PONE-D-24-46538Bridging the Knowledge-Practice Gap: A Cross-sectional Survey Assessing Physician Knowledge, Attitude and Practice toward Complementary MedicinePLOS ONE

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PLOS ONE

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 The authors gratefully acknowledge the funding of the Deanship of Graduate Studies and Scientific Research, Jazan University, Saudi Arabia, through Project Number: GSSRD-24 against publication costs of this article.  

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

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

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Partly

Reviewer #4: Yes

Reviewer #5: Yes

Reviewer #6: Yes

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

Reviewer #1: Yes

Reviewer #2: I Don't Know

Reviewer #3: Yes

Reviewer #4: I Don't Know

Reviewer #5: Yes

Reviewer #6: 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

Reviewer #2: No

Reviewer #3: Yes

Reviewer #4: Yes

Reviewer #5: Yes

Reviewer #6: Yes

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

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: No

Reviewer #3: No

Reviewer #4: Yes

Reviewer #5: Yes

Reviewer #6: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The manuscript presents a significant and timely study that evaluates physicians' knowledge, attitudes, and practices regarding complementary and alternative medicine (CAM) in the Jazan region of Saudi Arabia. Given the rising global interest in CAM, it is crucial for healthcare providers to have a solid understanding and positive outlook on these practices to ensure effective communication with patients and promote safe usage.

Specific Comments:

1. Introduction:

1) The introduction lays a solid foundation regarding CAM and its global relevance. However, it would be beneficial for the authors to delve deeper into the specific reasons for conducting this study in the Jazan region. What particular characteristics or challenges in this area make the findings particularly valuable?

2. Methods:

1) The methods section is thorough and well-organized, detailing the study design, sampling methods, sample size calculation, and data analysis. Nonetheless, it would help to clarify the convenience sampling method used for physician recruitment and discuss any potential limitations this may introduce.

2)The authors mention that a validated survey was used for data collection. It would be useful to elaborate on the validation process of this survey and its reliability and validity specifically within the context of the Jazan region.

3. Results:

1) The results are clearly presented and well-structured. The use of both descriptive and inferential statistics effectively assesses the relationships between participants’ awareness, attitudes, and practices concerning CAM and their sociodemographic characteristics. However, a deeper exploration of the significance of these findings and their implications for practice and policy would enrich this section.

2) The manuscript states that the median attitude score was 23 out of 30 but does not provide a detailed breakdown of these scores across different demographic groups. Including this information would offer readers greater insight into the diversity of attitudes toward CAM among physicians.

4. Discussion:

1) The discussion is well-articulated and thoughtfully analyzes the findings. The authors effectively link the implications of their results to educational initiatives aimed at enhancing physicians’ competencies in CAM. That said, it would be advantageous to discuss potential barriers to incorporating CAM into clinical practice and propose specific strategies to address these obstacles.

2) The authors mention that the level of awareness of CAM aligns with findings from other regions in Saudi Arabia. However, a more detailed comparative analysis with those studies would strengthen the discussion, highlighting both similarities and differences in the results.

5. Limitations:

1) The authors briefly address the limitations of the study, such as the small sample size and the lack of an in-depth exploration of the reasons behind physicians' attitudes and practices. A more extensive discussion of how these limitations may affect the generalizability of the findings would be helpful.

6. Data Availability:

1) The authors indicate that all relevant data are included within the manuscript and supporting information files. However, it would be beneficial to clarify whether the survey instrument used is available for other researchers to utilize or replicate the study.

Minor Comments:

1. A thorough proofreading of the manuscript is recommended to catch any grammatical, punctuation, or spelling errors.

2. The authors should ensure consistency in formatting and citation style throughout the document.

Overall, this manuscript offers valuable insights into physicians’ knowledge, attitudes, and practices concerning CAM in the Jazan region of Saudi Arabia. With some revisions and clarifications, it holds great potential to contribute meaningfully to the field.

Reviewer #2: Thanks for your valuable investigation in terms on CAM. Some points mentioned below:

• The duration of sampling was 3 months which could be wider to earn more participant. Your involved 159 physicians, which might not be representative of the entire physician population in the Jazan region.

• Please give information about validity and reliability of your questionnaire

• The study notes that only 25.8% of physicians plan to use CAM in practice, but it does not explore the barriers to integration in detail. Identifying and addressing these barriers could provide more actionable insights.

• Consider whether the findings can be generalized to other regions or healthcare systems. The cultural and healthcare context of the Jazan region might limit the applicability of the results elsewhere.

• You said that only 25.8% of physicians plan to use CAM in practice, but it does not explore the barriers to integration in detail. Identifying and addressing these barriers could provide more actionable insights.

Reviewer #3: Comments have been uploaded and also check the manuscript below are the comments;

Dear Editor, the authors need to improve the following;

1. The title should be changed by adding “Alternative “ on the phrase complementary medicine i.e CAM

2. The abstract needs to be written according to the journal guidelines. The statistics reported in the results section need improvement, e.g.; female physicians were not mentioned anywhere.

3. Authors must provide references for most of the statements used in the manuscript.

4. Authors should not generalise their findings to health practitioners while they only focus on physicians, as it can lead to misleading conclusions.

