Attitudes, beliefs, and practices regarding complementary and alternative medicine use: Influenza vaccine intake

Dala N. Daraghmeh; Ahmad Salah; Nasim Hamdan; Abdallah Zamareh

doi:10.1371/journal.pone.0320412

Peer Review History

Original SubmissionFebruary 26, 2025
Decision Letter - Tamer Aboushanab, Editor Dear Dr. Daraghmeh, 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 07 2025 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'. 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 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, Tamer Aboushanab Academic Editor PLOS ONE 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 2. In this instance it seems there may be acceptable restrictions in place that prevent the public sharing of your minimal data. However, in line with our goal of ensuring long-term data availability to all interested researchers, PLOS’ Data Policy states that authors cannot be the sole named individuals responsible for ensuring data access (http://journals.plos.org/plosone/s/data-availability#loc-acceptable-data-sharing-methods). Data requests to a non-author institutional point of contact, such as a data access or ethics committee, helps guarantee long term stability and availability of data. Providing interested researchers with a durable point of contact ensures data will be accessible even if an author changes email addresses, institutions, or becomes unavailable to answer requests. Before we proceed with your manuscript, please also provide non-author contact information (phone/email/hyperlink) for a data access committee, ethics committee, or other institutional body to which data requests may be sent. If no institutional body is available to respond to requests for your minimal data, please consider if there any institutional representatives who did not collaborate in the study, and are not listed as authors on the manuscript, who would be able to hold the data and respond to external requests for data access? If so, please provide their contact information (i.e., email address). Please also provide details on how you will ensure persistent or long-term data storage and availability. 3. Please include a copy of Table 3 which you refer to in your text on page 10. 4. We note you have included a table to which you do not refer in the text of your manuscript. Please ensure that you refer to Table 4,6 and 7 in your text; if accepted, production will need this reference to link the reader to the Table. 5. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. 6. 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. [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? 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 Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes Reviewer #2: Yes ****** Reviewer #1: The study explores the link between influenza vaccination and complementary and alternative medicine (CAM) practices among Palestinian adults, which is of great significance given the variability and pandemic potential of influenza. The research design is rational, with a clear objective and appropriate methodology. The cross-sectional study conducted through an online questionnaire provides valuable insights into the current vaccination rate and the factors influencing it. However, there are several areas that could be improved. Firstly, the sample size of 363 participants, while providing some useful data, may not be large enough to fully represent the diverse population of Palestinian adults. A larger and more diverse sample would strengthen the study's findings and their applicability. Secondly, the study mentions a significant correlation between certain CAM practices and vaccination status, but it would be beneficial to delve deeper into the underlying reasons for these correlations. For example, exploring the cultural and social factors that influence the adoption of specific CAM practices and how these practices interact with vaccination decisions could provide a more comprehensive understanding. Additionally, the study highlights a knowledge gap regarding CAM use for influenza, with 34% of participants having never used it despite 63% being familiar with it. This suggests a need for targeted educational interventions to bridge this gap and improve overall health literacy. In conclusion, the study provides a useful overview of the relationship between influenza vaccination and CAM practices in the Palestinian context. It highlights the need for targeted public health campaigns and further research into the cultural and social determinants of vaccination and CAM use. Future studies could benefit from larger sample sizes and more in-depth qualitative analysis to fully explore the complex interplay between these factors. Reviewer #2: I find this study very useful because as a medical doctor with the knowledge of both traditional herbal medications and also pharmacological medications, and familiarity with the traditional methods being used in different nations and cultures. It is great that the authors have focused on this data and approach towards a very common condition, influenza. I believe this study should be done in comparison with a few other nations and cultures by the same authors collaborative research with other universities. ****** 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: 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 https://doi.org/10.1371/journal.pone.0320412.r001
Revision 1
14 Jun 2025 Author Response Date: 11 Jun. 2025 Re: Response to reviewers’ comments on the manuscript: “Attitudes, Beliefs, and Practices Regarding Complementary and Alternative Medicine use: Influenza Vaccine intake”. The authors would like to thank the Editor for considering the manuscript for publication in PLOS ONE. The authors would also like to thank the Reviewers for their time and constructive comments and suggestions to improve the quality of the manuscript. The following responses have been prepared to address the comments in a point-by-point fashion. Reviewer #1: The study explores the link between influenza vaccination and complementary and alternative medicine (CAM) practices among Palestinian adults, which is of great significance given the variability and pandemic potential of influenza. The research design is rational, with a clear objective and appropriate methodology. The cross-sectional study conducted through an online questionnaire provides valuable insights into the current vaccination rate and the factors influencing it. However, there are several