Factors influencing the adoption of the BYOD policy in teaching hospitals: A cross-sectional study from Southeastern Iran

Jahanpour Alipour; Abolfazl Payandeh; Afsaneh Karimi

doi:10.1371/journal.pone.0326126

Peer Review History

Original SubmissionDecember 5, 2024
Decision Letter - Mariam Rehman, Editor PONE-D-24-55967Factors influencing the adoption of the BYOD policy in teaching hospitals: A cross-sectional study from Southeastern IranPLOS ONE Dear Dr. Alipour, 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 07 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. 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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: Yes Reviewer #2: Yes ******** 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: Yes 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: The topic of the article was intriguing from my perspective. BYOD in hospitals can lead to cost reduction and increased productivity. However, the adoption of this technology faces numerous challenges, such as security concerns and acceptance by staff. Given the significance of this topic in the field of health information technology, the article addresses these challenges clearly and accurately. Additionally, the appropriate sampling and the large sample size (1,130 individuals from five hospitals) enhance the credibility of the results, making it a noteworthy article. Overall: The methodology section should specify how hospitals were selected. While the article provides a general overview of the research methodology, it does not address potential limitations or sampling biases (e.g., selection of specific hospitals or types of staff). One of the challenges of BYOD in hospitals is data security. The article does not explore security issues. Given the sensitivity of medical information and health data, this aspect appears to be essential to consider. The study primarily utilized quantitative data; I believe that qualitative analyses, such as interviews, might have been more effective in understanding staff attitudes and experiences. In the conclusion and recommendations section, I think the article could be improved by offering more practical suggestions for hospitals and IT officials. It could present recommendations for better implementation of BYOD in hospitals. Some more recent and relevant sources from the field of health information technology and BYOD acceptance could be added to demonstrate the research's timeliness. Reviewer #2: 1. Although the study offers valuable insights, the sample is drawn from hospitals within a single province, and the representation of certain groups (e.g., physicians) is limited. The authors should discuss more explicitly how these sampling limitations might affect the generalizability of the findings and propose strategies for future research (e.g., expanding the study to multiple provinces or increasing subgroup representation). 2. While the manuscript uses TAM constructs effectively, the discussion could benefit from a deeper integration of recent literature specifically addressing BYOD in healthcare. Strengthening the theoretical framework with current studies could help position the work within broader debates about technology adoption in healthcare. The authors can consider other TAM-related studies in other fields such as "Moderating effects of policy measures on intention to adopt autonomous vehicles: Evidence from China" and "Analyzing factors influencing IoT adoption in higher educational institutions in Saudi Arabia using a modified TAM model". 3. The relatively low mean score for perceived ease of use merits further discussion. The authors might explore potential reasons for this finding (such as usability challenges or resistance to change among staff) and consider how this aspect could be addressed in practice. 4. More detail on the process of questionnaire development and validation (including potential biases or limitations in measurement) would be beneficial. For example, clarifying how the CVR and CVI thresholds were determined and discussing any steps taken to mitigate measurement error would strengthen the methodology 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: 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. https://doi.org/10.1371/journal.pone.0326126.r001
Revision 1
8 Mar 2025 Author Response Dear Reviewers, Thank you very much for your consideration. We really appreciate the comments and have learned a lot. According to the suggestions of the reviewers and editor, appropriate changes were made in the revised manuscript. Responses reviewers’ comments: Reviewer #1: The topic of the article was intriguing from my perspective. BYOD in hospitals can lead to cost reduction and increased productivity. However, the adoption of this technology faces numerous challenges, such as security concerns and acceptance by staff. Given the significance of this topic in the field of health information technology, the article addresses these challenges clearly and accurately. Additionally, the appropriate sampling and the large sample size (1,130 individuals from five hospitals) enhance the credibility of the results, making it a noteworthy article. Overall: 1. The methodology section should specify how hospitals were selected. While the article provides a general overview of the research methodology, it does not address potential limitations or sampling biases (e.g., selection of specific hospitals or types of staff). Response: We appreciate the reviewer's valuable scientific comments and constructive suggestions, which help us to improve the quality of the manuscript. � Regarding how the hospitals were selected, we selected all teaching hospitals affiliated with Zahedan University of Medical Sciences. We mentioned this in the method section for clarity. Page 4, line 107. � Regarding sampling limitations and biases, we reduced the possible measurement error by using an approximately