5. A sample size calculation formula should be indicated, as it ensures the study is statistically valid and reliable.

6. The results section needs to be summarised. Not everything should be presented, especially tables.

7. The discussion section and the conclusion section have to be improved.

8. More comments and suggestions have been indicated in the manuscript as track changes.

Reviewer #4: The manuscript is good study exploring the KAP among Jazan physicians which is very important for easy integration of complementary medicine with current conventional medicine practices. Few comments are important to be addressed by the authors which are:

The title; I think didn't address the content of the study, I suggest to be " Knowledge, Attitude and Practice toward Complementary Medicine Among Physicians: A Cross Sectional Study in Jazan"

Introduction:

Please add a description of the current situation of complementary medicine regulation in Saudi Arabia, you can use this published manuscript with the Title "A new official national regulations for complementary medicine practices in Saudi Arabia". And with the title "The present state of complementary medicine regulation in Saudi Arabia."

Results:

Please do not repeat information which are presented in Tables and figures again in the Text.. you can just highlight the important findings,.

Discussion:

Please add a section regrading the attitude of Medical students in Saudi Arabia towards complementary medicine espicially after implementation of complementary medicine curriculum with their medical studies, you have examples from Majmaa University and Taibah University.

Add a paragraph regarding the importance of implementation of complementary medicine into medical curriculum.

Reviewer #5: I liked the topic raised in the paper. The study has very interesting data.

I believe that the problem of the population using different complementary medicines, some of which are prescribed by doctors, and the doctors themselves not having received adequate training for this, could be reinforced a little more (one paragraph).

The acronym KAP was used twice in the text; the meaning should have been mentioned as soon as it appeared for the first time, at the end of the Introduction.

I did not understand why non-English speakers were excluded. Why was this and whether it was possible to quantify how many there were? I believe that would be another relevant piece of information.

I did not understand when they mentioned positive attitude and how this was measured. I was confused about whether it was about doctors recommending CAM to patients, applying CAM in their practices, participating in studies and research on CAM, encouraging patients to use CAM...

Reviewer #6: This study assessed physicians’ awareness, attitudes, and practices regarding complementary and alternative medicine (CAM) in Jazan through a cross-sectional survey. Based on data collection and basic analysis, the study found that although physicians exhibit high awareness and positive attitudes towards CAM, they lack formal training and practical experience. In the future, it is necessary to provide them with more training and guidance.

Major:

1.Have you considered potential subjectivity in the survey responses? If so, please explain how it was addressed.

2.In the Methods section, you mention that “visiting physicians or non-English speakers were excluded.” Please provide evidence supporting the reasonableness of this exclusion criterion.

3.In the Methods section, you state that “a score higher than the median was considered indicative of a positive attitude toward CAM.” If all scores are low, this approach would still categorize half of the participants as having a positive attitude. Is this method truly rigorous?

4.In Table 4 of the Results section, while the p-value is <0.001, the difference between 3.3% and 8.5% is minimal, indicating that few physicians received pre-service training. Is this difference truly statistically significant?

5.Please analyze or explore the reasons that different populations may have varying attitudes and levels of understanding toward CAM.

6.In the Background and Introduction sections, provide conclusive evidence demonstrating that CAM is indeed effective in treating diseases.Relative reference such as PMID: 34896048 and PMID: 36939781 could be cited to introduce current application and research on CAM.

7.How do you propose improving CAM education and training?

8.Given the cultural and economic differences between this region and others, have you considered unique factors or alternative approaches to implementing changes?

9.Are you certain that South Korea has the highest rate of CAM usage in Asia, rather than China? This is somewhat surprising.

10.All tables currently display detailed data. Consider presenting only the most critical data in the tables, with additional data included in the supplementary materials.

Minor:

11.Please provide a legend for each graph.

12.Indicate how you conducted random sampling across the five regions.

13.Attach the complete questionnaire in the supplementary materials.

14.Many of the references are either outdated or from relatively lesser-known journals. Consider updating them as appropriate.

15.The study only includes two figures. Consider adding more visual representations of the data.

16.In the Conclusion section on the second page, there are two consecutive commas—please correct this.

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: Yes:  Ivan Kahwa

Reviewer #4: No

Reviewer #5: Yes:  Kassia Martins Fernandes Pereira

Reviewer #6: Yes:  Chen Ling

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Submitted filename: critical review .docx

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Submitted filename: CAM - Manuscript with comments.docx

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Submitted filename: Comments PLOS ONE.docx

Bridging the Knowledge-Practice Gap: A Cross-sectional Survey Assessing Physician Knowledge, Attitude and Practice toward Complementary and Alternative Medicine

PONE-D-24-46538R1

Dear Dr. Salih,

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.

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Kind regards,

Mohammed Abutaleb, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

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 #7: All comments have been addressed

Reviewer #8: 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 #2: Yes

Reviewer #7: Yes

Reviewer #8: Yes

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

Reviewer #2: I Don't Know

Reviewer #7: Yes

Reviewer #8: 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 #2: Yes

Reviewer #7: Yes

Reviewer #8: 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 #2: Yes

Reviewer #7: Yes

Reviewer #8: 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 #2: Thank you so much you worked on a god topic and I hope these works will be continued in the future.

All comments addressed very well and there is no additional comments.

Reviewer #7: (No Response)

Reviewer #8: All the comments are addressed satisfactorily and the manuscript can now be accepted in its present form.

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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: Yes:  JAVAD NADALI

Reviewer #7: No

Reviewer #8: Yes:  Waquar Ahsan

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