Perceived attitudes toward LGBTQ+ physicians among Thai patients with psychiatric disorder: A multiregional cross-sectional study

Jarurin Pitanupong; Katti Sathaporn; Pichai Ittasakul; Nuntaporn Karawekpanyawong; Jaturaporn Sangkool; Suwannee Putthisri

doi:10.1371/journal.pone.0311795

Peer Review History

Original SubmissionAugust 16, 2024
6 Sep 2024 Decision Letter - Daniel Demant, Editor PONE-D-24-32784Perceived attitudes toward LGBTQ+ physicians among Thai patients with psychiatric disorder: a multiregional cross-sectional studyPLOS ONE Dear Dr. Karawekpanyawong, 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. As you can see, the reviewers are overall excited about this research as am I. Please ensure to also address my additional comments below that go beyond the points mentioned by the reviewers. Please submit your revised manuscript by Oct 19 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. 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The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. Thank you for stating in your Funding Statement: "This study was supported by Chiang Mai University (Nuntaporn Karawekpanyawong, RG 38/2566), Thailand. The funders had no involvement in the study design, data collection, data analysis, decision to publish, or preparation of the manuscript." Please provide an amended statement that declares all the funding or sources of support (whether external or internal to your organization) received during this study, as detailed online in our guide for authors at http://journals.plos.org/plosone/s/submit-now. Please also include the statement “There was no additional external funding received for this study.” in your updated Funding Statement. Please include your amended Funding Statement within your cover letter. We will change the online submission form on your behalf. Additional Editor Comments: Grammar and Language The manuscript contains a number grammatical errors and awkward sentence structures that affect readability. Inconsistent use of tense throughout the manuscript makes it difficult to follow the narrative. The flow between some sections, specifically in the introduction is sometimes poor. I would recommend a comprehensive language edit by a professional or a colleague who speaks English as a first language. Methodology The study employs a cross-sectional design, which is inherently limited in establishing causality. This limitation should be more explicitly discussed in the methodology and discussion sections. There is no justification provided for the selection of the three specific regions of Thailand, which limits the generalisability of the findings. The statistical methods used are appropriate, but the manuscript lacks a clear explanation of how confounding variables were controlled in the regression analysis. Clarity of Results The results section is cluttered with excessive numerical data without adequate contextual interpretation. Tables and figures are used but are not sufficiently explained in the text. A brief summary of the key points from each table should be included to aid reader comprehension. Critical Level of the Discussion The discussion provides a surface-level interpretation of results without delving deeply into potential reasons behind the observed patterns. There is an over-reliance on describing findings rather than critically engaging with them. Suggestions for future research are made but lack specificity and do not fully address the study's limitations. As an example, the differences in attitudes between the regions are reported, but there is little exploration of why these differences might exist beyond brief mentions in the discussion. Comparisons with existing literature are limited, reducing the critical engagement with the field. A more extensive literature integration would strengthen the discussion. There is an over-reliance on describing findings rather than critically engaging with them. Suggestions for future research are made but lack specificity and do not fully address the study's limitations. [Note: HTML markup is below. Please do not edit.] 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: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 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 ****** 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 ****** 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: I would like to congratulate the authors of the article for bringing such an interesting point of view in the diversity discussion. I think it would help the article if the authors put the "p value" in table 3, in order to help the comparisons. Reviewer #2: �Overall, the study is well-conducted and informative. The findings on perceived attitude toward LGBTQ+ physicians among Thai patients with psychiatric disorder, are supported by clear statistical results and are appropriately discussed within the context of current literature. ****** 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: I would like to congratulate the authors of the article for bringing such an interesting point of view in the diversity discussion. I think it would help the article if the authors put the "p value" in table 3, in order to help the comparisons. Reviewer #2: No ******** [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.0311795.r001
Revision 1
