Health care professionals’ attitudes, behaviours and barriers toward exercise promotion among patients: A systematic review

Pinar Avsar; Zena Moore; Husain Nasaif; Barry Moore; Declan Patton; Tom O’Connor; Vishnu Renjith

doi:10.1371/journal.pone.0330861

Peer Review History

Original SubmissionApril 19, 2024
5 Sep 2024 Decision Letter - Nuru Abdu, Editor Dear Dr. Avsar, 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 Oct 20 2024 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. 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, Mr. Nuru Abdu 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. We noticed you have some minor occurrence of overlapping text with the following previous publication(s), which needs to be addressed: -The economic impact of pressure ulcers among patients in intensive care units. A systematic review (DOI: 10.1016/j.jtv.2020.12.004) In your revision ensure you cite all your sources (including your own works), and quote or rephrase any duplicated text outside the methods section. Further consideration is dependent on these concerns being addressed. 3. PLOS requires an ORCID iD for the corresponding author in Editorial Manager on papers submitted after December 6th, 2016. Please ensure that you have an ORCID iD and that it is validated in Editorial Manager. To do this, go to ‘Update my Information’ (in the upper left-hand corner of the main menu), and click on the Fetch/Validate link next to the ORCID field. This will take you to the ORCID site and allow you to create a new iD or authenticate a pre-existing iD in Editorial Manager. 4. 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. 5. As required by our policy on Data Availability, please ensure your manuscript or supplementary information includes the following: A numbered table of all studies identified in the literature search, including those that were excluded from the analyses. For every excluded study, the table should list the reason(s) for exclusion. If any of the included studies are unpublished, include a link (URL) to the primary source or detailed information about how the content can be accessed. A table of all data extracted from the primary research sources for the systematic review and/or meta-analysis. The table must include the following information for each study: Name of data extractors and date of data extraction Confirmation that the study was eligible to be included in the review. All data extracted from each study for the reported systematic review and/or meta-analysis that would be needed to replicate your analyses. If data or supporting information were obtained from another source (e.g. correspondence with the author of the original research article), please provide the source of data and dates on which the data/information were obtained by your research group. If applicable for your analysis, a table showing the completed risk of bias and quality/certainty assessments for each study or outcome. Please ensure this is provided for each domain or parameter assessed. For example, if you used the Cochrane risk-of-bias tool for randomized trials, provide answers to each of the signalling questions for each study. If you used GRADE to assess certainty of evidence, provide judgements about each of the quality of evidence factor. This should be provided for each outcome. An explanation of how missing data were handled. This information can be included in the main text, supplementary information, or relevant data repository. Please note that providing these underlying data is a requirement for publication in this journal, and if these data are not provided your manuscript might be rejected. Additional Editor Comments: 1. English editing required. Coherence and readability of the manuscript need improvement. 2. Your manuscript does not adhere to PLOS ONE manuscript preparation guidelines. Use the following link to access the manuscript preparation guideline https://learn.inasp.info/pluginfile.php/159252/mod_folder/content/0/PLOS_ONE_manuscript_guidelines_saved.pdf?forcedownload=1 [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? Reviewer #1: Partly Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #1: N/A Reviewer #2: N/A ****** 3. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes Reviewer #2: No ****** Reviewer #1: Revision of Manuscript Number: PONE-D-24-13967 Abstract: Clear and nicely written abstract. However, I think the conclusion section sounds like list of recommendations than summary of the striking data. So please revise. Introduction: No need to include the PICO and research question. Probably the primary and secondary desired outcomes can be summarised in the aim part. Methods: I have concerns about the keywords used, for example “behavior” is a key word in the title but not found in the search strategy. Also, you should either use HCPs in general or list all related specialties involved not only physicians and nurses. Someone can argue physiotherapists are more attached to this than nurses, pharmacists ….etc. It would be useful if you provide the results of the search process on one of the databases as a supplementary (PubMed or Scopus). The manuscript needs language revision for better presentation. Data analysis section needs extensive revision as I was confused with why meta analysis is essentially mentioned in such type of review with mostly qualitative data (heterogeneity of what? Normally we use this term in studies with quantitative data in nature). How did you do the coding? Is it content analysis or thematic or sentimental ?..... etc Results: Where is figure 1? Why did you provide Table 1 with only 3 studies? In Table 2 you need to add the publication year next to authors and a column for quality assessment. It was very abrupt to see “Data collection techniques” in the results section page 22! Why here ? How did you dealt with data from weaker or incomplete studies? Discussion: There are parts where new results were presented for the first time this shouldn't be the case, please revise. The overall discussion needs more depth and critical evaluation. Readers want to see your input for why do you think these were the outcomes of the review. Reviewer #2: The study topic is of interest and highlights crucial points in the health promotion program. However, there certain limitations that should be addressed: 1. Within the electronic search section specify if there were no filters or limits used, 2. The keyword used in the search process are limited, justify the limited used of keywords for example, physiotherapist or clinician is not included. The keywords exercise or physical activity are also limited as synonyms such as aerobics or movement therapy are not included. 