after translation to their local language. I would recommend doing a reliability analysis as a small measure before adding the full analysis of the study.

By translation of the questionnaires used and not stating the reliability this would jeopardize the results of the study.

Results

The authors didn’t consider in multiple medication asking the combined pills strategy. There is new drugs on the market with three active ingredients for hypertension or medication for hypertension. May be this could lead to more adherence to medication rather than multiple medications during the day and night time.

Discussion

The authors didn’t mention drug to drug interaction as a cause of non adherence in the presence of co morbidities.

Overall comment

The study is overall well planned and well written. The authors did a huge effort in combining three questionnaires in this study to get the results of the study.

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Reviewer #1: No

Reviewer #2: No

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Predictors of non-adherence to antihypertensive medications: A cross-sectional study from a regional hospital in Afghanistan

PONE-D-23-29407R1

Dear Dr. Charuai,

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,

Kahsu Gebrekidan

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

Reviewer #3: 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

Reviewer #3: Yes

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

Reviewer #1: 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 #3: 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

Reviewer #3: Yes

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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: All the comments have been addressed carefully

1. Cut off points for assessing depression status is not mentioned in methodology.

Response: Thank you so much. We added the details for the cut off points for assessing the depression status in our study. Added details are:

The total scores were grouped into different categories of depression symptoms based on the following ranges: normal= 1–4, mild=5–9, moderate=10–14, severe=15–19, and extremely severe= 20-27 [34,35].

2. Cut-off points for assessing physical activity are not mentioned in methodology.

Response: Thank you. We added the details for the cut off points for assessing the physical activity level in our study.

We considered walking 3 days/week for at least 20 min/day to be low level of physical activity or < 3 metabolic equivalents (METs). Moderate physical activity 3-5days/week for at least 30 min/day represented medium level of physical activity or 3 to 7.9 METs. Vigorous physical activity 3-7 days/week signified high level of physical activity or >8.0 METs [36,37].

3. Class interval for age in Table (1) is not equal. In Table (4), why 40 is used as cut off point for age.

Response: Thank you so much. In table 1, we tried to primarily focus on distribution of age in our sample. In table 4, we focused to categorize age (<40, >40) for a modeling relationship based on relevant literature. This could help us to compare with other studies that have used a cut-off point similar to our one and as well as comparison among young age patients and old age patients.

4. Where is the p value for table (4)?

Response: Thank you so much for this suggestion. We have added p-values for both bivariate and multivariable analysis in Table 4.

Reviewer #3: Thank you for submitting manuscript and your hard work is really appreciated. Manuscript is clear, concise and well written. There is no any additional comments.

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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

Reviewer #3: No

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