-->PONE-D-25-24730-->-->The use of social media in PRiVENT to raise awareness of long-term invasive ventilation-->-->PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

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

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Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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-->2. Has the statistical analysis been performed appropriately and rigorously? -->

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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-->5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)-->

Reviewer #1: The Privent project's use of social media to spread knowledge about long-term invasive mechanical ventilation is examined in this publication. The study presents a well-planned campaign that incorporates blogs, podcasts, and social media platforms, and it is timely and pertinent. Novelty, transparency, and public health significance are among its strong points. The use of descriptive statistics (views, impressions) in the absence of explicit indicators of empowerment or awareness, however, has drawbacks that need to be more explicitly recognized. Conclusions ought to be more circumspect, focusing on possible effects rather than validated results. Data accessibility might be enhanced. All things considered, this is a worthwhile addition that would be appropriate with only slight to moderate editing.

Reviewer #2: The manuscript tackles a significant and little-studied subject: using social media to increase awareness about long-term invasive mechanical ventilation. The approach is transparent about funding, ethics approval, and conflicting interests, and it is well explained. The findings are pertinent and show that various audiences were meaningfully engaged. The findings align with the information provided. There was no proof of publication misbehavior, ethical transgressions, or dual publication. By emphasizing the importance of digital communication in raising health awareness, the study provides a significant contribution. The manuscript would be strengthened even more with minor adjustments to the topic of generalizability and the clarity of the findings presentation.

Reviewer #3: The manuscript addresses an important and timely issue: raising public awareness of long-term invasive mechanical ventilation (IMV) through the PRiVENT social media campaign. The study is well-structured, the objectives are clear, and the descriptive analysis provides valuable insight into how social media can serve as a platform for disseminating health-related information. I commend the authors for including a multidisciplinary team and for highlighting the role of patients, relatives, and healthcare professionals in shaping the campaign.

Strengths:

The study is innovative in its focus on social media as a tool to engage both the general public and healthcare professionals in a sensitive medical topic.

The dataset is substantial, covering a four-year period with diverse outputs (blog posts, podcasts, and social media posts).

Results are clearly presented with supporting figures and tables, which help illustrate reach and demographic differences across platforms.

Ethical considerations were well-handled, and the data were anonymized appropriately.

Points for Improvement:

Data Availability: The manuscript states that datasets are available upon request. PLOS ONE requires full data availability unless there are clear legal or ethical restrictions. Please clarify why full public access is restricted and consider providing at least anonymized aggregated data in a repository.

Statistical Rigor: While descriptive statistics are appropriate for measuring reach and impressions, the analysis could be enhanced by including trend analyses (e.g., growth over time, engagement per type of content) or comparisons between platforms using simple statistical tests. This would strengthen the conclusions.

Impact Assessment: The manuscript focuses primarily on quantitative reach. It would be beneficial to discuss qualitative outcomes, such as evidence of increased awareness, behavioral change, or stakeholder engagement beyond clicks and views.

Literature Context: The discussion could be enriched by integrating more recent references (within the past 5 years) on health communication via social media, to situate the study more firmly within current discourse.

Language and Style: The manuscript is overall well-written, but some minor typographical and grammatical errors should be revised at copyediting (e.g., occasional redundancies in describing the platforms and content types).

Overall Assessment:

This manuscript makes a useful contribution to the field of health communication and respiratory medicine. With improvements in data transparency, statistical depth, and contextual discussion, it will provide even stronger evidence for the role of social media in addressing underrepresented healthcare topics.

Reviewer #4: This manuscript addresses an important and underexplored issue: raising public awareness of long-term invasive mechanical ventilation through social media. The study is relevant, timely, and well-presented, with a clear description of campaign activities and transparent reporting of reach metrics. Its interdisciplinary approach and innovative use of multiple media formats are commendable.

However, the manuscript focuses primarily on quantitative reach without sufficiently addressing qualitative impact, such as changes in knowledge, attitudes, or behaviors among patients, relatives, or healthcare staff. The Methods section is overly descriptive in parts, while the Discussion could be strengthened by deeper analysis, including comparison with similar health communication campaigns and exploration of broader policy implications.

Overall, the manuscript is valuable but requires minor revision to improve its scientific contribution and generalizability.