areas that could be improved. Firstly, the sample size of 363 participants, while providing some useful data, may not be large enough to fully represent the diverse population of Palestinian adults. A larger and more diverse sample would strengthen the study's findings and their applicability. Response: We would like to thank the reviewer for their comment. We agree that a larger and more diverse sample would enhance the generalizability of our findings and provide a broader understanding of CAM use and influenza vaccination in the Palestinian population. While our current sample size meets the minimum statistical requirements for representativeness, we acknowledge this limitation and have recommended in the conclusion that future studies should be conducted on a larger cohort to validate and expand upon these results. Change: Add a sentence into the conclusion “A larger cohort study is necessary to generalize these findings across boarder population” Secondly, the study mentions a significant correlation between certain CAM practices and vaccination status, but it would be beneficial to delve deeper into the underlying reasons for these correlations. For example, exploring the cultural and social factors that influence the adoption of specific CAM practices and how these practices interact with vaccination decisions could provide a more comprehensive understanding. Response: Thank you for highlighting this point. We agree that while the study identifies a significant correlation between certain CAM practices and vaccination status, understanding the why behind these patterns is equally important. By examining these underlying factors, future research could provide more context-specific insights, which in turn could inform public health strategies aimed at improving vaccination uptake while respecting cultural practices. It’s a valuable area for further investigation and could meaningfully enhance the current findings. Change: Add the following sentence to the discussion part: “A deeper exploration of the cultural and social factors influencing the relationship between CAM practices and vaccination decisions is recommended for future research.” Additionally, the study highlights a knowledge gap regarding CAM use for influenza, with 34% of participants having never used it despite 63% being familiar with it. This suggests a need for targeted educational interventions to bridge this gap and improve overall health literacy. Response: Thank you for your insightful observation. We would like to note that this point has already been addressed in the final paragraph of the discussion, where we highlight the need for targeted educational initiatives to improve health literacy and address the knowledge gap regarding CAM use for influenza. Change: None In conclusion, the study provides a useful overview of the relationship between influenza vaccination and CAM practices in the Palestinian context. It highlights the need for targeted public health campaigns and further research into the cultural and social determinants of vaccination and CAM use. Future studies could benefit from larger sample sizes and more in-depth qualitative analysis to fully explore the complex interplay between these factors. Response: Thank you for your valuable feedback. We appreciate your recognition of the study’s contribution and agree with the importance of larger sample sizes and qualitative research to better explore the cultural and social factors influencing vaccination and CAM use. We have addressed this point in the revised discussion and highlighted the need for targeted public health campaigns and future collaborative studies. Change: Add a sentence into the conclusion “A larger cohort study is necessary to generalize these findings across boarder population” Reviewer #2: I find this study very useful because as a medical doctor with the knowledge of both traditional herbal medications and also pharmacological medications, and familiarity with the traditional methods being used in different nations and cultures. It is great that the authors have focused on this data and approach towards a very common condition, influenza. I believe this study should be done in comparison with a few other nations and cultures by the same authors collaborative research with other universities. Response: We thank the reviewer for this valuable suggestion. We agree that comparative studies involving different nations and cultural approaches to influenza management would offer important insights. While such comparisons are beyond the scope of the current study, we have included this point in the discussion section as a recommendation for future collaborative research. We appreciate the reviewer’s perspective and believe it will enhance the relevance of our work. Change: Add to the discussion part the following sentence: “Future research should include cross-cultural comparisons through international collaborations to better understand global treatment practices and support integrative, evidence-based care models.” Attachments Attachment Submitted filename: Reviewers response.docx https://doi.org/10.1371/journal.pone.0320412.r002
Decision Letter - Tamer Aboushanab, Editor Attitudes, Beliefs, and Practices Regarding Complementary and Alternative Medicine use: Influenza Vaccine intake PONE-D-25-08575R1 Dear Dr. Daraghmeh, 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, Tamer Aboushanab Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0320412.r003
Formally Accepted
Acceptance Letter - Tamer Aboushanab, Editor PONE-D-25-08575R1 PLOS ONE Dear Dr. Daraghmeh, 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 You will receive further instructions from the production team, including instructions on how to review your proof when it is ready. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few days 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. Tamer Aboushanab Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0320412.r004

Open letter on the publication of peer review reports

PLOS recognizes the benefits of transparency in the peer review process. Therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. Reviewers remain anonymous, unless they choose to reveal their names.

We encourage other journals to join us in this initiative. We hope that our action inspires the community, including researchers, research funders, and research institutions, to recognize the benefits of published peer review reports for all parts of the research system.

Learn more at ASAPbio .