Evaluate the stroke awareness of Palestinian undergraduate health students: A cross-sectional study on risk factors and warning signs

Mohammad Abuawad; Motaz Saifi; Maha Rabayaa; Mustafa Ghanim; Malik Alqub; Tartil Zarura; Diana Aldeek; Jomana Khateeb; Salah Abu Khalaf; Majdi Dwikat; Samar Alkhaldi; Johnny Amer; Ramzi Shawahna

doi:10.1371/journal.pone.0324157

Peer Review History

Original SubmissionDecember 13, 2024
13 Dec 2024 Author Response https://doi.org/10.1371/journal.pone.0324157.r001
17 Feb 2025 Decision Letter - Md. Shahjalal, Editor PONE-D-24-57604Evaluate the Stroke Awareness of Palestinian Undergraduate Health Students: A Cross-Sectional Study on Risk Factors and Warning SignsPLOS ONE Dear Dr. Abuawad, 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 Apr 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, Md. Shahjalal Academic Editor PLOS ONE Journal Requirements: 1. When submitting your revision, we need you to address these additional requirements. 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. 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 . [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? 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: No Reviewer #2: Partly ******** 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 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 ****** 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 Reviewer #2: Yes ****** 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 a good study regarding the assessment of knowledge and attitude of undergraduate students about stoke and its risk factors. However, there are some areas that require justifications and more detailed discussion to improve clarity in the manuscript. Reviewer #2: 1. Unexpected higher awareness of stroke warning signs among preclinical students: The findings suggest that preclinical medicine students had higher awareness on recognizing stroke warning signs as compared to students who had clinical training, which contradicts expectations. Since clinical medicine students have more experience and direct patient exposure, they should logically perform better in recognizing stroke symptoms. The authors should explicitly address this unexpected result in the discussion section. 2. Potential response bias due to negative question framing: The question, "Do you think people who have stroke cannot lead a happy life?" is negatively framed, which may have influenced responses. Negative framing can lead to acquiescence bias, where participants are more likely to agree even if they are unsure. It could also cause priming where participants focus on challenges rather than recovery possibilities, potentially overestimating negative perceptions. The authors could consider discussing this potential response bias under the limitations section. ****** 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 Reviewer #2: Yes: Aaryan Dahal ******** [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: PLOS_Review.doc https://doi.org/10.1371/journal.pone.0324157.r002
Revision 1
24 Feb 2025 Author Response Response to reviewer is attached in submitting file. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0324157.r003
28 Mar 2025 Decision Letter - Md. Shahjalal, Editor PONE-D-24-57604R1Evaluate the Stroke Awareness of Palestinian Undergraduate Health Students: A Cross-Sectional Study on Risk Factors and Warning SignsPLOS ONE Dear Dr. Abuawad, 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 12 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, Md. Shahjalal 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. [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 #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: No 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: Yes 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: No 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: The paper is unclear regarding the needs of this paper in Palestinian setting and fails to deliver a coherent picture of the works done. The paper lacks coherence and the discussion is poor. Sampling and data collection is not robust. Reviewer #2: This study has highlighted the gaps in the understanding of stroke risk factors among certain students. However, more explicit mention of how the medical and health science curriculum may be adjusted to improve stroke awareness among students would increase the value of this study. Similarly, how these findings could inform educational policy in Palestinian universities is needed. Overall, the manuscript is well-written, and addressing these points would strengthen its contribution to the field. ****** 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: Yes: Aaryan Dahal ******** [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: Review_PLOS_AD.docx https://doi.org/10.1371/journal.pone.0324157.r004
Revision 2
2 Apr 2025 Author Response Dear editor and reviewer, Reviewer 1: The paper is unclear regarding the needs of this paper in Palestinian setting and fails to deliver a coherent picture of the works done. The paper lacks coherence and the discussion is poor. Sampling and data collection is not robust. Thank you for your recommendations. All the comments below have been elaborated as requested Abstract: 1.The abstract starts with “A complete understanding” of..Im my view, understanding is a vague term and understanding something completely has no limits. Therefore, please use a suitable line to replace the statement, something that is more measurable. Response: thanks for your comment. The sentence has been edited and become “ Adequate knowledge of clinical facts about stroke, including risk factors and warning signs is critical for improving health care outcomes” 1. This study aims to (you have written aimed to). Please consider writing in present tense as much as possible in the your abstract. Response: thanks for your comment. The abstract has been elaborated as requested. 