Health literacy among patients with non-communicable diseases at a tertiary level hospital in Nepal- A cross sectional study

Hari Joshi; Bhoj Raj Kalauni; Kiran Bhusal; Rabindra Bhandari; Aastha Subedi; Buna Bhandari

doi:10.1371/journal.pone.0304816

Peer Review History

Original SubmissionFebruary 16, 2024
20 Mar 2024 Decision Letter - Nimesh Lageju, Editor PONE-D-24-05594Health literacy among patients with non-communicable diseases at a tertiary level hospital in Nepal- A cross sectional studyPLOS ONE Dear Dr. Bhandari, 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 May 04 2024 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. 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Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: I Don't Know ****** 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: No ****** 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: No ****** 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: This study by Buna Bhandari, et al., assessed HL levels and related factors among 303 NCD patients who came for follow-up from December 2022 to February 2023 at Tribhuvan University Teaching Hospital (TUTH) in Nepal. Data was collected via face-to-face interviews by the trained enumerators using a structured Health Literacy Questionnaire (HLQ) containing 44 items (containing nine domains). Multivariate logistic regression analysis was performed using SPSS version 26, with statistical significance at 0.05, to determine the associated factors with HL. The mean ±SD age of the respondent was 47.4 ± 16.18 years. More than half of the respondents were female (56.1%) and had higher HL for all the domains of HL except ‘Navigating the healthcare system’. Results revealed that educational status was significantly associated with six of nine HL domains. Co morbidity, attending the health-related seminar, regular physical activity, and social connectedness were associated with at least one of the domains of HL. This study identified the important factors of HL, such as socio-demographic and medical factors among NCD patients. The patients with NCDs had more than half of high HLL for all the domains of HLQ except the domain navigating the healthcare system. The major findings revealed that educational attainment, regular physical activity, participation in health-related seminars, and a strong sense of social connectedness emerged as positive contributors to higher HLL across various domains. Conversely, the presence of comorbidities exhibited a negative association with HL, underscoring the intricate interplay between personal factors and HL outcomes. Dependent (outcome) variables: All the 9 domains of the HL Questionnaire Independent (predictors) variables: age, gender, educational status, religion, ethnicity, occupation, economic status, residence, chronic disease profile, presence of co-morbidity, complications arise from NCDs, involvement in social activities, regular engagement in physical activities, attendance at health related seminars, and social connectedness The authors made all data underlying the findings fully available. The data was also analyzed using both descriptive and inferential statistics which were rigorous and appropriate. Discussions of the results were robust, citing similar studies conducted both within and outside Kenya and the continent. Conclusions are in line with the findings Writing quality and clarity: Satisfactory Other observations: 1. Limitations of the study: The authors did well to mention the limitations of the study, including recommendations for future research in this area 2. Inclusion/exclusion criteria clearly explained. Reviewer #2: Comments on Manuscript PONE D-24-05594 “ Health literacy among patients with non-communicable diseases at a tertiary level hospital in Nepal - A cross sectional study General Comments: This is a good attempt. However, the entire manuscript needs to be reviewed and revised. The use of english needs to be improved throughout the manuscript. Abstract: Will need to be reviewed after the manuscript is revised Introduction: Lines 67-76 - Paragraph needs to be revised. English language needs to be improved, to clarify the information presented and make it more understandable to the reader. Some words are used repeatedly (for example similar/similarly), however, it is unclear what is being compared. Study Population: English language needs improvement - sentence construction and consistency. Suggest use “Patients with NCDs” rather than NCD patients. Statistical Analysis: Use of Acronymn (VIF) with no explanation provided. Language needs improvement - review paragraphing; improve readability and understanding Results: Lacks clarity. Needs thorough review. Language needs to be improved significantly. The text lacks clarity, and is difficult to read and understand. Lines 153 156 - For example “most” and major are being used for percentages which are around a quarter (1/4) or just over a third (1/3) of the study population. In some cases the percentages are quite similar yet one is reported as being major. Tables 1, 2 and 3 need to be reviewed and revised to improve the presentation, accuracy of the data and readability. The tables should be simple to read and interpret. The abbreviation AOR needs to be explained at the end of each Table. The information in the text must reflect what is in each table. This is sometimes not the case. At times one decimal place is reported in presenting data, while at other times two decimal places are reported. There is little or no reference to the specific table when the results are reported in the text. The reader has to search for the data in the tables, which makes understanding difficult. Sometimes what is reported as results in the text cannot be found in the table/s. Discussion The discussion is difficult to follow and understand. The use of the english language is at times incomprehensible. Example: Lines 236-242 The language needs significant revision to improve readability and understanding. Statements are made throughout the section without adequate provision of references. Example lines 236-238;245-247;254=256;265-267;267-269 Some sentences are lengthy and at other times difficult to understand. Example lines 297-300; 310-311 As far as is possible, use language throughout so the manuscript that is easy to understand Abbreviations Not all the abbreviations used in the manuscript are noted ****** 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: Yes: Haruna Ismaila ADAMU, MBBS; MPH; PhD Reviewer #2: Yes: Glennis Andall-Brereton ******** [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. https://doi.org/10.1371/journal.pone.0304816.r001
Revision 1
