PLOS One

Dear Dr. Min,

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Academic Editor

PLOS One

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“This study was financially supported by the Chongqing Science and Health Joint Medical Research Project (2024MSXM172), and Shapingba District Science and Health Joint Medical Research Project (2024SQKWLHMS032), and Shapingba District Science and Health Joint Medical Research Project (2025SQKWLHMS072).”

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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?

Reviewer #1: Partly

Reviewer #2: Yes

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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.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??>

Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: This paper focuses on the coordinated development of disease prevention and control regions, and it holds great research significance.

1.The description of the Delphi research method is too simplistic. It is suggested to include the process of expert selection and indicator construction.

2. Kano sampled four cities. Please provide a representative description of the sampling cities. The description mentioned as "multistage sample" merely indicates the sequence of sampling surveys conducted by the institution leaders and other personnel. The analysis does not reflect the differences in results among different subgroups, resulting in insufficient depth of the results.

3. "Two permits" is a policy term. It is recommended to provide a definition of the term at the first mention and not to explain it until the discussion section.

4. In terms of English expression: Simplify sentences, unify terminology, and complete the references in accordance with the journal requirements.

Reviewer #2: I. Overall Evaluation

This study focuses on the collaborative development needs of grassroots Centers for Disease Control and Prevention (CDCs) in the Chengdu-Chongqing Economic Circle, innovatively applying the Kano Model to the analysis of regional collaborative needs in the public health field. The research topic aligns with global public health governance priorities and holds significant practical value and theoretical reference significance. Overall, the paper has a complete structure and clear logic with a relatively standardized research design. However, there is room for improvement in format details, language expression, methodological refinement, and discussion expansion. Detailed comments on specific dimensions are as follows:

II. Specific Review Dimensions

(I) Compliance with Paper Format Requirements

Conclusion: Basically compliant with PLOS ONE's submission format requirements, but with some non-standard details.

Detailed Explanation:

1. Strengths: The paper includes complete modules such as title, abstract, introduction, methods, results, discussion, conclusion, acknowledgments, author contributions, conflict of interest statement, ethics and consent, funding information, data availability, ORCID, and references, conforming to the standard structure of academic papers. Tables and figures are numbered standardizedly (e.g., Figure 1, Table 1) and accurately cited in the main text, with unified data presentation formats (e.g., categorical data expressed as frequency and proportion).

2. Weaknesses:

- Layout issues in tables: The content layout of "Table 5. Importance analysis scale" is chaotic, with unclear correspondence between column headers and data, affecting readability.

- Insufficient clarity in the hierarchy of some section headings: For example, the subheadings in the "Methods" section do not strictly follow the "Level 1 Heading - Level 2 Heading" hierarchical logic (e.g., "Literature Review and Delphi Expert Consultation Method" and "Questionnaire Design" should be peer subheadings with inconsistent formats).

(II) Adequacy of Academic English for Publication

Conclusion: The English language basically meets the needs of academic communication but has issues such as grammatical errors, redundant expressions, and inconsistent terminology use, failing to fully meet PLOS ONE's academic English publication standards.

Detailed Explanation:

1. Strengths: Core academic terms (e.g., "Kano Model", "must-be attribute", "Better-Worse coefficient") are used accurately, and sentence structures basically conform to academic English expression habits, enabling clear communication of research ideas and results.

2. Weaknesses:

- Grammatical and syntactic issues: Some sentences have subject-verb disagreement, tense confusion, and other errors (e.g., in "the capacity for public health governance varies significantly among CDCs across different countries and regions, with grassroots CDCs facing particular disadvantages", "facing" should be changed to "face" to maintain syntactic consistency). Some long sentences are logically redundant; for example, "Establishing stable and efficient collaborative development mechanisms among CDCs across diverse regions to maximize overall effectiveness and ensure sustainable development has emerged as a critical public health science issue" can be simplified for readability improvement.

- Inconsistent terminology use: For example, "social financial media information" appears multiple times in the text with an inaccurate expression; it should be "social integrated media information" (consistent with the secondary need expression in the table), resulting in contradictions in terminology.

- Non-idiomatic expressions: Some phrases do not conform to common academic English usage. For example, "provide scientific reference and theoretical basis" can be optimized to "provide scientific references and a theoretical foundation", and "strengthen public health systems" can be adjusted to "strengthen the construction of public health systems" to better fit the academic English context.

(III) Appropriateness of Methodology and Rationale

Conclusion: The methodology selection is appropriate and the design is reasonable, aligning with the research objectives. However, some details lack sufficient explanation and can be further refined.

