Evaluation of knowledge and awareness of diabetes in higher secondary level students of Kaski district: A cross-sectional study

Arpana Pandit; Biswash Sapkota; Nishan Poudel; Renu Karki; Bharat Poudel; Ramakanta Lamichhane

doi:10.1371/journal.pone.0313755

Peer Review History

Original SubmissionJune 19, 2024
19 Jun 2024 Author Response Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0313755.r001
13 Aug 2024 Decision Letter - Sunil Shrestha, Editor Dear Dr. Lamichhane, 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 Sep 27 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. 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'. 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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? Reviewer #1: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #1: No ****** 3. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #1: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes ****** Reviewer #1: The current study assesses the knowledge and awareness of diabetes in higher secondary-level students. I have some questions and suggestions given below: 1. In the introduction section, the author described that most of the population had poor knowledge including health professionals. This kind of background makes it rational for intervention studies instead of observational studies. Previously it has been reported that education has a significant impact on diabetes knowledge, which means higher education has higher diabetes knowledge. There it is suggested that kindly provide a proper rationale for the current study. 2. In the method section, what is the rationale for taking 10% of the population, and how did the authors conclude, that 10% of the population is representative of the total population? 3. What is the need for the development of the study tool for the current study, if already developed tools are available like the Diabetes Knowledge Test? 4. Kindly provide the pilot study result in the method section and clarify whether the pilot study participants were included in the final analysis. 5. Was the use self-administered questionnaire? 6. In the result section, it would be great if you stratified the results based on the student grades. 7. In Table 3, the author used the word “correlation” which is specifically used for the correlational analysis in the statistics, however, the author used a paired t-test. I am wondering why the author used a paired t-test instead of using independent t-test. 8. In discussion, “the international diabetes federation (IDF) has also emphasized on the dire need of public awareness in Nepal regarding diabetes to prevent the diseases and the complications.” Kindly look at this statement, is that correct, if yes kindly provide the reference. 9. In the discussion, the author discusses the knowledge of the participants in the hospital setting, however, the study population of the current study is students of higher education, what is the rationale of comparing these students with other study settings? 10. In general, kindly look for grammatical mistakes and look at the sentence structure in terms of its meaning concerning your current study. ****** what does this mean? ). 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Revision 1
19 Oct 2024 Author Response Responses to the Comments from Reviewer: 1. In the introduction section, the author described that most of the population had poor knowledge including health professionals. This kind of background makes it rational for intervention studies instead of observational studies. Previously it has been reported that education has a significant impact on diabetes knowledge, which means higher education has higher diabetes knowledge. There it is suggested that kindly provide a proper rationale for the current study. Answer: Thank you for your comment. In the introduction part we have depicted the poor knowledge of healthcare professionals like medical students during their preclinical courses (i.e. 1st and 2nd year) based on some studies. At this stage, their knowledge level is also affected by their education system and exposure during their studies in higher secondary level which is just before the start of the journey of medical science studies. So, the poor knowledge level of diabetes knowledge of preclinical medical students may also indicates their poor knowledge of higher secondary students which can be proved after we extensively researched diabetes knowledge levels in students of higher secondary levels. So, such a scenario was presented in the introduction part. The reviewer has suggested the necessity of intervention studies instead of observational studies as we have many studies that reflect poor diabetes knowledge in most of the population. We really acknowledge this opinion from the reviewer. However, in Nepal, no studies have been conducted in higher secondary students regarding the knowledge of diabetes. Though we can take reference from other countries, but we felt that it would be better to find out the actual scenario in our Nepalese community rather than generalizing from other studies. For that concern we opted for this study. We believe that the results of this study will motivate for the interventional studies in future 2. In the method section, what is the rationale for taking 10% of the population, and how did the authors conclude, that 10% of the population is representative of the total population? Answer = It has been accepted that a good maximum sample size would be usually 10% of the total population as long as it does not exceed 1000 (https://survicate.com/blog/survey-sample-size/). In our case, total population was 5500 (students in the science stream) and its 10% would be 550. So, we took 561 (near to 550) students as the sample for the study. We could have calculated the sample size using the Rao soft sample size calculator (http://www.raosoft.com/samplesize.html.) with a 95% confidence level, a 5% margin of error and assuming the response distribution for each question to be 50%. The calculated sample size would be 377 individuals. Though the two methods are equally acceptable, we opted to survey for higher number of samples i.e. 561 individuals to increase the dependability of the results. 