3. Provide operational definitions for HCPs and exercises, as it will simplify the issues concerning selection of keywords. 4. In the study selection section specify that studies in English language were used 5. The initials of the reviewers who did the first screening of the studies are not mentioned in the study selection section 6. On page 8, amend the sentence “… the themes and categories presented under the sections of attitudes, practices, and behaviors.” As “…. attitudes, behaviors and barriers.” As practice was not assessed. 7. Amend the table referring to the CASP assessments to table 3, on page 9. 8. The criteria used in the CASP assessments should be described in the methods section or provided as footnotes in the tables. 9. On page 10, use consistent citation style as per the PLOS One referencing guidelines. 10. I recommend table 2, the characteristics of the studies used to be handled as supplementary file, as it increases the bulkiness of the manuscript without added benefit. 11. How did you manage to avoid bias from the themes already presented in the quantitative questionnaires? As discussed in the limitations, the way questions are phrased or framed can influence how participants respond, leading to response bias and inaccurate measurements of attitudes and themes generated. The same applies to behaviors and barriers, justify. 12. The abbreviations SD and the presented figures are not consistent, if you are referring to SD should be presented in integers not percentages as percentage refers to relative standard deviation (RSD). 13. In the discussion section, page 27, the issue that dancing was not recommended to patients by HCP may be due to the keywords and should not be discussed as a major result. 14. The manuscript needs English language editing. ****** 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: Reveiw Report.docx https://doi.org/10.1371/journal.pone.0330861.r001
Revision 1
22 Oct 2024 Author Response Dear Editor, We would like to thank the reviewer for careful and thorough reading of this manuscript and for the thoughtful comments and constructive suggestions, which help to improve the quality of this manuscript for publication. We believe that we have carefully addressed all the comments. Should you have any additional requests or questions, please do not hesitate to contact me. Yours sincerely, Pinar Avsar Reviewer Comment Answered Page Review report Within the electronic search section specify if there were no filters or limits used, We have clarified the details regarding the use of filters and limits in the electronic search section of our manuscript. 7 The keyword used in the search process are limited, justify the limited used of keywords for example, physiotherapist or clinician is not included. The keywords exercise or physical activity are also limited as synonyms such as aerobics or movement therapy are not included. While appreciating the comment of the respected reviewer, the keywords were selected based on the most commonly used terms in the literature to ensure that the search captures a broad range of studies involving healthcare professionals' perspectives on exercise. We intentionally focused on general terms like "healthcare professionals" rather than more specific terms such as "physiotherapist" to avoid narrowing the scope of the search too much. Additionally, while "exercise" and "physical activity" were chosen as umbrella terms to capture a variety of interventions, specific terms like "aerobics" or "movement therapy" were excluded to maintain a manageable scope and to avoid overly fragmenting the search results. However, these terms were considered during the title and abstract screening phase to ensure relevant studies were not missed. Provide operational definitions for HCPs and exercises, as it will simplify the issues concerning selection of keywords. To address your concerns, we have added operational definitions for "Healthcare Professionals (HCPs)" and "exercise" to the manuscript. 8 In the study selection section specify that studies in English language were used Thanks for the comment. It was added. 7 The initials of the reviewers who did the first screening of the studies are not mentioned in the study selection section Thank you for your feedback. We have added the initials of the reviewers involved in the study selection process to the manuscript for clarity. 8 On page 8, amend the sentence “… the themes and categories presented under the sections of attitudes, practices, and behaviors.” As “…. attitudes, behaviors and barriers.” As practice was not assessed. Thank you for your suggestion. We have amended the sentence and practice is removed. Amend the table referring to the CASP assessments to table 3, on page 9. Thanks for the comment. We amended it. 9 The criteria used in the CASP assessments should be described in the methods section or provided as footnotes in the tables. Thank you for your suggestion. We have added a "Quality Appraisal" subheading to the methods section, where we describe the criteria used in the CASP assessments, as recommended. 