Detailed Explanation:

1. Appropriateness Analysis:

- High alignment between research methods and objectives: To address the core goal of "classifying and prioritizing collaborative development needs of grassroots CDCs", a combined method of "literature review + Delphi expert consultation + Kano Model" is adopted. The literature review and Delphi method ensure the scientific of the demand indicator system (expert authority coefficient Cr > 0.7, significant Kendall's coefficient of concordance), while the Kano Model's two-dimensional attribute classification advantage compensates for the defect of traditional demand analysis tools (e.g., AHP) that ignore the "negative impacts of unmet needs", enabling comprehensive capture of the different attribute characteristics of needs. Moreover, Delphi method was not clearly and explicitely descripted in the methodolgy section.

- Reasonable sampling method and sample size: A multi-stage sampling method was used to select 8 grassroots CDCs from 4 cities in the Chengdu-Chongqing Economic Circle, ultimately obtaining 110 valid questionnaires (effective recovery rate of 94.02%). The sample size meets the basic requirements of Kano Model analysis, and the sample covers respondents from different regions, ages, and positions, with certain representativeness.

- Standard statistical analysis methods: SPSS was used for data processing, and the Better-Worse coefficient method was employed to calculate SI, DSI, and satisfaction sensitivity. The formula derivation is clear, and the selection of statistical test methods is appropriate (e.g., Bartlett's sphericity test for reliability and validity analysis).

2. Suggestions for Improvement:

- Insufficient detailed explanation of the Delphi expert consultation method: The specific selection criteria for experts (e.g., professional title, research field, years of experience) are not clearly defined; only "13 experts were selected from the Public Health Management Special Committee of the Sichuan and Chongqing Preventive Medicine Associations" is mentioned, lacking detailed descriptions of expert backgrounds, which affects the credibility of the methodology.

- The design logic of the Kano Model questionnaire can be further supplemented: The specific assignment rules for each option (e.g., "like it very much", "should be") in the "five-point Likert scale" and the operational process of attribute classification based on positive and negative answers are not explained, which is not conducive to readers replicating and verifying the research results.

- Insufficient demonstration of sample representativeness: It is not analyzed whether the distribution of the sample in demographic characteristics such as "work field" and "education level" is consistent with the overall situation of grassroots CDCs in the Chengdu-Chongqing Economic Circle, nor is the existence of sampling bias and corresponding countermeasures explained.

(IV) Clarity of Results Presentation and Alignment with Research Theme

Conclusion: The research results are basically presented clearly, with core data highly relevant to the research theme. However, the interpretation of some results is not in-depth enough, and the auxiliary explanatory effect of tables and figures needs to be improved.

Detailed Explanation:

1. Strengths:

- Clear classification of results: The results are presented in the logic of "general situation analysis → Kano Model attribute classification → priority ranking of needs", progressing layer by layer and closely focusing on the core theme of "analysis of collaborative development needs".

- Highlighting core data: The priority ranking of needs and satisfaction sensitivity values for different attributes (must-be, one-dimensional, attractive, indifferent) are clearly presented. For example, "performance compensation (0.883)" has the highest priority among must-be attributes, and "joint risk assessment and emergency command (0.937)" has the highest satisfaction sensitivity among one-dimensional attributes, providing solid data support for the analysis in the discussion section.

- The four-quadrant scatter plot (Figure 2) intuitively shows the attribute classification of each need, helping readers quickly understand the characteristics of different needs.

2. Weaknesses:

- Overly brief interpretation of results: Only data rankings are listed, without preliminary explanation of the internal logic of some key results. For example, "talent exchange and scientific research innovation cooperation" appears in both must-be attributes and one-dimensional attributes, but the reasons for this phenomenon (e.g., differences in perceptions of the need among different respondent groups) are not explained.

- Unclear presentation of table data: In "Table 4. Frequency table of collaborative development needs attributes based on the Kano Model", the column alignment of some data (e.g., Q3, Q5) is chaotic, and the proportional values of attributes such as A, I, and M are not clearly corresponding.

- Lack of statistical significance analysis of results: For example, whether there are differences in the perception of need attributes among respondents from different regions (Sichuan vs. Chongqing) and different positions (ordinary staff vs. leaders) has not been analyzed through inter-group comparison, resulting in insufficient richness of results.

(V) Sufficiency of Discussion and Practical Guidance Significance

Conclusion: The discussion section focuses on core results with a certain depth, but there are problems such as a narrow discussion scope, insufficiently specific practical guidance significance, and inadequate dialogue with existing research.

Detailed Explanation:

1. Strengths:

- Closely linking to research results: For the core needs of must-be, one-dimensional, attractive, and indifferent attributes, analysis is conducted by combining relevant research at home and abroad (e.g., the performance-based pay system of the UK's NHS, the collaboration network of the African Research Universities Alliance), explaining the realistic background of demand formation (e.g., the prominent demand for performance compensation due to the high turnover rate of grassroots CDC personnel).

- A three-dimensional collaborative demand framework of "basic guarantee - core operational capacity - supporting system" is refined, providing a theoretical model for the collaborative development of regional CDCs.

