PONE-D-24-32138The association between health literacy and quality of life of patients with type 2 diabetes mellitus: a cross-sectional studyPLOS ONE

Dear Dr. Al-Qerem,

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Dr. Othman Alfuqaha

Academic Editor, PLoS ONE

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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: Yes

Reviewer #2: Yes

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

Reviewer #1: Yes

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: The association between health literacy and quality of life of patients with type 2 diabetes mellitus: a cross-sectional study

Comments for the Authors

The study discussed an important issue regarding health literacy and quality of life. The study is well written and easy to follow. Some questions and points were raised during the review process and need to be addressed.

Abstract

Please state the place where the data collection happened.

Please specify what type of diabetes. Consider this throughout the manuscript

Please elaborate on more details including study site, data collection, instruments and data analysis

In the result section: Reword to become more clear ‘The results indicated that increased age was associated with decreased HRQOL

Introduction

Please provide the most recent statistics concerning prevalence of diabetes worldwide, and is there any statistics concerning Jordan.

Is there any site for health literacy in Jordan, the introduction lacks details describing health literacy and HRQOL in Jordan.

Before The Ref [11] Please move The HRQOL paragraph to become before the health literacy paragraph

Material and Methods

Why only Type 2 diabetes were included. I would think that Type 1 would need more education concerning insulin use, could be added as future work

Please specify who collected the data

Have you evaluated the validity and reliability of the study instruments

Regarding EQ-5D REF before ref. [22] mention that this instrument has been used in several earlier studies that evaluated HRQOL among the Jordanian population

Have you conducted a univariate analysis to determine which variables to be included in the regression analysis

Results

Why did the authors use quantile regression and what is the difference between a normal one

Regarding the JDHLQ score How this could be interpreted as high, moderate, low, need improvement, ….etc

The median EQ5-D index score was 0.66 (0.41-0.78). How this could be interpreted as low, moderate, high, …etc

Regarding EQ5-D index scores (Table 3) paragraph make your focus on the association between health literacy and HRQOL, then describe the other associations

Please mention the statistics describing the fitness if the model

Discussion

Similar studies were conducted from your lab please emphasize the novelty and importance of this study.

It would be good to compare your sample with the general population when possible

Reviewer #2: 1. The study is interesting. However, the methods adopted is not geared to answer the research question. It is suggested that the authors develop a clear framework for DM related HL and QOL assessment. Without basic understanding of HL levels of the patient population in the region of study, the assessment of HL-QOL will generate structural flaws in HL assessment. The following points need to addressed too.

2. It is not clear of the questionnaire used to assess HL in DM patients is validated and tested for reliability given the fact that the Arab population is not homogenous, and Jordan DM patients could be patients from Palestine, and other neighboring countries.

3. How was the questionnaire administered for illiterate patients, how were consents obtained from the same study population group?

4. Was the questionnaire categorized into different domains? And how specific is the questionnaire for DM patients HL assessment? It is advised to provide a breakup of DM direct HL assessment and non-DM related HL assessment items. A reliability and validity score for each of those groups will be beneficial.

5. How was the questionnaire administered? Was it by a study coordinator or the treating physician? What were the bias in completing the questionnaire?

6. This is multicenter-multinational study, was ethics approval obtained from the ethics committees of all the participating institutions/countries?

7. How was the sample size calculated? How many patients with DM withing the inclusion criteria are seen at the study site annually? There is a high probability that the study is underpowered.

8. The results of the study oscillate between HL and QOL. What was the HL rate among the DM patients? Is there a correlation between sociodemographic and HL, and does that impact QOL in DM patients?

9. The authors need to explore literature very well, a few landmark studies from the middle east allude to very low levels of HL among DM patients, and the challenges in DM care. Designing a health literacy model for patients with diabetes | BMC Health Services Research | Full Text (biomedcentral.com) and BMJ Open 2023 Feb 6;13(2):e069489.doi: 10.1136/bmjopen-2022-069489.

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Reviewer #1: No

Reviewer #2: Yes: Satish C Nair

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Attachments

Attachment

Submitted filename: Comments for authors health literacy.docx

The association between health literacy and quality of life of patients with type 2 diabetes mellitus: a cross-sectional study

PONE-D-24-32138R1

Dear Dr.

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,

Othman A. Alfuqaha, Ph.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Dear authors,

I am writing to offer my sincere congratulations on the successful completion and review of your cross-sectional study on the quality of life among participants with Type 2 diabetes mellitus. Your dedication to addressing the reviewers' comments with care and precision has not gone unnoticed, and it is clear that your hard work has greatly contributed to the strength and rigor of your research.

It is particularly commendable that this important study was conducted with funding solely from Al-Zaytoonah University.

Once again, congratulations on this significant achievement, and I wish you continued success in your future endeavors

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 #2: (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 #1: Yes

Reviewer #2: Partly

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

Reviewer #1: Yes

Reviewer #2: No

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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 #2: No

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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 #2: 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: The authors addressed all the comments in the first revision and made the ammendment needed in the text manuscript

Reviewer #2: The authors have to carefully go through the reviewer comments and revise the manuscript. Additionally, the authors also need to provide a point-by-point response to the reviewer queries on a separate note.

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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 #2: Yes: Satish Chandrasekhar Nair

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Attachments

Attachment

Submitted filename: Evaluation of revised manuscript.docx