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Reviewer #2: No

Reviewer #3: No

Reviewer #4: No

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Attachments

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Submitted filename: PONE-D-25-24730_reviewer.pdf

-->PONE-D-25-24730R1-->-->The use of social media in PRiVENT to raise awareness of long-term invasive ventilation-->-->PLOS One

Dear Dr. Trudzinski,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that a significant revision has been done on the manuscript. However, there are some few outstanding issues to address in order to 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 few points raised during the review process particularly by the second reviewer.

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We look forward to receiving your revised manuscript.

Kind regards,

Sulemana Bankuoru Egala

Academic Editor

PLOS One

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Reviewers' comments:

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-->Comments to the Author

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Reviewer #1: (No Response)

Reviewer #3: All comments have been addressed

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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 #3: Yes

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Reviewer #1: Yes

Reviewer #3: Yes

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Reviewer #1: Yes

Reviewer #3: Yes

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Reviewer #3: Yes

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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: (No Response)

Reviewer #3: The revised manuscript has addressed the major points raised in the previous round of review satisfactorily. The overall structure is clear, the objectives are well defined, and the methodological approach is appropriate for the research questions posed.

The data analysis is coherent and adequately supports the conclusions. The discussion section successfully links the findings to existing literature, although minor strengthening of the theoretical implications would further enhance the manuscript’s contribution.

1. Minor language polishing is recommended, particularly in the Introduction and Discussion sections, to improve clarity and flow.

2. Please ensure consistency in terminology and formatting throughout the manuscript.

3. Where applicable, adding brief justifications for selected analytical parameters would improve methodological transparency.

Overall, the manuscript is scientifically sound and suitable for publication after minor revisions.

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Reviewer #1: No

Reviewer #3: Yes:    Alexander Adrian Saragi

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Attachments

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Submitted filename: Plos one accept.docx

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PONE-D-25-24730R2

The use of social media in PRiVENT to raise awareness of long-term invasive ventilation

PLOS One

Dear Dr. Trudzinski,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that the manuscript still falls short of the quality desired for publication in its current form. Consequently, we have decided to request another round of major revisions to enable you to thoroughly revise the manuscript to ensure it is fit for purpose.

While Reviewer 6 recommends acceptance, Reviewer 5 has raised critical concerns that are essential to address in order to make the manuscript suitable for publication in this journal. Specifically, these concerns relate to the conceptual framing and theoretical rigor, weak methodological approaches and operationalization of targets, and insufficient contributions.

Therefore, we invite you to submit a revised version of the manuscript that addresses the critical points raised during the review process, particularly those noted by Reviewer 5.

We wish to stress that this stage is very critical in accordance with the journal's standards, and we recommend that you adequately address all the issues raised by the reviewer.

Please submit your revised manuscript by May 02 2026 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A 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'.
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• 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,

Sulemana Bankuoru Egala

Academic Editor

PLOS One

Journal Requirements:

If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise.

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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 #5: (No Response)

Reviewer #6: All comments have been addressed

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

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #5: Partly

Reviewer #6: Yes

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

Reviewer #5: I Don't Know

Reviewer #6: Yes

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

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

Reviewer #5: Yes

Reviewer #6: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #5: Yes

Reviewer #6: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #5: Review of manuscript no. PONE-D-25-24730

1. Conceptual overclaim: The central problem is conceptual. The study claims to assess whether social media “raises awareness,” yet no awareness, knowledge, attitude, perception, or behavioral outcomes were measured. Only platform analytics (views, impressions, followers) were analyzed. Visibility cannot be equated with awareness or empowerment. The conclusions therefore overstate what the data support. The manuscript must either (a) narrow its claims to “digital reach and engagement,” or (b) include outcome measures demonstrating actual awareness impact.

2. Lack of theoretical framework: The manuscript is descriptive and operational but theoretically underdeveloped. There is no engagement with communication theory, health literacy frameworks, public sphere theory, digital engagement models, or knowledge translation literature. For a paper that positions itself around “public awareness,” this absence is a major weakness. The introduction should be grounded in established frameworks of science communication, digital health communication, or misinformation research.

