PONE-D-24-39283Adoption of Evidence-Based Medicine: A Comparative Study of Hospital and Community Pharmacists in Saudi ArabiaPLOS ONE

Dear Dr. Alzahrani,

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Habtamu Setegn Ngusie

Academic Editor

PLOS ONE

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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: 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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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: 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: Actuality, Evidence Based Medicine has become an essential discipline for the decision-making process in the individual care of patients, with a judicious, and conscious use of the best scientific available evidence.

The relevance of this study takes root in the need to incorporate in an accurate way the basic knowledge of EBM into daily pharmacist’s practice. There are still few studies that evaluate the knowledge, attitudes and practices of pharmacists regarding the practice of EBM.

I consider that the document is written appropriately, presents a clear methodology, with adequate data analysis and presentation of results.

I don’t have any observation or consideration regarding the document.

Reviewer #2: The study employed convenience sampling and a combination of purposive and snowball sampling methods to select research subjects, which might lead to selection bias among respondents. Additionally, only 38.1% of the recruited samples were ultimately included in the analysis, thereby limiting the validity and representativeness of the results. Therefore, it is recommended to supplement the analysis with a comparative study of some of the unincluded samples to further clarify the authenticity and representativeness of the results.

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Reviewer #1: No

Reviewer #2: No

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PONE-D-24-39283R1Adoption of Evidence-Based Medicine: A Comparative Study of Hospital and Community Pharmacists in Saudi ArabiaPLOS ONE

Dear Dr. Alzahrani,

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.

Authors are required to reply all the queries, raised by the reviewers. Please submit your revised manuscript by May 10 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,

Priti Chaudhary, M.S.

Academic Editor

PLOS ONE

[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 #2: (No Response)

Reviewer #3: (No Response)

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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: Partly

Reviewer #3: Partly

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

Reviewer #2: Yes

Reviewer #3: 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: No

Reviewer #3: 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 #3: 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:  1) The response rate after sampling in this study was only 38.15%, and the average age of the participants was relatively young (31 years old), so the representativeness of the research results is limited and there may be selective bias. It is suggested to supplement the overall number of research subjects that meet the inclusion and exclusion criteria, as well as compare the basic information of the sample obtained from this sampling with the overall population.

2) In addition, the research topic is a comparison between hospital and community pharmacists, and there is a lack of corresponding KAP comparison data in the results. Suggest adding baseline data comparison between hospitals and community pharmacists; Comparison of KAP survey results between hospital and community pharmacists.

Reviewer #3:  The manuscript titled "Adoption of Evidence-Based Medicine: A Comparative Study of Hospital and Community Pharmacists in Saudi Arabia" is well-structured and presents valuable insights into pharmacists' knowledge, attitudes, and practices regarding EBM. The study is methodologically sound, with clear objectives, a well-defined methodology, and a thorough statistical analysis. The discussion effectively interprets the results, comparing them with existing literature. However, some areas require improvement before recommending the manuscript for publication.

Major recommendations

Clarity and Consistency in Writing

• The manuscript is generally well-written, but some sections contain redundancy. For instance, in the introduction, the definition of EBM is repeated in multiple ways. Consider merging these statements for conciseness.

• Some sentences are overly long and complex, making them harder to follow. For example, in the introduction: "It combines the best available scientific evidence with the clinician's expertise and the patient's values to guide medical decisions effectively." This could be revised for better flow: "EBM integrates scientific evidence, clinical expertise, and patient values to improve medical decision-making."

Research Justification and Novelty

• The study’s importance is well-stated, but there is limited emphasis on the novelty of the research. Consider explicitly stating how this study fills a gap in previous research. For example:

o Does this study provide the first comparative analysis of hospital vs. community pharmacists in Saudi Arabia?

o How does it add to previous research findings on EBM adoption in pharmacy practice?

Strengthening this section will help establish the study's significance.

Methodology

• The response rate (38.15%) is relatively low. Was there any effort to mitigate potential non-response bias?

• The use of convenience and snowball sampling raises concerns about selection bias. While this is acknowledged, a stronger justification is needed to explain why this method was chosen over random sampling.

• The exclusion criteria are mentioned briefly. Were there any specific reasons for excluding pharmacists from the pharmaceutical industry or academia? Clarifying this will strengthen the study's rigor.

Statistical Analysis - Additional Clarifications

• The manuscript states that Bloom's threshold was used to categorize knowledge, attitude, and practice scores. While this is a reasonable approach, it would be beneficial to justify why this method was chosen over other classification methods.

• The use of net agreement and net frequency scores is well-documented, but some readers may not be familiar with these terms. Consider adding a brief explanation or reference in the Methods section.

• The effect size (Cohen’s d = 0.15 - 0.16) is interpreted as "small." This should be explicitly stated in the Results section, as some readers may not be familiar with effect size thresholds.

Interpretation of Findings

• The results indicate that pharmacists with less than one year of experience had higher EBM practice scores than more experienced pharmacists. This is an interesting finding but needs further exploration. Could it be that recent graduates receive better EBM training? If so, how can this be addressed in continuing education programs?

• Community pharmacists had lower EBM scores than hospital pharmacists. The manuscript attributes this to differences in professional settings, but other factors (e.g., lack of access to resources, workload differences) should be discussed in more depth.

• The misconception that EBM ignores clinical experience was reported by 41.7% of participants. This is a crucial barrier and should be highlighted in the discussion as a key area for intervention.

Practical Implications and Recommendations

• The manuscript does a good job of discussing barriers to EBM adoption, but the recommendations for overcoming these barriers are somewhat vague.

o What specific training strategies should be implemented?

o Would workshops, online courses, or mentorship programs be more effective?

o How can institutions support pharmacists in overcoming time constraints?

Adding specific recommendations will strengthen the manuscript's practical impact.

Minor Changes

Abstract:

o “EBM in Saudi Arabia’s pharmacies is an under-researched area despite its importance in pharmacy practice.”

o Consider rewording to: "Despite its importance in pharmacy practice, EBM adoption in Saudi Arabian pharmacies remains under-researched."

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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 #2: No

Reviewer #3: No

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[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.

Adoption of Evidence-Based Medicine: A Comparative Study of Hospital and Community Pharmacists in Saudi Arabia

PONE-D-24-39283R2

Dear Dr. Fahad Alzahrani,

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,

Priti Chaudhary, M.S.

Academic Editor

PLOS ONE

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