17 Sep 2024 Author Response Response to reviewer We would like to thank you for your careful consideration of our manuscript, your pertinent questions, and your helpful suggestions. Your comments have led to several important changes to our manuscript that have considerably improved it in our opinion. We have revised our manuscript according to your recommendation, as follows: The comments by the reviewers appear in the boxes below. The response to these comments and the associated change to the manuscript are listed below. The changes are also highlighted in the revised manuscript. Journal requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf Answer: We have revised the manuscript to ensure it adheres to PLOS ONE's style requirements. 2. Thank you for stating in your Funding Statement: "This study was supported by Chiang Mai University (Nuntaporn Karawekpanyawong, RG 38/2566), Thailand. The funders had no involvement in the study design, data collection, data analysis, decision to publish, or preparation of the manuscript." Please provide an amended statement that declares all the funding or sources of support (whether external or internal to your organization) received during this study, as detailed online in our guide for authors at http://journals.plos.org/plosone/s/submit-now. Please also include the statement “There was no additional external funding received for this study.” in your updated Funding Statement. Please include your amended Funding Statement within your cover letter. We will change the online submission form on your behalf. Answer: We have revised the funding statement as follows: "This study was supported by Chiang Mai University (Nuntaporn Karawekpanyawong, RG 38/2566), Thailand. The funders had no involvement in the study design, data collection, data analysis, decision to publish, or preparation of the manuscript. There was no additional external funding received for this study." Additional Editor Comments: Grammar and Language The manuscript contains a number grammatical errors and awkward sentence structures that affect readability. Inconsistent use of tense throughout the manuscript makes it difficult to follow the narrative. The flow between some sections, specifically in the introduction is sometimes poor. I would recommend a comprehensive language edit by a professional or a colleague who speaks English as a first language. Answer: We have thoroughly edited the manuscript to improve clarity in English usage. Methodology The study employs a cross-sectional design, which is inherently limited in establishing causality. This limitation should be more explicitly discussed in the methodology and discussion sections. There is no justification provided for the selection of the three specific regions of Thailand, which limits the generalisability of the findings. The statistical methods used are appropriate, but the manuscript lacks a clear explanation of how confounding variables were controlled in the regression analysis. Answer: - We have noted the reasons for selecting the three specific regions of Thailand due to the limitation of data in the Methods section. Please see page 5, lines 88-89. - We have discussed the limitation of generalization of the finding due to region selection in the discussion section. Please see page 18, lines 309-311. - We have explained how confounding variables were controlled in the regression analysis in the Methods section. Please see pages 7-8, lines 145-149. Clarity of Results The results section is cluttered with excessive numerical data without adequate contextual interpretation. Tables and figures are used but are not sufficiently explained in the text. A brief summary of the key points from each table should be included to aid reader comprehension. Answer: - We have summarized the key points from the Results section to aid reader comprehension. For Tables 1 and 2, please refer to pages 8-9, lines 156-169. For Table 3, please refer to page 11, lines 192-198. For Table 4, please refer to pages 12-13, lines 218-227. For Table 5, please refer to page 14, lines 231-236. Critical Level of the Discussion The discussion provides a surface-level interpretation of results without delving deeply into potential reasons behind the observed patterns. There is an over-reliance on describing findings rather than critically engaging with them. Suggestions for future research are made but lack specificity and do not fully address the study's limitations. As an example, the differences in attitudes between the regions are reported, but there is little exploration of why these differences might exist beyond brief mentions in the discussion. Comparisons with existing literature are limited, reducing the critical engagement with the field. A more extensive literature integration would strengthen the discussion. Answer: - We have provided a deeper discussion of potential reasons behind the results, such as differences in attitudes between regions. Please refer to page 17, lines 278-291. - We have suggested specific directions for future research. Please refer to pages 18-19, lines 322-324. - We have fully addressed the study's limitations. Please refer to pages 18-19, lines 304-324. Reviewer #1: I would like to congratulate the authors of the article for bringing such an interesting point of view in the diversity discussion. I think it would help the article if the authors put the "p value" in table 3, in order to help the comparisons. Answer: We apologize for any misunderstanding. Table 3 presents the attitudes toward LGBTQ+ physicians across six processes of medical management for all participants, without comparisons between processes or between attitudes toward non-LGBTQ+ physicians for these processes. Therefore, no p-values are provided for this result. Attachments Attachment Submitted filename: Response to Reviwers 670915 for Plosone.docx https://doi.org/10.1371/journal.pone.0311795.r002
25 Sep 2024 Decision Letter - Daniel Demant, Editor Perceived attitudes toward LGBTQ+ physicians among Thai patients with psychiatric disorder: a multiregional cross-sectional study PONE-D-24-32784R1 Dear Dr. Karawekpanyawong, 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, Daniel Demant, PhD, MPH, GradCertHEd, BAppSocSc Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0311795.r003
Formally Accepted
29 Oct 2024 Acceptance Letter - Daniel Demant, Editor PONE-D-24-32784R1 PLOS ONE Dear Dr. Karawekpanyawong, 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. Daniel Demant Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0311795.r004

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