large sample, careful design of the sampling, data collection, and analysis procedures. Extra information was added accordingly. Pages 4 and 5, lines 119-123. One of the challenges of BYOD in hospitals is data security. The article does not explore security issues. Given the sensitivity of medical information and health data, this aspect appears to be essential to consider. Response: We agree with the reviewer and appreciate the reviewer’s scientific comment and suggestion. Given the sensitivity of healthcare data, information security and its related dimensions, including privacy and confidentiality of patient information, are very important and sensitive issues. In the present study, we briefly addressed this issue in the dimension of perceived trust to some extent. We also mentioned it in the discussion section. However, a comprehensive examination of the all dimensions of security, privacy, and confidentiality of patient information in the implementation and use of the BAYOD policy in healthcare institutions seems more than necessary, and future studies focusing on this area are needed. We have added this as a limitation of the present study in the study limitations section. Page 13, lines 304-308. The study primarily utilized quantitative data; I believe that qualitative analyses, such as interviews, might have been more effective in understanding staff attitudes and experiences. In the conclusion and recommendations section, I think the article could be improved by offering more practical suggestions for hospitals and IT officials. It could present recommendations for better implementation of BYOD in hospitals. Response: We agree with the reviewer, we had mentioned this in the study limitations section and suggested that future studies focus on qualitative methods. A qualitative study of this topic is also part of the authors' future research plans. Page 13, lines 301-304. Some more recent and relevant sources from the field of health information technology and BYOD acceptance could be added to demonstrate the research's timeliness. Response: We agree with the reviewer and we used five new relevant references that published in 2024 or 2025. Reviewer #2: 1. Although the study offers valuable insights, the sample is drawn from hospitals within a single province, and the representation of certain groups (e.g., physicians) is limited. The authors should discuss more explicitly how these sampling limitations might affect the generalizability of the findings and propose strategies for future research (e.g., expanding the study to multiple provinces or increasing subgroup representation). Response: Revised and extra information added. Page 13, Lines 294-304. 2. While the manuscript uses TAM constructs effectively, the discussion could benefit from a deeper integration of recent literature specifically addressing BYOD in healthcare. Strengthening the theoretical framework with current studies could help position the work within broader debates about technology adoption in healthcare. The authors can consider other TAM-related studies in other fields such as "Moderating effects of policy measures on intention to adopt autonomous vehicles: Evidence from China" and "Analyzing factors influencing IoT adoption in higher educational institutions in Saudi Arabia using a modified TAM model". Response: We appreciate the reviewer for the constructive comment, we used some new references in the discussion section and we cited the studies mentioned by the reviewer in the theoretical framework section of the manuscript to strengthen the theoretical framework of our manuscript. Page 4, line 99; page 11, lines 235-237, page 12, lines 282-87. 3. The relatively low mean score for perceived ease of use merits further discussion. The authors might explore potential reasons for this finding (such as usability challenges or resistance to change among staff) and consider how this aspect could be addressed in practice. Response: We agree with the reviewer’s comment. We added explanations in the discussion section about the reason for the low score of the referenced dimension and how to improve the situation. Page 11, lines 255-230. 4. More detail on the process of questionnaire development and validation (including potential biases or limitations in measurement) would be beneficial. For example, clarifying how the CVR and CVI thresholds were determined and discussing any steps taken to mitigate measurement error would strengthen the methodology section. Response: We agree with the reviewer. we add extra information accordingly. Regarding sampling limitations and biases, we reduced the possible measurement error by using an approximately large sample, careful design of the sampling, data collection, and analysis procedures. Pages 4 and 5, lines 119-123. A reference was added for the CVI and CVR thresholds clarity. Page 5, line 141. Attachments Attachment Submitted filename: Response to Reviewers Comments.docx https://doi.org/10.1371/journal.pone.0326126.r002
Decision Letter - Asli Karakulah, Editor Factors influencing the adoption of the BYOD policy in teaching hospitals: A cross-sectional study from Southeastern Iran PONE-D-24-55967R1 Dear Dr. Alipour, 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, Asli Suner Karakulah, 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 ******** 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 ****** 3. Has the statistical analysis been performed appropriately and rigorously? 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 #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 #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 #2: The authors have addressed all my concerns. I have nothing to add to this comment to authors. No further questions. ****** 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 ******** https://doi.org/10.1371/journal.pone.0326126.r003

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