2. A survey “ questionnaire “, the word questionnaire is missing. Response: thanks for your comment. The abstract has been elaborated as requested. 3. Please write how was attitute analysed or scored or what scale was used in your study. Response: thanks for your comment. The following sentence has been added:” Attitudes were evaluated using a Likert scale”. Additionally, the following statement is added to methods: ‘’The last section was descriptively analyzed, with responses summarized as frequencies and percentages. Attitudes were reported on a 3-point Likert scale (no, yes, or uncertain) to evaluate the attitude of participants regarding the ability of stroke patients to lead a happy life and the role of families in patient recovery.’’ 4. The results in your abstract is too long. Please highlight major findings only in your abstract. Response: thanks for your comment. The result section has been elaborated as requested. Introduction: 1. Line 64 what are the best practices? Please mention. Response: Thanks for your comment. The phrase has been edited and elaborated as requested. And become as follow “ Optimal patient care necessitates adherence to best practices that ensure adequate knowledge of clinical facts pertaining to diseases, including evidence-based learning and continous education, an integrated medical curriculum, active clinical training and simulation, an interdisciplinary approach, and patient-centered learning.” 2. Please include your definition of medical and other undergraduates as operationalized in your study to introduce your study population. Response: Thank you for your comment. The study population is explained in the last paragraph of the introduction. 3. Line 102, how many universities ? Thanks for your comment. The sentence has been edited and became as follow: “This study employed a cross-sectional survey design to gather data from undergraduate health students across five universities (An-Najah National University, Al-Quds University, Palestine Polytechnic University, Arab American University, and Hebron University) located in the West Bank of Palestine” 4. Line 103, who developed the questionnaire, team work? You hav only mentioned from previous publications, please provide some context of those papers as well. Response: thank you for your comment. The study tool was adapted from previously validated studies about the knowledge and attitude of undergraduate health students about stroke (references 9, 11). The study questions were then evaluated by specialists in the medical field and academics in neuroscience to ensure the properness of the study questions for undergraduate students and the comprehensiveness and understandability of the questions. 5. Line 107 .It can contribute…, please mention how to add more clarity. Response: thanks for your comment. The sentence has been rephrased as follow: “This knowledge could direct toward the development of specialized educational interventions aimed at strengthening undergraduate health students' comprehension of stroke risk factors and warning signs, hence improving their capacity to identify and respond to stroke incidents proficiently.” 6. Line 113..and beyond, please refrain from using such vague words. Please mention how many years in exact number. Response: thanks for your comment. The sentence has been elaborated as follow:” This research included a survey of undergraduate health-related students from universities located in the West Bank of Palestine. The students were in their second, third, fourth, fifth, and sixth years of study.” Methodology 7. Please consider adding a table showing medical related streams and non medical related streams in a flowchart to give a comprehensive picture of how many were selected from which stream. Response: thanks for your comment. the following flowchart in methods has been made and added in the methods as figure 2. 8. Why was 1006 samples used and probability sampling technique not applied if we has such a large sampling frame? Response: Thanks for your insightful question. The minimum sample size was 385, but we collected 1006 to improve statistical power and generalizability. The greater sample size reduces variability and better represents health student groupings. Convenience sampling was used to enhance the quality and reliability of the results and to provide a more thorough comprehension of the population. Probability sampling proved impractical for the study's time and resources. We included students from numerous colleges and academic years to ensure diversity. Although non-random, this method reveals students stroke knowledge and attitudes. 9. Please add the map after your study site section in the methodology part. Response: Thanks for your comment. The figure has been inserted as requested under study design and setting section in the methodology. 10. Again, please elaborate how the “attitude” variable was interpreted or only knowledge was interpreted, was it only presented descriptively? Response: thanks for your comment. The following phrase has been added “Descriptive statistics (frequencies and percentages) were applied for demographic characteristics, participants’ attitudes toward stroke.” Discussion Please mention discussions regarding the attitude variable as well. Please add lines regarding how and in what ways attitude can be changed regarding stroke in Palestinian undergraduates. The discussion is very simple and needs to be significantly improved with strong recommendations for policy makers. Response: thanks for your comment. Edited, the following phrases has been added to the discussion part: “Nearly one quarter of the students (25.3%) in this study believed that stroke patients could not lead a happy life. These findings could be explained by an insufficient understanding of the role of rehabilitation in improving stroke patients' quality of