PONE-D-23-02398Evaluation of the Effect of Reinforced Education on the Satisfaction of Patients Undergoing Colonoscopy: a Randomized TrialPLOS ONE

Dear Dr. Farid,

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.

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We look forward to receiving your revised manuscript.

Kind regards,

Antonio Brillantino

Academic Editor

PLOS ONE

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Additional Editor Comments:

According with reviewers comments, the manuscript needs a a careful and thorough review to be considered for acceptance.

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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: No

Reviewer #2: Partly

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

Reviewer #1: No

Reviewer #2: No

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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: Dear authors,

good luck with your efforts. However, I think that the scientific writing of the article is not enough. My suggestions are attached on the file. It can be developed in line with the recommendations. I wish you good work.

Reviewer #2: This manuscript presents data analysis from a randomized control trial (RCT) to compare the effectiveness of the reinforced education (RE) procedure (intervention), versus control, on improving satisfaction of colonoscopy patients. The topic is of importance, the study was registered as a RCT (with a valid number), and was approved by the respective IRB/Ethics Committee. While the study objectives sound interesting, is important, and on target, some shortcomings were observed, in regards to abiding by the CONSORT guidelines for conducting and reporting results of high-quality randomized controlled trials (RCTs). Some other (statistical) comments were also provided.

1. Methods:

Methods reporting need some work. An orderly manner is suggested, following CONSORT guidelines, without repeating information, such as Trial Design, Participant Eligibility Criteria and settings, Interventions, Outcomes, sample size/power considerations, Interim analysis and stopping rules, Randomization (details on random number generation, allocation concealment, implementation), Blinding issues, etc, should be mentioned. The authors are advised to create separate subsections for each of the possible topics (whichever necessary), and that way produce a very clear writeup. They are advised to write it carefully, following nice examples in the manuscript below:

https://www.sciencedirect.com/science/article/pii/S0889540619300010

Specific comments:

(a) For instance, the randomization and allocation concealment should be made very clear (they are NOT the same thing); the trial staff recruiting patients should NOT have the randomization list. Randomization should be prepared by the trial statistician, and he/she would not participate in the recruiting.

(b) The manuscript does not provide details on the randomization procedure; any reasoning, why a block randomization was not used, which is often recommended to ensure a balance in sample size across groups?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2267325/

(c) The authors write in the Abstract: "In order to prevent the dissemination of information between the two groups, first the data of the control group was collected". This is not clear! You may easily attain information blockade between the 2 groups via blinding, and a proper randomization procedure. More details needed.

(d) Sample size/power: A sample size/power statement is made available, but its recommended to place it as a separate subsection within the Methods section, following CONSORT guidelines.

(e) Statistical Analysis:

(e1) Alternative analysis methods under data non-Gaussianity is not mentioned, such as using well-known nonparametric tests.

(e2) Several additional covariates (via the questions) were also obtained. Why a formal regression analysis was not conducted?

(e3) It's not clear if data was collected longitudinally; please provide details. If that is the case, mixed modeling should be used.

(e4) Overall writeup has various inconsistencies; please fix incomplete sentences. For example, a sentence started like "it should be mentioned......" (Page 7). Sentences start with Capital letters.

2. Results & Conclusions:

(a) The authors should check that any statement of significance should be followed by a p-value in the entire Results section. Otherwise, the Results section look OK.

(b) Conclusions should state that the current findings are ONLY based on the random samples derived from an Iranian population, and should allude to future studies with much larger sample sizes and collected at other geographical areas to confirm the effectiveness of the RE procedure.

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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: No

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Attachments

Attachment

Submitted filename: REVIEWER1_Evaluation of the Effect of Reinforced Education on the Satisfaction of the Patients Undergoing Colonoscopy a Randomized Trial.docx

PONE-D-23-02398R1Evaluation of the effect of reinforced education on the satisfaction of patients undergoing colonoscopy: a randomized controlled trialPLOS ONE

Dear Dr. Farid,

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 Nov 09 2023 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,

Antonio Brillantino

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 #2: (No Response)

Reviewer #3: All comments have been addressed

Reviewer #4: All comments have been addressed

Reviewer #5: All comments have been addressed

Reviewer #6: (No Response)

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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 #2: Yes

Reviewer #3: No

Reviewer #4: Yes

Reviewer #5: Yes

Reviewer #6: Partly

**********

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

Reviewer #2: Yes

Reviewer #3: No

Reviewer #4: Yes

Reviewer #5: Yes

Reviewer #6: 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 #2: Yes

Reviewer #3: No

Reviewer #4: Yes

Reviewer #5: Yes

Reviewer #6: 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 #2: Yes

Reviewer #3: No

Reviewer #4: No

Reviewer #5: Yes

Reviewer #6: No

**********

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 #2: The authors were mostly responsive to the previous comments raised. However, there is no description of the alternative nonparametric methods (such as, Wilcoxon rank-sum, or signed rank, or even Kruskal-Wallis tests, as the case might be) in the statistical analysis plan, under situations of non-Gaussianity.

I recommend the authors to create a new section on Statistical Analysis, which will describe what they are going to do. Later on, they may not do all (such as, just stick to the t-tests), if they can confirm that Gaussian assumptions are all valid.

