-->PONE-D-25-15876-->-->Assessing attitude, self-efficacy, and perceived risk toward seasonal influenza vaccination among primary care physicians in Qatar: A cross-sectional study-->-->PLOS ONE

Dear Dr. Bibars,

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.

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We look forward to receiving your revised manuscript.

Kind regards,

Ameel Al Shawi

Academic Editor

PLOS ONE

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Reviewers' comments:

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-->Comments to the Author

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

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Reviewer #1: Partly

Reviewer #2: Partly

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

Reviewer #1: Yes

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 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: Yes

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Reviewer #1: Yes

Reviewer #2: 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: General comments:

Thank you for giving me the opportunity to review this manuscript. Previous studies have primarily focused on primary care doctors' attitudes toward influenza vaccine, with limited research on their self-efficacy. Therefore, this study may contribute further to the literature. However, further details are required to add clarity to the manuscript.

Specific comments as below:

Title:

I suggest removing the word ‘Assessing’ in the title to be more concise.

Introduction:

Line 61: ‘...nearby 0.65 million…’ is not clear. I suggest changing the word ‘nearby’ or rephrase.

Line 69: to add reference(s) supporting the statement ‘vaccination rates among health care workers remain suboptimal.’

The aim of the study is not clearly stated.

Method:

A brief background of primary healthcare corporation in Qatar will be useful for the reader as it is not clear whether this constitutes a chain of clinics.

More details about the questionnaire used in this study are required. Was the questionnaire adopted unchanged from Asma et al or were any modifications made? This is in view that Asma et al’s study was regarding factors affecting influenza vaccine uptake and not directly on attitude. If any translation of language was done, this need to be stated too.

If the questionnaire was adapted, whether pilot testing and validation were conducted.

How many items are there for attitude, self-efficacy and perceived risks respectively?

What is meant by ‘positive items?’

The statement: ‘each positive item was awarded a score of one point’ needs more explanation as it is not clear. How was ‘negative item’ analysed?

Line 101: it is stated that total score was calculated. However, Table 5 and 7 shows mean self-efficacy and perceived risk score. This needs to be clarified.

How were the primary healthcare physicians identified, e.g. was it through a database? How were they invited to the study, e.g. was it via emails?

What was the total number of physicians invited to participate in the study?

Were there any strategies done to maximise the response rate e.g. reminders?

Results:

Tables 1 & 2: to state the total number of respondents (N) after the title (as stated in Table 3). The last row in the table ‘Total’ is not relevant and can be removed.

Table 1: it was not stated what PHCC means.

Table 2: columns 2 & 3, there are no title to the columns, whether it describes number and percentages.

Table 3 and 4: does column ‘n’ represents the number of respondents who answered ‘agree’ and strongly agree’ to each statement (referring to the method of study)? If so, it also needs to be stated in the table.

Line 148: ‘Time’ should be written in lower case.

The items in Table 4 appears to be factors influencing influenza vaccination or factors influencing self-efficacy. Self-efficacy is assessed by determining ‘levels of confidence in performing tasks and whether or not someone can do or accomplish a given task’. This need to relate with the objectives of this study which need to be clearly stated.

Table 5 and Table 7:

The term ‘physicians’ frequency’ is confusing.

Stating the responses as ‘yes’ or ‘no’ for ‘history of chronic disease’, ‘ever taken influenza vaccine’ and ‘influenza vaccination last season’ will give more clarity compared to ‘negative’ and ‘positive’.

Written as ‘Ever taken influenza vaccine’ in Table 5, whereas in Table 7, it is written as ‘Positive history of influenza vaccination’. It is best to standardise the statements if it refers to the same questionnaire statement. Same with ‘influenza vaccination last season’.

Table 7: suggest removing ‘[NS]’.

Discussion:

Discussion can be further elaborated:

Is there a policy on influenza vaccination in the healthcare corporation of Qatar which may explain the why two thirds of the respondents had been vaccinated?

What are the possible reasons that may explain the respondents having not enough time and no access to the vaccine?

To include discussion on limitations of this study and future recommendations.

Lines 212 – 215, 220 – 224, 242 – 243: the flow of writing need to be improved as it appears disjointed.

References:

To check reference (15): the page in the link could not be found. It is not necessary to explain on what the reference is about in the reference list.

Reviewer #2: Dear Author,

Thank you for this study on very important topic of global concerns.

I think you still need a lot of work to put into it for it to fulfil the minimum criteria of a good research article. Please find below my comments:

Ln 1: I don't think this word (Assessing) is needed in the title.