life. Certain studies have shown the importance of professional reintegration with structured vocational programs in improving the quality of life and mental health status of stroke survivors (26,27). Similarly for family involvement, which has been shown to be a valuable support for post-stroke patients (28).” “Students’ attitudes toward stroke can be effectively shifted through focused educational interventions, such as simulation-based training and structured engagement with stroke survivors (30). Interdisciplinary training should be promoted to ensure that all healthcare providers, not just those in medicine, are well prepared to manage stroke. Additionally, structured curriculum adjustments, such as including stroke case scenarios in clinical training and encouraging collaboration between medical and allied health students, could help to further support this.” “From a policy perspective, a revision to stroke education strategies should be considered by academic institutions in collaboration with healthcare institutions to ensure that students are exposed to stroke management and prevention theoretically and practically.” Overall: The manuscript lacks clarity at many parts. Please consider showing your work to a person fluent in English language. Response: done. thanks for the comment. Reviewer 2: This study has highlighted the gaps in the understanding of stroke risk factors among certain students. However, more explicit mention of how the medical and health science curriculum may be adjusted to improve stroke awareness among students would increase the value of this study. Similarly, how these findings could inform educational policy in Palestinian universities is needed. Overall, the manuscript is well-written, and addressing these points would strengthen its contribution to the field. Response: Edited, thanks for the comment. The following has been added in the discussion part. “Students’ attitudes toward stroke can be effectively shifted through focused educational interventions, such as simulation-based training and structured engagement with stroke survivors (30). Interdisciplinary training should be promoted to ensure that all healthcare providers, not just those in medicine, are well prepared to manage stroke. Additionally, structured curriculum adjustments, such as including stroke case scenarios in clinical training and encouraging collaboration between medical and allied health students, could help to further support this.” “From a policy perspective, a revision to stroke education strategies should be considered by academic institutions in collaboration with healthcare institutions to ensure that students are exposed to stroke management and prevention theoretically and practically.” Attachments Attachment Submitted filename: Response to Reviewers 1.4.2025.docx https://doi.org/10.1371/journal.pone.0324157.r005
15 Apr 2025 Decision Letter - Md. Shahjalal, Editor PONE-D-24-57604R2Evaluate the Stroke Awareness of Palestinian Undergraduate Health Students: A Cross-Sectional Study on Risk Factors and Warning SignsPLOS ONE Dear Dr. Abuawad, 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 30 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, Md. Shahjalal 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. [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 #1: All comments have been addressed 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: Yes 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: No 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: Please improve your English language. Technically, the paper has improved so much from its last submission but the re are some language and grammar related issues can be improved to enhance the readability and clarity of your paper. Reviewer #2: The submission is well presented and acceptable for publication. All comments have been thoroughly addressed. ****** 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: Yes: Aaryan Dahal ******** [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. https://doi.org/10.1371/journal.pone.0324157.r006
Revision 3
17 Apr 2025 Author Response Dear editor and reviewer, Thank you for your time and your valuable comments which we believe they helped us in improving the quality of our manuscript. Kind regards, Corresponding author 6. Review Comments to the Author Reviewer #1: Please improve your English language. Technically, the paper has improved so much from its last submission but the re are some language and grammar related issues can be improved to enhance the readability and clarity of your paper. Response: thanks for your comment. The English language has been edited all over the manuscript as highlighted in red in the revised manuscript by authors and with the help of an English expert from our university to whom we add acknowledgment at the end of the manuscript. Reviewer #2: The submission is well presented and acceptable for publication. All comments have been thoroughly addressed. Response: thanks for your recommendation Attachments Attachment Submitted filename: Response_to_Reviewers_auresp_3.docx https://doi.org/10.1371/journal.pone.0324157.r007
22 Apr 2025 Decision Letter - Md. Shahjalal, Editor Evaluate the Stroke Awareness of Palestinian Undergraduate Health Students: A Cross-Sectional Study on Risk Factors and Warning Signs PONE-D-24-57604R3 Dear Dr. Mohammad, 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, Md. Shahjalal Academic Editor PLOS ONE Additional Editor Comments (optional): Thanks for addressing all comments appropriately. Reviewers' comments: https://doi.org/10.1371/journal.pone.0324157.r008
Formally Accepted
Acceptance Letter - Md. Shahjalal, Editor PONE-D-24-57604R3 PLOS ONE Dear Dr. Abuawad, 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. Md. Shahjalal Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0324157.r009

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