3. Methodological limitation: purely descriptive analytics: The study design is retrospective and purely descriptive. There is no comparator (e.g., before–after, control topic, similar campaigns), no inferential analysis, no engagement rate calculation (per post, per follower), and no evaluation of content effectiveness beyond raw counts. Without normalization or benchmarking, the 2.6 million views cannot be interpreted. The analysis lacks analytical depth and risks being perceived as a campaign report rather than research.

4. Weak operationalization of target groups: The manuscript assumes that certain demographic distributions (e.g., young female Instagram users) indicate successful reach of nurses. This inference is speculative. No direct occupational verification exists. Similarly, LinkedIn professional categories are interpreted as specific healthcare roles without validation. The conclusions about reaching intended target groups are not sufficiently supported by the data.

5. Limited contribution: From a scholarly perspective, the contribution is unclear. Many health projects use social media; descriptive reporting of output volume and views is not, in itself, novel. The manuscript needs to clarify what new knowledge this study generates for digital health communication, implementation science, or public engagement research. At present, it reads as documentation of project dissemination activities.

6. Discussion lacks critical reflection: The discussion remains largely affirmative. There is minimal critical interrogation of:

• algorithmic bias.

• paid promotion effects.

• regional targeting limitations.

• sustainability of engagement.

• potential echo-chamber effects.

• cost-effectiveness.

Hence, a more rigorous critical appraisal is required.

Overall assessment: The topic is relevant and socially meaningful. The execution of the campaign appears substantial. However, as a scientific manuscript, it currently overinterprets descriptive analytics and lacks theoretical and methodological depth. Substantial revision is required to align claims with evidence and to clarify the scholarly contribution.

Reviewer #6: This paper investigates the use of social media in the PRiVENT project to raise awareness of long-term invasive ventilation. While the methodological approach is relatively basic, it is highly appropriate and sufficient for the research objective.

The manuscript's core strength lies in its significant practical application and strong social value. By addressing a critical health communication need through social media, the findings offer actionable insights for public health practitioners and related initiatives. The paper is well-structured and clearly written. Given its robust practical contribution, I recommend this manuscript for acceptance.

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Reviewer #5: No

Reviewer #6: Yes:    chen jinghao

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-->PONE-D-25-24730R3-->-->Social media activities to enhance the visibility of long-term invasive ventilation: A content and visibility analysis from the PRiVENT study -->-->PLOS One

Dear Dr. Franziska Trudzinski,

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.-->--> -->-->Specifically, reviewer 3 acknowledges that the manuscript has improved, particularly in aligning claims with the descriptive nature of the data, and that the topic is socially relevant and underexplored. However, several issues remain that require attention before acceptance. These include: further softening of interpretative claims based solely on view counts, adding basic analytical depth (e.g., normalization of metrics, temporal or benchmarking analysis), strengthening statistical description (even within a descriptive framework), tempering inferred audience characteristics without direct evidence, clarifying the novel scholarly contribution relative to digital health communication literature, and expanding critical discussion to include algorithmic bias, paid vs. organic reach, sustainability, echo chambers, and cost-effectiveness. Minor language, structural, and data availability improvements are also requested.

Given that these revisions do not require new data collection or fundamental changes to the study design, a minor revision is sufficient to address the reviewer’s concerns.

-->-->Please submit your revised manuscript by Jun 18 2026 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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We look forward to receiving your revised manuscript.

Kind regards,

Sulemana Bankuoru Egala (PhD)

Academic Editor

PLOS One

Journal Requirements:

If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise.

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.

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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 #3: All comments have been addressed

Reviewer #6: All comments have been addressed

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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 #3: Partly

Reviewer #6: Yes

**********

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

Reviewer #3: No

Reviewer #6: Yes

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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 #3: No

Reviewer #6: 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 #3: Yes

Reviewer #6: Yes

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-->6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)-->

Reviewer #3: The manuscript addresses a socially relevant and underexplored topic, namely the role of social media in increasing the visibility of long-term invasive mechanical ventilation (IMV). The authors present a substantial communication effort through the PRiVENT project, and the dataset spans multiple years and platforms, which is commendable. The revision has improved the manuscript, particularly in aligning claims with the descriptive nature of the data. However, several critical issues remain that limit the scientific contribution of the study.