Reviewer #3: (No Response)

Reviewer #4: Here are some of the main grammatical errors I noticed in the manuscript:

Abstract:

Inconsistent verb tense - switches between past and present tense

Missing articles "a" and "the" in some places

Sentence fragments instead of complete sentences in some places

Introduction:

Run-on sentences

Missing transition words between some sentences

Subject/verb agreement issues - ex. "patients frequently find it uncomfortable" should be "patients frequently find them uncomfortable"

Methods:

Inconsistent verb tense

Missing articles

Sentence fragments

Run-on sentences

Words missing between some phrases

Results:

Inconsistent verb tense

Missing articles

Sentence fragments

Discussion:

Run-on sentences

Missing transition words between sentences

Inconsistent verb tense

Sentence fragments

Overall:

Inconsistent verb tense throughout manuscript

Missing articles "a" and "the" throughout

Run-on sentences in multiple sections

Sentence fragments instead of complete sentences

Missing transition words between sentences

Subject/verb agreement issues in some places

I would recommend having the manuscript edited by a native English speaker to fix these grammatical issues and improve the overall flow and clarity. Let me know if you would like me to clarify or expand on any of these issues!

Abstract:

"Fourteen million colonoscopies are performed annually in the United States, where the colonoscopy results depend on bowel preparation before the procedure."

This mixes tenses - "are performed" is present tense while "depend" is present tense. It should be:

"Fourteen million colonoscopies are performed annually in the United States, where the colonoscopy results depended on bowel preparation before the procedure."

"Furthermore, the training will be more influential if it is based on problem-solving techniques..."

The subject "training" is singular but the verb is plural "will be." It should be:

"Furthermore, the training will be more influential if it is based on problem-solving techniques..."

Introduction:

"Although proper bowel preparation is the most important factor in colonoscopy, patients frequently find it uncomfortable."

The subject "patients" is plural but the verb "find" is singular. It should be:

"Although proper bowel preparation is the most important factor in colonoscopy, patients frequently find them uncomfortable."

"Education is provided through various methods, such as pamphlets animations, messages and videos which increase patient readiness by 11-36%."

This is a run-on sentence without proper punctuation or transition words. It should be:

"Education is provided through various methods, such as pamphlets, animations, messages, and videos, which increase patient readiness by 11-36%."

Methods:

"Analyses were conducted using IBM SPSS software was employed for analyses (v. 20, IBM Corp., Armonk, NY)."

This contains a fragment "software was employed" that doesn't fit the sentence structure. It should be:

"Analyses were conducted using IBM SPSS software (v. 20, IBM Corp., Armonk, NY)."

Let me know if these examples help explain the types of errors or if you need me to clarify or provide more examples!

Reviewer #5: (No Response)

Reviewer #6: Thank you for the opportunity to review this manuscript exploring the effect of reinforced education on patient satisfaction with colonoscopy. Overall, the topic addresses an important healthcare issue and the randomized controlled study design is methodologically rigorous. However, certain aspects of the manuscript could be strengthened to enhance clarity and scientific rigor. My recommendation is Major Revision.

The introduction could be shortened and streamlined to more directly convey the study purpose upfront. Additionally, citing recent literature would help establish the scientific/clinical context and significance.

Regarding methods, greater detail on procedures like randomization, blinding, outcome measurement and data analysis would allow better evaluation of internal and external validity. Adhering to standard reporting guidelines also ensures all relevant aspects are addressed.

Presentation of results requires numerical data like test statistics and significance levels to facilitate interpretation. Demographic tables could be reorganized for clarity.

While acknowledging limitations is appropriate, further discussion on their potential impact on generalizability and implications for future research would strengthen conclusions. Mechanisms of the intervention effectiveness should also be proposed and prior evidence synthesized.

Consideration of intervention risks and the importance of informed consent protects participant welfare and supports ethical standards.

Overall, with revisions to enhance methodological transparency and rigor in data reporting/analysis, this study offers insights into improving colonoscopy care through patient education. I hope these suggestions are useful in strengthening the scientific quality and impact of the manuscript. Please let me know if any part of the review requires clarification.

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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 #2: No

Reviewer #3: No

Reviewer #4: Yes: Morteza Shamsizadeh

Reviewer #5: No

Reviewer #6: Yes: Younes Mohammadi

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[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.

Attachments

Attachment

Submitted filename: Reviewer Plo.docx

Attachment

Submitted filename: PONE-D-23-02398_R1 (1).pdf

PONE-D-23-02398R2Evaluation of the effect of reinforced education on the satisfaction of patients undergoing colonoscopy: a randomized controlled trialPLOS ONE

Dear Dr. Farid,

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 07 2023 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,

Antonio Brillantino

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.]

[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.

Evaluation of the effect of reinforced education on the satisfaction of patients undergoing colonoscopy: a randomized controlled trial

PONE-D-23-02398R3

Dear Dr. Negin Farid,

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,

Antonio Brillantino

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

All the questioned issues were adequately addressed. The manuscript, in its actual form, is suitable for publication.

Reviewers' comments: