PONE-D-23-12580Comparative readability of information on different treatment options for breast cancer, based on WeChat public accountsPLOS ONE

Dear Dr. Xie,

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 Jul 13 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:

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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,

Nenad Filipovic

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

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

Reviewer #1: Yes

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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

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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: No

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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: This is an interesting study and I congratulate the authors on this manuscript. It is interesting to note the difference in CAM and non-CAM online information.

There are a small number of changes that I think will enhance this manuscript:

1) Page 9 – end of the page it reads “in worldwide, Approximately 29-57%” – could this be changed to “Worldwide, approximately 29-57%”.

2) Introduction is very thorough, but this information can be presented more succinctly.

3) First paragraph of discussion seems to be repeating what has already been discussed in "Introduction"

4) The discussion is very long. I would recommend shortening the length of the discussion to make it easier to read and follow

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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

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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.

PONE-D-23-12580R1Comparative readability of information on different treatment options for breast cancer, based on WeChat public accountsPLOS ONE

Dear Dr. Xie,

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,

Nenad Filipovic

Academic Editor

PLOS ONE

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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: All comments have been addressed

Reviewer #3: (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

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

Reviewer #2: Yes

Reviewer #3: 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 #2: Yes

Reviewer #3: 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 #2: Yes

Reviewer #3: Yes

**********

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: Was the readability assessment performed by two physicians? Since this is a general

audience article, why not ask a non-medical person to evaluate it? Would you get a

different result?

Reviewer #3: Thank you for the chance to review this study that calculated readability levels for online information about breast cancer.

The researchers selected 136 articles on various aspects of treatment for breast cancer that were published on 37 different WeChat accounts. Readability is an important to help ensure equity of care irrespective of levels of formal educations.

I appreciate the work that has gone into the paper, including responding to previous review comments.

Unfortunately I had difficulty in understanding the methods and the rationale for the study which lacked many important details and also lacked the source data that I would expect in a such a study, even allowing for the language difficulties.

Data access

Although the researchers say they have provided all relevant material, they only provide the readability scores for these papers and not the papers themselves.

Even though I do not understand Chinese, the researchers have used a tool to evaluate readability that focusses on the visual layout of material, including the use of headings, space, illustrations and other graphics (top of page 8: "graphics, layout and typography, learning stimulation and motivation, and cultural appropriateness”) . These are actually easy to understand irrespective of language, as the analysis or the paper explains. Currently, the results of the study are presented - ie the readability score - but not the actual examples that the study is based on. If this study was about readability of resources produced in English, I would want to look at these original papers which would immediately tell me about the range of resources. This option to see the source material should be available to Chinese readers.

The most important aspect of readability for resources in English is the language used, the structure of the language and the simplicity of the words. At it’s simplest, this involves using short simple words, short sentences and short paragraphs, using the Flecsh-Kincaid or similar reading ease score. Because structural challenges of the Chinese language have not led to a translatable version of Flecsh-Kincaid or similar, test readability has been dropped from the analysis, only relying on visual aspects mentioned above, making access to the source resources essential.

Background and general comments

As an English reader, and as the publication is in English, it is not helpful that the paper has no explanation for WeChat as a publisher. Without this context it is difficult to decide on the context of this information. WeChat appears to be similar to FaceBook, and so-called Official or Public accounts look similar to a Facebook profile for individuals where individuals or organisations can publish content commercial or free content, also building up followers. Content doesn’t appear to need to pass any quality control but is just self-published.

WeChat would be easily known to a Chinese reader - with apparently 360 million users in 2021 according to the paper - so will be a vast source of potential information, but there is little information for how the researcher selected 126 articles or the 37 WeChat profiles. The last paragraph on page 6 just says ’37 WPAs were selected’.

Without, for example, knowing if these are just personal accounts or breast cancer charities/NGOs I have no interest in readab ility scores.

The cut-off criteria for poor readability also seems like an unusually low threshold - ie anything above reading grade 6. Very little general medical information in English achieves reading grade 6 or lower, and yet the main result from the paper is that much of the material they looked at is reading grade 7.

Although ‘content’ of the resources is included in the SAMS algorithm, the paper doesn’t explain how this was evaulated - unless I missed this, and apologise. Yet content is arguably the most important criteria for knowing whether the material is a good source of information. I don’t want to know whether unreliable information is easy to read.

Introduction

Although breast cancer clearly affects a very large numbers of people I worry when I read sentences like:

"Worldwide, 29–57% of breast cancer patients have searched for relevant health information online.” (halfway down page 4).

The context is the rapid development of the internet and this statement is based on two tiny studies (approx 200 people) that were published over a decade ago.

I have no confidence that 66.7% of people with breast cancer in China searched for information online. It is not true and isn;t a fact. It makes be see this paper, unfortunately, as a lot of generated data, that is disconnected from any real-world understanding of the issues related to readability of real information used by real people who depend on this for essential life choices about their future.

Statistics

Perhaps this is a cultural difference that I am not aware of, but given the paper refers to an unequal distribution of data, it is appropriate to present median and IQR for all data. I don’t understand why the IQR is given as a numeral rather than a range - ie being presented as an SD when standard practice ot to give a clear interquartile range.

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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

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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.

PONE-D-23-12580R2Comparative readability of information on different treatment options for breast cancer, based on WeChat public accountsPLOS ONE

Dear Dr. Xie,

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 10 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.

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,

Shahabedin Rahmatizadeh, Ph.D.

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.

Additional Editor Comments:

"Thank you for taking the reviewers' comments into consideration and making corrections in the manuscript. Please also review and address the other comments provided by the esteemed reviewer and resubmit the revised manuscript."

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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 #3: All comments have been addressed

Reviewer #4: (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 #3: Yes

Reviewer #4: Partly

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

Reviewer #3: I Don't Know

Reviewer #4: 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 #3: Yes

Reviewer #4: 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 #3: Yes

Reviewer #4: Yes

**********

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 #3: Thank you for responding to my previous points - good luck with this and future reseaerch.

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Reviewer #4: This is a fascinating study exploring a tool of which I was unaware. WeChat and its WPAs seem like a popular resource for patients seeking reliable medical information, and I applaud your recommendations for making them easier to use and understand.

I do have a few questions, though, about your methods.

In Section 2.2.1 you mention that a translation of the Suitability Assessment of Materials (SAM) was used to gauge the readability of each article. As you note the SAM recommends using the Flesch-Kincaid readability formula to assess the Literacy Demand of an article, and you also note that this particular tool has not been translated into Chinese and therefore this component was deleted.

How, then, was the Literacy Demand calculated? We see a score for this component in each of the Tables, but I’m unsure how this was determined. Did you use the original English version of Flesch-Kincaid, or did you substitute something else? Did you use the Chinese Readability Index Explorer mentioned earlier in the Introduction? I re-read the paper a few times and this escaped me, and I apologize if I simply missed it.

As has been noted by other Reviewers, the Discussion section is too long, and parts of it seem speculative as opposed to rooted in fact. For example, on Page 18, you discuss the benefits of using graphics to support concepts discussed in the text, and you provide a relevant citation. This is well done. However, on Page 19, you mention that patients’ interest level in CAM articles is due to including the topic of nutritional therapy and mentioning “commonly used foods, such as oranges and spinach”. Where is the citation for that? How did you determine interest? Does WeChat display the number of reads for a WPA? Even if you had such usage data, how can you determine which aspect of the paper engendered interest? Does WeChat allow users to post comments, and, if so, did you read them? Or did you read a paper that somehow tracks patient interest and simply forgot to cite it here?

A similar question is raised in the next paragraph where you state,” medical treatment articles tended to lack descriptions of behavioral information that patients valued”. Again, how do you determine what patients value or what they like? Scoring papers on readability or suitability is logical, based on objective, known assessment scales, but determining reasons for popularity is not.

On Page 21 you discuss a circular “Clinical value-oriented clinical development guidelines for antineoplastic drugs” issued by the Chinese Drug Review Center of the State Drug Administration. Is this a WPA? If so, was this written as a WPA, or was it simply posted to WeChat? This passage does a thorough job of articulating the perceived deficiencies of the circular (and again, we are told what patients want with no context or citation, “clinical trial articles provided little information about behavioral skills and applications of the information described, which are precisely what patients are most interested in and want to read”), but if this circular isn’t actually a WPA is this relevant?

My final question has to do with what you hope to achieve with this study, or, perhaps more importantly, how you plan on carrying out this plan. On Page 11 you state, “The present study, therefore, assessed the readability of information available in WPAs regarding different treatment options for breast cancer to clarify the dimensions of relatively high and low readability of each type of information, and to help WPA producers focus on improving the readability of this information”. This is an admirable goal – the world is awash in misinformation, especially on social media platforms discussing medical topics. What is your plan for sharing this study with WeChat? Do you plan on sending the Editorial Board a link to the final, published paper? Are you hoping that WeChat content creators will come across this paper on their own? As a peer reviewer I was taught to always ask a final question about generalizability or ease of implementation, and I don’t know you intend to transmit your findings to your intended audience so that your recommendations can be implemented.

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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 #3: No

Reviewer #4: No

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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.

PONE-D-23-12580R3Comparative readability of information on different treatment options for breast cancer, based on WeChat public accountsPLOS ONE

Dear Dr. Xie,

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 18 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.

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,

Shahabedin Rahmatizadeh, Ph.D.

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.

Additional Editor Comments:

Thank you for revising the article. Considering the reviewers' comments, please address the mentioned issues and submit the revised version to the journal.

[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 #5: (No Response)

Reviewer #6: (No Response)

Reviewer #7: (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 #5: No

Reviewer #6: (No Response)

Reviewer #7: Yes

**********

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

Reviewer #5: Yes

Reviewer #6: (No Response)

Reviewer #7: 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 #5: Yes

Reviewer #6: (No Response)

Reviewer #7: Yes

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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 #5: Yes

Reviewer #6: (No Response)

Reviewer #7: 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 #5: Articles on breast cancer treatment options found in WeChat are not necessarily the result of research by authors in their specialty, are not peer-reviewed, and have no real experimental data to offer. So these articles are not credible. There is no academic value in studying these articles.

Reviewer #6: (No Response)

Reviewer #7: The article is scientific and systematically organized; even so, it might be improved with the following additions.

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Reviewer #5: No

Reviewer #6: No

Reviewer #7: No

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Attachments

Attachment

Submitted filename: review.docx

Comparative readability of information on different treatment options for breast cancer, based on WeChat public accounts

PONE-D-23-12580R4

Dear Dr. lunfang Xie,

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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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,

Shahabedin Rahmatizadeh, Ph.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Thank you for addressing the comments made by the reviewers. A very good paper has been prepared, and I hope it will attract the attention of the journal's readers.

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 #8: All comments have been addressed

Reviewer #9: All comments have been addressed

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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 #8: Yes

Reviewer #9: Yes

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

Reviewer #8: Yes

Reviewer #9: Yes

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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 #8: Yes

Reviewer #9: Yes

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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 #8: Yes

Reviewer #9: 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 #8: This is a very interesting study that evaluates and compares the readability of breast cancer treatment information on public WeChat accounts, confirming that the readability of articles on medical treatment options is poor and has significant room for improvement.

This research has already been evaluated previously. The authors have made a great effort by applying the majority of the proposed recommendations, thus substantially improving their paper.

In this regard, they have enhanced the arguments for the credibility of WeChat by providing an in-depth description of WPAs. They also better justify the added value of their research and how it can serve as a powerful tool to improve health education.

Additionally, they have expanded significantly on the Suitability Assessment of Materials (SAM) and its value as a tool for evaluating both textual and non-textual complexity.

They have also provided much more detail on how they adapted the SAM to the Chinese context, using specific translations and guidelines for this purpose.

Moreover, they simplified the text and analyzed each dimension of the SAM, offering specific recommendations to improve readability.

Finally, while it is true that they decided not to change the title, this reviewer considers this decision legitimate, and their justification is reasonable.

Considering all the effort put into improving the manuscript, this reviewer believes that no further adjustments are necessary and that this research deserves to be published.

Reviewer #9: I reviewed this research and thought it to be an intriguing study, and I applaud the writers on this manuscript. It is fascinating to compare CAM and non-CAM web information.

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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 #8: No

Reviewer #9: No

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