3. What is the need for the development of the study tool for the current study, if already developed tools are available like the Diabetes Knowledge Test? The target group for this research is Higher secondary students. They have different education levels and backgrounds compared to lay people. Therefore, we modified the questionnaire and developed our own. The questionnaire is attached here in the appendix below. 4. Kindly provide the pilot study result in the method section and clarify whether the pilot study participants were included in the final analysis. Answer= The questions were revised based on a pilot study conducted with 50 students to eliminate any confusion or misinterpretation. The tables given below include results regarding the pilot study. From the pilot study we found insufficient knowledge levels in students regarding diabetes. Table: Demographic characteristics of participating students (N = 50) Characteristics Number (%) Sex Male 27(54) Female 23 (46) High school education Class 11 28(56) Class 12 22 (44) Table 3: Correlation of characteristics of the participants with mean knowledge score Dependent Variable Mean Knowledge Score (%) P-value Gender Male 51.2 0.61 Female 54.1 High school education Class 11 52.0 0.03 Class 12 60.0 Results were obtained from chi-squared tests. P-value <0.05 is considered statistically significant. The responses from the pilot study were used to enhance the questionnaire but were not included in the final results. Considering the word limit of the journal for the manuscript, we decided to exclude the content of the pilot study. 5. Was the use self-administered questionnaire? Answer=The questionnaire is self-administered. Participants were instructed to seek clarification if they found any part of the content difficult to understand. Please refer to the comment 3 above. 6. In the result section, it would be great if you stratified the results based on the student grades. We equally agree that it would have been much better if we had stratified the results based on the student grades. It would help us to find some correlation between grades and the knowledge level of students. However, during the time of the survey, we didn’t include the requirement to write the grades for the students while filling out the questionnaire. So, we couldn’t collect any data related to student grades. So, in this study, we could not include the results based on the students’ grades. However, this could be an important point to consider in future studies. Thank you for raising such an important issue which we missed it at the initial time of the study. 7. In Table 3, the author used the word “correlation” which is specifically used for the correlational analysis in the statistics, however, the author used a paired t-test. I am wondering why the author used a paired t-test instead of using independent t-test Answer= The test was done using chi-squared test instead to paired t-test, which was a typo on our hand. Throughout the manuscript, we replaced paired t-test with chi-squared test. 8. In discussion, “the international diabetes federation (IDF) has also emphasized on the dire need of public awareness in Nepal regarding diabetes to prevent the diseases and the complications.” Kindly look at this statement, is that correct, if yes kindly provide the reference. Answer: Thank you for notifying us to add the reference to a statement that was missed. The new reference is included in the bibliography (Ref. no. 15). 9. In the discussion, the author discusses the knowledge of the participants in the hospital setting, however, the study population of the current study is students of higher education, what is the rationale of comparing these students with other study settings? This is the first study done in Nepal regarding high school students. We didn’t find any study to compare the knowledge of diabetes among higher secondary students in Nepal. So, for comparative study, we took studies focused on medical students (1st/2nd year) in a hospital setting as a reference. 10. In general, kindly look for grammatical mistakes and look at the sentence structure in terms of its meaning concerning your current study. Thank you so much for your time and valuable suggestions and comments. We have a strong belief that your comments and guidance would certainly enhance the quality of the article. We have made many grammatical corrections as per your suggestion after thorough investigations. We hope that we have tried our level best to satisfy your queries. Attachments Attachment Submitted filename: Response to reviewers_oct 5.docx https://doi.org/10.1371/journal.pone.0313755.r003
31 Oct 2024 Decision Letter - Wen-Jun Tu, Editor Evaluation of knowledge and awareness of diabetes in higher secondary level students of Kaski district: A cross-sectional study PONE-D-24-24606R1 Dear Dr. Lamichhane, 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, Wen-Jun Tu Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: Reviewer's Responses to Questions Comments to the Author Reviewer #1: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions??> Reviewer #1: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #1: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #1: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes ****** Reviewer #1: (No Response) ****** 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 ******** https://doi.org/10.1371/journal.pone.0313755.r004
Formally Accepted
Acceptance Letter - Wen-Jun Tu, Editor PONE-D-24-24606R1 PLOS ONE Dear Dr. Lamichhane, 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. Wen-Jun Tu Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0313755.r005

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