15 May 2024 Author Response Dear Editor, We thank the editor and reviewers for critically reviewing our manuscript, “Health Literacy among the Patients with Non-communicable Disease at a Tertiary Hospital in Nepal—A Cross-sectional Study,” and for your valuable comments. We appreciate the time and effort you and the reviewers spent in reviewing our work. We have carefully considered each comment and are grateful for the constructive feedback. Please find the point-by-point response to the reviewers’ comments below. Response Reviewer #1: This study by Buna Bhandari et al. assessed HL levels and related factors among 303 NCD patients who came for follow-up from December 2022 to February 2023 at Tribhuvan University Teaching Hospital (TUTH) in Nepal. Data was collected via face-to-face interviews by the trained enumerators using a structured Health Literacy Questionnaire (HLQ) containing 44 items (containing nine domains). The authors made all data underlying the findings fully available. The results were discussed robustly, citing similar studies conducted both within and across the continent. The conclusions are in line with the findings. Writing quality and clarity: Satisfactory Other observations: Limitations of the study: The authors did well to mention the study’s limitations, including recommendations for future research in this area. Inclusion/exclusion criteria were clearly explained. Response: We thank the reviewer for thoroughly reviewing our manuscript and appreciating our work. Reviewer 2 comments General Comments: This is a good attempt. However, the entire manuscript needs to be reviewed and revised, and the use of English needs to be improved throughout. Response: We would like to thank the reviewer for the constructive comments. We have reviewed and revised the language and English throughout the manuscript. Comment 1.1 Abstract: Will need to be reviewed after the manuscript is revised Response: We have revised the abstract after revising the manuscript Introduction Comment: Lines 67-76 - Paragraph needs to be revised. English language needs to be improved, to clarify the information presented and make it more understandable to the reader. Some words are used repeatedly (for example similar/similarly), however, it is unclear what is being compared. Response: Thank you for the feedback. The language has been refined to enhance clarity and readability. Complex sentences have been simplified, and the information is presented clearly. The repetition of words, such as ‘similar’ and ‘similarly’, has been minimised. The paragraph provides clearer transitions between studies and findings, helping the reader understand more effectively. (Line 24-56) Study Population Comment: English language needs improvement - sentence construction and consistency. Suggest the use of “Patients with NCDs” rather than NCD patients. Response: Thank you. The necessary improvements are made to ensure clarity, especially focusing on sentence construction and consistency. The use of ‘patient with NCDs’ instead of ‘NCD patients’ has been implemented throughout the revised manuscript. Statistical Analysis Comment: Use of Acronym (VIF) with no explanation provided. Language needs improvement - review paragraphing; improve readability and understanding. Response: The acronym VIF is explained in the manuscript. We improved the readability of the paragraph, making it understandable. (see Lines 114-116) Results Comment: Lacks clarity. Needs thorough review. Language needs to be improved significantly. The text lacks clarity, and is difficult to read and understand. Lines 153 156 - For example “most” and major are being used for percentages which are around a quarter (1/4) or just over a third (1/3) of the study population. In some cases the percentages are quite similar yet one is reported as being major. Response: The results section's paragraphs are revised to improve the language and clarity. The sentences are made more concise, and the information is presented clearer and more organised. The usage of terms such as ‘most’ and ‘major’ for the relatively small percentages (around a quarter or just over a third) of the study population have been removed, and the percentages are reported without any subjective qualifiers, leading to a more accurate representation of the data. In the revised paragraph, consistency in reporting percentages is maintained. (See Line 136-180) Comment: Tables 1, 2 and 3 need to be reviewed and revised to improve the presentation, accuracy of the data and readability. The tables should be simple to read and interpret. The abbreviation AOR needs to be explained at the end of each Table. Response: Thank you for your valuable feedback. We have reviewed and simplified the format to make it easier to understand. Additionally, explanations for the abbreviation ‘AOR’ are included at the end of each table. Comment: The information in the text must reflect what is in each table. This is sometimes not the case. At times one decimal place is reported in presenting data, while at other times two decimal places are reported. There is little or no reference to the specific table when the results are reported in the text. The reader has to search for the data in the tables, which makes understanding difficult. Sometimes what is reported as results in the text cannot be found in the table/s. Response: Thank you for bringing this point to our attention. The text is carefully reviewed to accurately reflect the data presented in each table and referenced accordingly in the text (Line 141, 146, 150, 156, 169, 180). The 2-place decimal digit is standardized throughout the manuscript for consistency. Discussion Comment: The discussion is difficult to follow and understand. The use of the English language is, at times, incomprehensible. Example: Lines 236-242 Response: Thank you. Lines 236-242 have been revised and improved in readability. The English language has also been revised and restructured, making the sentences clearer and more understandable throughout the manuscript. Comment: The language needs significant revision to improve readability and understanding. Statements are made throughout the section without adequate provision of references. Example lines 236-238;245-247;254=256;265-267;267-269 Response: Thank you for highlighting the referencing part. The language used in the above-mentioned lines has been revised and restructured for better flow. The statements are expressed clearly and concisely with proper references. Comment: Some sentences are lengthy and, at other times, difficult to understand. Example lines 297-300; 310-311 Response: We have revised the lengthy sentences and restructured them to enhance their readability and understanding. Comment: As far as is possible, use language throughout so the manuscript that is easy to understand. Response: The language in the manuscript has been revised. We made necessary adjustments to enhance its readability while maintaining the integrity and accuracy of its content. Abbreviations Comment: Not all the abbreviations used in the manuscript are noted Response: All the abbreviations used in the manuscripts are now listed in the manuscript. We hope we can satisfactorily address the comments, and now our revised manuscript is suitable for publication in your esteemed journal. Thank you https://doi.org/10.1371/journal.pone.0304816.r002
20 May 2024 Decision Letter - Nimesh Lageju, Editor Health literacy among patients with non-communicable diseases at a tertiary level hospital in Nepal- A cross sectional study PONE-D-24-05594R1 Dear Dr. Bhandari, 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 will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. If you have any questions relating to publication charges, 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, Nimesh Lageju Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0304816.r003
Formally Accepted
24 May 2024 Acceptance Letter - Nimesh Lageju, Editor PONE-D-24-05594R1 PLOS ONE Dear Dr. Bhandari, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. 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. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Nimesh Lageju Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0304816.r004

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