9 On page 10, use consistent citation style as per the PLOS One referencing guidelines. Thank you for your suggestion. We have revised the citations on page 10 to ensure consistency with the PLOS ONE referencing guidelines. 10 I recommend table 2, the characteristics of the studies used to be handled as supplementary file, as it increases the bulkiness of the manuscript without added benefit. Thank you for your recommendation. We have moved Table 2, which outlines the characteristics of the studies. This is added as a supplementary file. How did you manage to avoid bias from the themes already presented in the quantitative questionnaires? As discussed in the limitations, the way questions are phrased or framed can influence how participants respond, leading to response bias and inaccurate measurements of attitudes and themes generated. The same applies to behaviors and barriers, justify. Thank you for your insightful comment regarding the potential for bias stemming from the themes presented in the quantitative questionnaires. To mitigate this risk, we employed a multi-faceted approach: Diverse Sources: We ensured that the findings are derived from a variety of sources, including interviews and focus groups, in addition to the quantitative questionnaires. This allowed us to capture a broader range of perspectives and minimize reliance on any single data source. Thematic Analysis: We conducted a rigorous thematic analysis, where the themes were developed. The emerged themes were reviewed by the research team to ensure the internal validity. This process strived to minimize individual biases and led to a more balanced representation of the data. Reflexivity: To ensure rigor we acknowledged our own biases and preconceptions during the data analysis process, actively reflecting on how these might influence the interpretation of the findings. We recognize that response bias can affect the accuracy of measurements related to attitudes, behaviors, and barriers, and we have highlighted these limitations in our discussion. However, we believe that the measures taken have strengthened the validity of our findings. The abbreviations SD and the presented figures are not consistent, if you are referring to SD should be presented in integers not percentages as percentage refers to relative standard deviation (RSD). Thank you for your feedback. We have revised the manuscript to ensure consistency in the presentation of the standard deviation (SD), now presenting it as integers rather than percentages. Whole document In the discussion section, page 27, the issue that dancing was not recommended to patients by HCP may be due to the keywords and should not be discussed as a major result. Thank you for your feedback. We have revised the discussion section. 28 The manuscript needs English language editing. The manuscript has been edited for English language. Whole document. Reviewer #1 Abstract: Clear and nicely written abstract. However, I think the conclusion section sounds like list of recommendations than summary of the striking data. So please revise. Thank you for your comment. The conclusion section was revised. 1 Introduction: No need to include the PICO and research question. Probably the primary and secondary desired outcomes can be summarised in the aim part. Thank you for your suggestion. We have integrated the primary and secondary desired outcomes into the 'Aim' section to provide a more concise overview of the study's focus, as recommended. 8 Methods: I have concerns about the keywords used, for example “behavior” is a key word in the title but not found in the search strategy. Also, you should either use HCPs in general or list all related specialties involved not only physicians and nurses. Someone can argue physiotherapists are more attached to this than nurses, pharmacists ….etc. It would be useful if you provide the results of the search process on one of the databases as a supplementary (PubMed or Scopus). Thank you for your valuable feedback. We have updated our search strategy to include the keyword 'behavior' to ensure consistency with the title and the scope of the study. While we appreciate the insightful comment from the respected reviewer, the decision to use the general term 'healthcare professionals' rather than listing specific specialties such as 'pharmacists' was intentional. This approach aimed to capture a broad range of studies and perspectives without unduly restricting the scope of the search. Using a more general term allowed us to include various healthcare professionals involved in exercise promotion, such as physicians and nurses, ensuring that relevant studies from different disciplines were considered. During the title and abstract screening phase, we carefully evaluated the relevance of each study, including those focusing on specific groups like physiotherapists, pharmacist to ensure that significant contributions were not overlooked. The manuscript needs language revision for better presentation. It was added. Whole document. Data analysis section needs extensive revision as I was confused with why meta analysis is essentially mentioned in such type of review with mostly qualitative data (heterogeneity of what? Normally we use this term in studies with quantitative data in nature). How did you do the coding? Is it content analysis or thematic or sentimental ?..... etc Thank you for your valuable comments. We agree that the term 'meta-analysis' was not appropriate given the qualitative nature of much of the data. As such, we have removed the reference to meta-analysis and clarified that a narrative analysis was used. This narrative approach allowed us to accommodate the diverse methodologies and outcomes of the included studies. We employed a qualitative coding process, which involved creating codes, grouping them into categories, and clustering them into themes. We have updated the manuscript to better explain our analysis process. 