You may leave it if you feel so strong about it.

Ln 36 -57: While you have very important points in this abstract, it does not have the minimum requirement of a good research abstract.

Please re-write this section bearing in mind the following:

-Introduction

-Methods

-Results

-Discussions

-straight to point and brief

-Word count

Note that your Abstract should be able to invite the readers to read the whole of the study. Thanks

Ln 66/67: Reference please.

Ln 67: T

Ln 67:is reinforced

Ln 74/75: Reference please

Ln 77-79: Reference please

Ln 86: replace with "to"

Ln 88- 90: This is the statement of the scientific value of your study. You need to summarize the "hows?" in this introduction as well.

I will prefer the paragraph is framed as:

This research looked into improving attitudes and self-efficacy........... by:

1.Boosting the knowledge of the PCPs in training about influenza dx..

2. Ready availability of the influenza vax to pcp at their working units..

3...

4....

etc.

Ln94-95: consider replacement with "demographic characteristics"

Ln 105/106: How? Please state

Table2: What exactly do you mean by this question? Influenza vaccine is routinely 1 dose of either the trivalent or quadrivalent vaccine administered annually. Please clarify or re-frame your question

Ln 185: Good discussion with adequate comparison with available similar studies. Thank you

Ln 244: While this study addressed a common global seasonal health issue, I think the conduct of this research leaves a lot of factors that may affect its validity and transferability.

Please can you highlight the limitations of your study.

Thanks

Ln 245: This conclusion is too scanty and lacks the basic elements of a good conclusion of a research article.

Please rewrite bearing in mind: restatement of the social value of the study, summary of key arguments and brief discussion of the implications of your research.

Thanks.

**********

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Reviewer #1: No

Reviewer #2: Yes:  Adeloye Amoo Adeniji (MBBS; MMed; FCFP; FACRRM)

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Attachments

Attachment

Submitted filename: PONE-D-25-15876 Comments.docx

Attachment

Submitted filename: Assessing attitudes,....pdf

-->PONE-D-25-15876R1-->-->Attitude, self-efficacy, and perceived risk toward seasonal influenza vaccination among primary care physicians in Qatar: A cross-sectional study.-->-->PLOS ONE

Dear Dr. Bibars,

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 Dec 03 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.

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,

Ameel Al Shawi

Academic 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.

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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 #1: (No Response)

Reviewer #2: All comments have been addressed

**********

-->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 #1: Yes

Reviewer #2: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: 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 #1: No

Reviewer #2: 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 #1: Yes

Reviewer #2: 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 #1: General comments:

Thank you for giving me the opportunity to review the revised manuscript. The author had addressed all the comments. However, there are some comments for further improvement.

Specific comments as below:

Introduction:

Line 74-78: This study did not investigate strategies to improve PCPs’ attitude and self-efficacy; therefore, this sentence does not align with the study’s aims. Suggest remove or re-phrase the sentence.

Method:

Line 84-85: The word ‘physician’ is in lower case; ‘A list of physicians’ emails….’

Line 85: Write ‘PHCC’ in full at first mention and use the abbreviation from line 88 onwards.

Line 97-100: This sentence is lengthy and difficult to understand. Suggest rephrasing.

Line 102: To improve clarity, suggest amending: ‘….five-point Likert scale questions’.

Line 119: Is there a missing sentence after ‘The…’?

Line 128: The letter ‘a’ is lower case in this sentence; ….a survey link…

Results:

Line 146: the term ‘primary care physician’ was earlier used, suggest to standardize throughout the manuscript.

Formatting of Table 2 can be improved.

Table 4: the first column described the ‘statements’. ‘Those who answered ‘agree’ and ‘strongly agree’ are the description for the second and third columns (‘N’ and ‘%’).

Limitations of the study:

Line 260: The limitation of this study was the low response rate.

Suggestion for the author to check the overall manuscript as there are some spelling mistakes to be corrected e.g. ‘health canter’ and to check the use of proper noun and common noun.

Reviewer #2: Dear Author,

Thank you for addressing my concerns appropriately in this round of reviewing.

I think your study is very relevant in preventive health care

I wish you the best outcome.

**********

-->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 #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 . Please note that Supporting Information files do not need this step.-->

Attachments

Attachment

Submitted filename: Attitudes...pdf

Attitude, self-efficacy, and perceived risk toward seasonal influenza vaccination among primary care physicians in Qatar: A cross-sectional study.

PONE-D-25-15876R2

Dear Dr. Bibars,

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,

Ameel Al Shawi

Academic Editor

PLOS One

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