Dear Dr. Owolabi,

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.

==============================

ACADEMIC EDITOR:Request to Editor in Chief: Reviewer 1 has raised concern for plagiarism. I would like the journal to evaluate the article for plagiarism and take appropriate steps. If no concerns about plagiarism exist, the authors should tackle the reviewer's comments and respond.

==============================

Please submit your revised manuscript by Sep 20 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.

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Kind regards,

Nishant Kumar Mishra, FRCP PhD MD

Academic Editor

PLOS ONE

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8.  Concerns have been raised that this manuscript is very closely related to the following papers, of which you are an author:

Jenkins C, Ovbiagele B, Arulogun O, Singh A, Calys-Tagoe B, Akinyemi R, et al. (2018) Knowledge, attitudes and practices related to stroke in Ghana and Nigeria: A SIREN call to action. PLoS ONE 13(11): e0206548. https://doi.org/10.1371/journal.pone.0206548

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Thank you for your attention to these requests.

Additional Editor Comments:

Please respond to the reviewer's comments.

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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?

Reviewer #1: Yes

Reviewer #2: Yes

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

Reviewer #1: N/A

Reviewer #2: Yes

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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

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4. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: No

Reviewer #2: Yes

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Reviewer #1: The authors have conducted a qualitative analysis on the beliefs, attitudes and practices related to stroke prevention, risk factors and modern/ complementary medicine treatment. This is very much a replication of the methods and findings of the earlier SIREN study which the authors have also referenced. In fact, the layout, tables and content are also similar. I hope the plagiarism check has been done by the authors and the journal- If not, I would recommend that.

The title is: Recommendations for Improving Stroke Prevention and Stroke Care. I do not think the paper has and can address this.

Thus, although the concept is not novel and the findings are also similar to the earlier studies, the study could have emphasized on the solutions/ methods which were adopted to improve awareness of stroke and dispel myths and the effectiveness of these methods.

Reviewer #2: Title: Community Voices: Exploring Beliefs, Attitudes, Practices and Recommendations for Improving Stroke Prevention and Stroke Care in Rural and Urban Communities in

Nigeria

Comments:

This is an important qualitative study which explores and contrasts the topic of stroke from alternative and modern medicine perspectives, but at the same time looks at rural and urban perceptions. By doing this, the author is able to comprehensively tackle the topic and bring out all the important issues around beliefs, attitudes, practices and recommendations for improving prevention and care for stroke in a low resource setting.

Unfortunately, the author needs to work on the manuscript to make it a smooth read for publication.

1. The introduction in the abstract and the manuscript should be tailored towards the topic more than constant reference to the research team/group (ARISES)

2. The same applies to the method section which is filled with descriptions about the research team/group and not much detail about recruitment criteria and sampling. Was the sampling method the same in rural vs. urban? alternative vs. modern medicine? The 5 persons who refused to participate due to conflict of time, which group where they from?

3. There are several published works which have touched on one aspect or the other of this research work. Therefore, the author might have to rephrase on this paper being the first to investigate and contrast community beliefs........

4. The results section could have been better reported by focusing on comparisons e.g. rural vs. urban and alternative vs. modern medicine in table form as opposed to tables 3 and 4, which are lengthy and difficult to follow. The recommendations for improving prevention and care for stroke patients could also have been presented in table form.

5. The results section could also have clearly outlined the similarities and differences between rural vs. urban findings with regards to alternative vs. modern medicine for stroke prevention and care.

6. The author should also work on the typographical and grammatical errors in the manuscript.

All in all, this is a good manuscript which makes a significant contribution to the community voice and can be improved for publication.

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what does this mean? ). If published, this will include your full peer review and any attached files.

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Reviewer #1: No

Reviewer #2: No

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Attachments

Attachment

Submitted filename: Reviwer comments.docx

Dear Dr. Owolabi,

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 Jun 14 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 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,

Jianhong Zhou

Staff Editor

PLOS ONE

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #2: All comments have been addressed

Reviewer #3: (No Response)

Reviewer #4: (No Response)

**********

2. Is the manuscript technically sound, and do the data support the conclusions??>

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

**********

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

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy

Reviewer #2: Yes

Reviewer #3: No

Reviewer #4: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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Reviewer #2:  The authors have to find a way to streamline tables 3 and 4 which still look untidy, but I am happy with all the corrections made.

Reviewer #3: The authors sought to use epidemiological qualitative data to explore non-traditional factors that impact stroke prevention, risks and approaches to improving outcomes. I welcome the "outside the box" thinking to tackle these obstacles. The methodology is sound and rigorous. The paper is well written. References to other studies incorporated. Conclusion is appropriate, except that a statement of non-generalizability of the findings to other cultures should be added.

Reviewer #4: This is an excellent manuscript with meaningful findings and discussions. I have a few recommended revisions, with the main revision being an expansion of written results and removal (or substantial shortening) of tables 3 and 4.