10 Results: Where is figure 1? Why did you provide Table 1 with only 3 studies? Thank you for your comments and for bringing this to our attention. Figure 1 has been provided as a separate file in accordance with the journal's submission requirements. The figure outlines the PRISMA flow diagram, detailing the study selection process, including the number of studies screened, excluded, and included in the review. Regarding Table 1, we included the details of only three studies to provide a concise illustration of the type of data extracted and analyzed in this review. We believed it was a systematic review requirement to present a summary of excluded studies to enhance transparency and clarify the reasons for exclusion. In Table 2 you need to add the publication year next to authors and a column for quality assessment. Thank you for your valuable suggestion regarding the addition of the publication year next to the authors' names and including a column for quality assessment in Table 2. We used EndNote for reference management as required by the journal, and the system's formatting limitations did not allow us to automatically display the publication year directly alongside the authors in the table. It was very abrupt to see “Data collection techniques” in the results section page 22! Why here ? Thank you for your observation. The section on 'Data collection techniques' in the results section refers to the methods and approaches used in the included studies, rather than the data collection process for our systematic review. As such, we felt it was most appropriate to include this information in the results section to provide a comprehensive summary of the methodologies used across the studies we reviewed. This placement aims to give readers a better understanding of how data were gathered in the studies included in our analysis. How did you dealt with data from weaker or incomplete studies? Thank you for your insightful question. In our systematic review, we adopted a rigorous approach to assess the quality of the included studies using the Critical Appraisal Skills Programme (CASP) tool. For studies identified as weaker or incomplete, we carefully considered their findings in the context of the overall evidence base. We aimed to extract relevant data while noting any limitations or biases present in these studies. Where applicable, we highlighted the potential impact of these limitations on our findings and discussions. Discussion: There are parts where new results were presented for the first time this shouldn't be the case, please revise. The overall discussion needs more depth and critical evaluation. Readers want to see your input for why do you think these were the outcomes of the review. We have revised the discussion to enhance its depth and critical evaluation. We have also ensured that all presented results align with those previously reported in the literature, avoiding any new findings being introduced. Discussion section Reviewer #2 Reviewer 2's comments overlapped with the review report. Therefore, we have addressed this in our response above. Attachments Attachment Submitted filename: Response Table.docx https://doi.org/10.1371/journal.pone.0330861.r002
8 Dec 2024 Decision Letter - Nuru Abdu, Editor Dear Dr. Avsar, 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 Jan 22 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. 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 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, Nuru Abdu, BPharm 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. Additional Editor Comments: 1. Massive English Editing required. Coherence and readability of the manuscript need an improvement. 2. The style of the reference citations should be consistent throughout the manuscript and avoid over-citations where applicable. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author Reviewer #1: (No Response) Reviewer #2: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions??> Reviewer #1: Yes Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #1: N/A Reviewer #2: N/A ****** 4. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #1: Yes Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: No Reviewer #2: Yes ****** Reviewer #1: Please revise the manuscript again . I will put here one paragraph only and comment on the issues in it: “Geographical location A wide spread of countries are represented in the studies, with the USA having 8 studies(27, 30, 32, 33, 35, 39, 44, 46), the UK having 5 studies (Douglas et al., 2006; Goodman et al., 2011; Kime et al., 2020; Mc Dowell et al., 1997; Williams et al., 2016). Australia, Canada, Germany, The Netherlands, and Saudi Arabia having 2 studies each (17, 24, 25, 29, 38, 41, 43, 47-49). The remaining studies were from Australia and New Zealand (16), Belgium (50), Brazil (14), Ireland (20), Italy (26), Korea (45), Singapore (28), Taiwan (51), The UK and Ireland (15) and Wales (31). One study included people from seven international oncology societies (37).” • Different referencing style. • “Australia, Canada, Germany, The Netherlands, and Saudi Arabia having 2 studies each (17, 24, 25, 29, 38, 41, 43, 47-49)” … one missing reference if each country has 2 papers. • “The remaining studies were from Australia and New Zealand (16)”.. did you count this as Australian or New Zelandian paper? Reviewer #2: I have no further comments. However, if the recommendation suggested provided in the first review on the methods used to mitigate the risk of bias stemming from the themes presented in the quantitative questionnaires to be included in the methods section. ****** 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: Yes: Dr Abdullah Al Hamid 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 https://doi.org/10.1371/journal.pone.0330861.r003