2. Weaknesses:

- Insufficient dialogue with existing research: Only some relevant literature is cited for corroboration, without systematically sorting out the research status in the field, nor clearly defining the differences and innovations between this study and existing research (e.g., methodological differences from studies on the collaborative development of grassroots CDCs in other regions, reasons for differences in results).

- Insufficiently specific practical guidance significance: The proposed suggestions are relatively macro (e.g., "establish a coordinated supplementary funding mechanism", "build a regional monitoring and early warning information management system"), without providing operable implementation paths combined with the localized characteristics of the Chengdu-Chongqing Economic Circle such as the administrative system and resource endowments (e.g., the source of funds for the funding mechanism, the construction subject of the information system, and data sharing standards).

- Insufficiently in-depth discussion of indifferent attributes: Only the surface reasons why needs such as "construction of a cross-regional expert database" are classified as indifferent attributes are explained, without further analyzing how to transform such "potential needs" into "effective needs" through policy guidance and mechanism innovation, which limits the practical value of the research.

- Failure to respond to the impact of research limitations on results: For example, the limitation of sample size prevents in-depth subgroup analysis, and it is not discussed whether this limitation will affect the reliability of demand ranking, nor are specific directions for future research proposed.

III. Summary and Revision Suggestions

(I) Overall Summary

This study has clear research value and innovations, with a reasonable methodological design and reliable results, basically meeting PLOS ONE's submission standards. However, comprehensive revisions are needed in format standardization, language polishing, supplementation of methodological details, deepening of result interpretation, and expansion of discussions.

(II) Specific Revision Suggestions

1. Format Optimization:

- Unify reference formats, supplement complete literature information (e.g., page numbers, DOIs) in strict accordance with PLOS ONE's requirements, and ensure consistent formatting.

- Reformat chaotic tables (e.g., Table 5) to clarify the correspondence between column headers and data, improving table readability.

- Standardize the hierarchy of section headings and unify the format of subheadings (e.g., font, indentation, numbering).

2. Language Revision:

- Engage professional academic English editors to polish the full text, correct grammatical errors, optimize sentence structures, and ensure concise, accurate, and idiomatic expression.

- Unify terminology use (e.g., uniformly change "social financial media information" to "social integrated media information") to avoid contradictions.

3. Methodological Supplementation:

- Clearly explain the specific selection criteria (e.g., professional title, years of experience, research field) and background information of Delphi experts to enhance methodological credibility.

- Supplement the assignment rules of the Kano Model questionnaire and the specific operational process of attribute classification to facilitate readers' replication and verification.

- Strengthen the demonstration of sample representativeness, analyze the consistency between sample distribution and the overall situation, and explain countermeasures for sampling bias.

4. Optimization of Results Presentation:

- Supplement preliminary interpretations of key results (e.g., the reasons for "talent exchange and scientific research innovation cooperation" appearing across attributes).

- Correct table layout errors to ensure clear and readable data.

- Add inter-group comparison analysis (e.g., differences in needs among respondents from different regions and positions) to enrich the dimensions of results.

5. Discussion Expansion:

- Systematically sort out relevant research at home and abroad, clarify the innovations and limitations of this study, and strengthen dialogue with existing research.

- Combine the localized characteristics of the Chengdu-Chongqing Economic Circle to propose specific and operable practical suggestions (e.g., specific paths for the funding mechanism and information system construction).

- Deepen the discussion on indifferent attributes and analyze the possibility and paths of transforming them into effective needs.

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what does this mean?). If published, this will include your full peer review and any attached files.). If published, this will include your full peer review and any attached files.). If published, this will include your full peer review and any attached files.). If published, this will include your full peer review and any attached files.

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Reviewer #1: No

Reviewer #2: No

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<p>Analyzing the collaborative development needs of grassroots centers for disease control and prevention using the Kano model: A case study of China’s Chengdu–Chongqing Economic Circle

PONE-D-25-68754R1

Dear Ms. Zhang Min,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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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,

Wuqi Qiu

Academic Editor

PLOS One

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

**********

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

Reviewer #1: Yes

Reviewer #2: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.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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5. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: In subsequent related research, expand the research area, enhance the representativeness of the survey questionnaire; improve the English expression level.

Reviewer #2: The authors have carefully revised the manuscript following all reviewer comments. The key limitations and weaknesses pointed out in the initial review have been fully eliminated or satisfactorily fixed. On this basis, I confirm that the revised manuscript satisfies the standards for publication and recommend acceptance

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what does this mean?). If published, this will include your full peer review and any attached files.). If published, this will include your full peer review and any attached files.). If published, this will include your full peer review and any attached files.). 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 For information about this choice, including consent withdrawal, please see our For information about this choice, including consent withdrawal, please see our For information about this choice, including consent withdrawal, please see our Privacy Policy..-->

Reviewer #1: Yes: ZhangyingZhangyingZhangyingZhangying

Reviewer #2: No

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