Introduction:

- Great work, clear.

Methods:

- Page 6: Can remove the sentence "The COREQ domains, such as research team..." as it is repeating information you've already explained.

- Domain 1 section can be shortened. You provide many details.

- Theoretical models: in your second paragraph on page 10, about the health belief model, you provide clarification in parentheses about what "perceived severity" means. That is helpful and you could provide clarification about each of these factors (perceived susceptibility, etc).

Results:

- Overall, the written section is very short, and you leave it in the hands of the reader to go through all the information in your four tables. I recommend summarizing the key findings (which you partially did within tables 3 and 4). You could include 1 or 2 quotes per theme to illustrate your findings. Tables 3 and 4 should therefore be substantially shortened in order to include some quotation examples. They can even be pushed to supplementary materials if you are able to succinctly synthesize your main findings within the written results.

- Tables 1 and 2 contain identifying information for each participant. To protect anonymity, provide this information in a descriptive general way. For instance, you can indicate mean age and age range, provide education levels in percentages (e.g., "30% of participants have a first degree"), and provide examples of community roles.

- Provide a shorter way to refer to "orthodox/modern medicine/healthcare providers" and "alternative/complementary medicine providers and healers." These terms are lengthy and are used repeatedly throughout, which makes your text hard to read. You can describe these groups and choose one shorter term to refer to them.

- Page 33: at the end of the first paragraph, you can remove the last two sentences (i.e., "It is worthy of mention ..."). These have already been explained your previous text.

Discussion:

- This is the strength of this manuscript. The discussion explores important findings, hypotheses for these results, and future directions. It is comprehensive, clear, and meaningful. Excellent work.

- Page 34: at the end of the first paragraph, you have a grammatical error. You say "previous studies perceive stroke to be avoidable..." but studies do not perceive, people perceive. You can correct this by writing, "previous studies indicate that some individuals perceive stroke to be avoidable..."

Conclusion:

- Strong ending. Great work.

- Page 38: You have a quote but do not cite someone -- please provide a reference for whoever said, "it takes all of us to improve...". Or, if this is not a quote, and the authors are writing this themselves, remove the quotation marks.

Great work overall. Thank you for your important research and for considering my suggested revisions.

**********

what does this mean? ). If published, this will include your full peer review and any attached files.

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Reviewer #2: No

Reviewer #3: Yes: Felix E. Chukwudelunzu, MD, MBA, FAHA, FAAN

Reviewer #4: 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.

Dear Dr. Owolabi,

Please submit your revised manuscript by Dec 05 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,

Sarah Jose, Ph.D.

Staff Editor

PLOS ONE

Journal Requirements:

If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise.

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

Reviewer #2: All comments have been addressed

Reviewer #4: (No Response)

**********

2. Is the manuscript technically sound, and do the data support the conclusions??>

Reviewer #2: Yes

Reviewer #4: Yes

**********

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

Reviewer #2: N/A

Reviewer #4: N/A

**********

4. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy

Reviewer #2: Yes

Reviewer #4: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #2: Yes

Reviewer #4: Yes

**********

Reviewer #2: The authors have addressed all my concerns. By eliminating the tables 3 and 4, an explanation of these findings makes better reading than before. The methods section has also been improved with more detailed explanation of what they set out to achieve. The discussion also flows in tandem with the results.

Reviewer #4: The authors did a nice job of re-working this manuscript, notably expanding on the results and making tables 3&4 into supplementary data. Thank you for addressing the recommended changes.

My main recommendation for revisions is to condense the results section as it is extensively long and remove many of the quotes provided. In qualitative research, a quote should only be provided when it illustrates a point you are explaining. Instead, the authors appear to provide quotes as a way to "back up" their results analysis. This is not needed. Please summarize the main findings and only provide quotes when it helps illustrate a particular point.

Page 16: "bagged a university degree" -- this word is slang. Please reconsider your word choice (e.g., received, obtained, earned).

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what does this mean? ). If published, this will include your full peer review and any attached files.

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Reviewer #2: Yes: Dr Stanley Zimba

Reviewer #4: No

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NAAS will assess whether your figures meet our technical requirements by comparing each figure against our figure specifications.

Community Voices: Exploring Beliefs, Attitudes, Practices and Recommendations for Improving Stroke Prevention and Stroke Care in Rural and Urban Communities in Nigeria.

PONE-D-24-25604R3

Dear Dr. Owolabi,

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,

I Gede Juanamasta

Academic Editor

PLOS One

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #4: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions??>

Reviewer #4: Yes

**********

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

Reviewer #4: N/A

**********

4. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy

Reviewer #4: (No Response)

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #4: Yes

**********

Reviewer #4: Thank you for addressing my comments and suggestions. The manuscript appears stronger and clearer now that results have been condensed. It has been a pleasure reviewing your research. This study is important and valuable.

**********

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 #4: No

**********