Revision 2
31 Dec 2024 Author Response Dear Editor, We would like to thank the reviewer for careful and thorough reading of this manuscript and for the thoughtful comments and constructive suggestions, which help to improve the quality of this manuscript for publication. We believe that we have carefully addressed all the comments. Should you have any additional requests or questions, please do not hesitate to contact me. Yours sincerely, Pinar Avsar Reviewer Comment Answered Page Additional Editor Comments Massive English Editing required. Coherence and readability of the manuscript need an improvement. We have thoroughly revised the manuscript to enhance its language, clarity, and overall structure. The introduction, discussion, and limitations sections were particularly refined to ensure they are more coherent and easier to follow. Whole document The style of the reference citations should be consistent throughout the manuscript and avoid over-citations where applicable. Thank you for your feedback. We have revised the manuscript to ensure that the style of reference citations is consistent throughout and have minimized over-citations where applicable. Whole document Reviewers Please revise the manuscript again . I will put here one paragraph only and comment on the issues in it: “Geographical location A wide spread of countries are represented in the studies, with the USA having 8 studies(27, 30, 32, 33, 35, 39, 44, 46), the UK having 5 studies (Douglas et al., 2006; Goodman et al., 2011; Kime et al., 2020; Mc Dowell et al., 1997; Williams et al., 2016). Australia, Canada, Germany, The Netherlands, and Saudi Arabia having 2 studies each (17, 24, 25, 29, 38, 41, 43, 47-49). The remaining studies were from Australia and New Zealand (16), Belgium (50), Brazil (14), Ireland (20), Italy (26), Korea (45), Singapore (28), Taiwan (51), The UK and Ireland (15) and Wales (31). One study included people from seven international oncology societies (37).” • Different referencing style. We have carefully reviewed and edited all references in the manuscript to ensure they adhere to a consistent referencing style format. Page 11 • “Australia, Canada, Germany, The Netherlands, and Saudi Arabia having 2 studies each (17, 24, 25, 29, 38, 41, 43, 47-49)” … one missing reference if each country has 2 papers. Thank you for identifying the discrepancy in the references. The section has been revised to accurately reflect that Australia, Canada, Germany, The Netherlands, and Saudi Arabia each have two studies, with the correct references now cited as (17, 27, 28, 32, 41, 44, 46, 50-52). Page 11 “The remaining studies were from Australia and New Zealand (16)”.. did you count this as Australian or New Zelandian paper? Thank you for highlighting this point. The study referenced as (16) was conducted jointly in both Australia and New Zealand, so it was not attributed exclusively to either country. The revised text now clarifies this to avoid any ambiguity. Page 11 Reviewer #2: I have no further comments. However, if the recommendation suggested provided in the first review on the methods used to mitigate the risk of bias stemming from the themes presented in the quantitative questionnaires to be included in the methods section. Thank you for your valuable suggestion. We have revised the manuscript accordingly and included a detailed subsection under the "Data Analysis" subheading in the Methods section to address this. 9 Attachments Attachment Submitted filename: Response_Table_auresp_2.docx https://doi.org/10.1371/journal.pone.0330861.r004
5 Feb 2025 Decision Letter - Nuru Abdu, Editor Dear Dr. Avsar, 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 Mar 22 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. 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 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, Nuru Abdu, BPharm 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. Additional Editor Comments: 1. Massive English editing required. Coherence and readability of the manuscript need improvement. 2. Your manuscript does not follow PLOS ONE manuscript preparation guidelines. [Note: HTML markup is below. Please do not edit.] [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 https://doi.org/10.1371/journal.pone.0330861.r005
Revision 3
17 Feb 2025 Author Response Dear Editor, We would like to thank the reviewer for careful and thorough reading of this manuscript and for the thoughtful comments and constructive suggestions, which help to improve the quality of this manuscript for publication. We believe that we have carefully addressed all the comments. Should you have any additional requests or questions, please do not hesitate to contact me. Yours sincerely, Pinar Avsar Reviewer Comment Answered Page Additional Editor Comments Massive English editing required. Coherence and readability of the manuscript need improvement.. Thank you for your feedback. We have revised the manuscript for improved clarity, coherence, and readability to ensure the content is more accessible and aligns with the expectations of the review process. All document Your manuscript does not follow PLOS ONE manuscript preparation guidelines Thank you for your feedback. We have carefully edited the manuscript to align with the PLOS ONE manuscript preparation guidelines and ensure compliance with all required formatting and structural specifications. 8 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. We conducted a thorough search using the Retraction Watch Database, PubMed, and the publishers' official websites. None of the cited references in our manuscript have been retracted. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0330861.r006
14 Mar 2025 Decision Letter - Nuru Abdu, Editor Dear Dr. Avsar, 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 28 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. 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 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, Nuru Abdu, BPharm 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. Additional Editor Comments: 1. Your manuscript does not follow PLOS ONE manuscript preparation guidelines 2. Your citation does not follow PLOS ONE manuscript 3. Further English editing required to improve the coherence and readability of the manuscript [Note: HTML markup is below. Please do not edit.] [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.0330861.r007
Revision 4
27 Apr 2025 Author Response Dear Editor, We would like to thank the reviewer for careful and thorough reading of this manuscript and for the thoughtful comments and constructive suggestions, which help to improve the quality of this manuscript for publication. We believe that we have carefully addressed all the comments. Should you have any additional requests or questions, please do not hesitate to contact me. Yours sincerely, Pinar Avsar Reviewer Comment Answered Page Editor Comments • The manuscript does not follow the PLOS ONE manuscript preparation guidelines. • The citation style does not comply with PLOS ONE requirements. • Further English editing is required to improve the coherence and readability of the manuscript. Thank you for your constructive feedback. In response to your comments, we have thoroughly revised the manuscript to ensure full compliance with the PLOS ONE manuscript preparation guidelines. The citation style has been corrected throughout the text to align with PLOS ONE referencing requirements. Additionally, the manuscript has undergone comprehensive English editing to improve coherence, grammar, and overall readability. We hope that these revisions address your concerns and enhance the clarity and quality of the submission. All document Attachments Attachment Submitted filename: Response_to_Reviewers_auresp_4.docx https://doi.org/10.1371/journal.pone.0330861.r008
14 May 2025 Decision Letter - Nuru Abdu, Editor Dear Dr. Avsar, 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 Jun 28 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. 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 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, Nuru Abdu, BPharm 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. Additional Editor Comments: 1. Your manuscript does not follow PLOS ONE manuscript preparation guidelines 2. Your citation does not follow PLOS ONE manuscript 3. Further English editing required to improve the coherence and readability of the manuscript [Note: HTML markup is below. Please do not edit.] [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 https://doi.org/10.1371/journal.pone.0330861.r009
Revision 5
16 Jun 2025 Author Response Dear Editor, We would like to thank you for providing the opportunity to revise the manuscript. There were three comments. We believe that we have carefully addressed all the comments. Your suggestions have helped us to improve the quality of this manuscript. Should you have any additional requests or questions, please do not hesitate to contact me. No Editorial comments Response from the Author 1 The manuscript does not follow the PLOS ONE manuscript preparation guidelines Thanks for the comment. We have reviewed the manuscript preparation guidelines as provided by PLOS ONE. Thorough modifications were made to fit the manuscript into the journal guidelines. File format: The manuscript has been prepared in docx format Font: Standard Arial font has been used throughout the manuscript, font size 12. Layout and spacing: The manuscript is now double-spaced and formatted in a single-column layout. Page and line numbers: Page numbers and continuous line numbers have been included as required. Footnotes: All footnotes have been removed. Abbreviations: Abbreviations are defined upon first use, used consistently. Abbreviations are given at the end of the manuscript. 2 The citation style does not comply with PLOS ONE requirements. All references have been formatted according to the Vancouver style, in line with PLOS ONE guidelines. EndNote was used to manage the references. 3 Further English editing is required to improve the coherence and readability of the manuscript. A native language speaker edited the manuscript. We then had the manuscript reviewed by a professional copyeditor. Redundancies were eliminated, sentence restructuring was done as needed, and citations were corrected. This has significantly improved the manuscript. Attachments Attachment Submitted filename: Response_to_Reviewers_auresp_5.docx https://doi.org/10.1371/journal.pone.0330861.r010
7 Aug 2025 Decision Letter - Nuru Abdu, Editor Health care professionals' attitudes, behaviours and barriers toward exercise promotion among patients: A systematic review PONE-D-24-13967R5 Dear Dr. Avsar, 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. For questions related to billing, please contact billing support . 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, Nuru Abdu, BPharm Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0330861.r011
Formally Accepted
Acceptance Letter - Nuru Abdu, Editor PONE-D-24-13967R5 PLOS ONE Dear Dr. Avsar, 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. You will receive an invoice from PLOS for your publication fee after your manuscript has reached the completed accept phase. If you receive an email requesting payment before acceptance or for any other service, this may be a phishing scheme. Learn how to identify phishing emails and protect your accounts at https://explore.plos.org/phishing. 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 Mr. Nuru Abdu Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0330861.r012

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