Major Comments

1. Conceptual Framing and Claims

The authors have improved the terminology by shifting from “awareness” to “visibility” and “reach,” which is appropriate. However, some residual interpretative statements still imply user interest or informational needs based solely on view counts. These interpretations should be further softened, as platform analytics cannot capture cognitive engagement, understanding, or behavioral impact.

2. Methodological Limitations and Analytical Depth

The study remains purely descriptive. While the authors acknowledge this limitation, the manuscript still lacks analytical depth expected for a research article. Specifically:

- No normalization of metrics (e.g., engagement rate per post or per follower) is provided.

- No temporal or comparative analysis (e.g., trends over time, pre/post campaign phases) is included.

- No benchmarking against similar campaigns or baseline metrics is attempted.

As a result, the reported figures (e.g., 2.6 million views) remain difficult to interpret in a meaningful scientific context.

3. Statistical Analysis

The absence of inferential or even basic comparative statistical analysis significantly weakens the rigor of the study. Even within a descriptive framework, additional analyses (e.g., distribution comparisons across platforms or content types) could strengthen the manuscript.

4. Operationalization of Target Groups

Although the authors have removed earlier overinterpretations, the discussion still occasionally suggests inferred audience characteristics (e.g., healthcare professionals, nurses) without direct evidence. Platform-derived demographic and professional data should be treated with caution and clearly labeled as indirect indicators.

5. Scholarly Contribution

The manuscript still struggles to clearly articulate its novel contribution. While documenting a large-scale communication effort is valuable, the authors should more explicitly position their findings within digital health communication literature. What transferable insights does this study offer beyond descriptive reporting? This point requires further strengthening.

6. Discussion and Critical Reflection

The discussion has improved but remains somewhat limited in critical depth. Important aspects are still underdeveloped, including:

- Algorithmic bias and platform-specific visibility mechanisms

- The role of paid promotion versus organic reach

- Sustainability of engagement over time

- Potential echo-chamber effects

- Cost-effectiveness of the campaign

A more critical and reflective discussion would significantly enhance the manuscript’s academic value.

Minor Comments

- Some grammatical inconsistencies and minor language issues remain and should be carefully proofread.

- The Methods section would benefit from clearer structuring, particularly in distinguishing between content production and analytical procedures.

- The Data Availability Statement does not fully comply with open data requirements; providing at least anonymized aggregated datasets in a repository would improve transparency.

The manuscript has improved compared to previous versions and addresses a relevant topic. However, it still requires moderate to major revision to enhance methodological rigor, analytical depth, and clarity of scholarly contribution before it can be considered suitable for publication.

Reviewer #6: Thank you for the revision. The manuscript has improved, especially by narrowing the claim from “raising awareness” to “enhancing visibility.” This better matches the available data, which mainly include views, reach, impressions, followers, and platform user profiles.

The study remains descriptive and does not directly measure awareness, knowledge change, patient outcomes, or behavioral effects. Its theoretical and methodological contributions are therefore limited. However, the manuscript documents a meaningful practice in digital health communication. The PRiVENT project produced substantial public-facing content, including blog posts, social media posts, and podcast episodes, on long-term invasive mechanical ventilation, a highly specialized and often overlooked topic.

I especially appreciate the practical value of providing plain-language information for patients, relatives, and healthcare professionals. The strong interest in basic explanatory content, such as weaning and invasive ventilation, suggests a real need for accessible information in this field.

I believe that the manuscript has now met the requirements for publication.

**********

-->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.

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Reviewer #3: Yes:    Alexander Adrian Saragi

Reviewer #6: Yes:    chen jinghao

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-->

-->PONE-D-25-24730R4-->-->Social media activities to enhance the visibility of long-term invasive ventilation: A content and visibility analysis from the PRiVENT study -->-->PLOS One

Dear Dr. Franziska Trudzinski,

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.-->--> -->-->Soecifically, it is acknowledged that the manuscript addresses an important, underexplored topic (digital communication for long-term invasive mechanical ventilation and weaning) and notes that the revised version has improved substantially, particularly in the appropriate use of “visibility”/“reach” and a more balanced discussion of limitations. However, several issues require further refinement before publication. The reviewer raises four gemaine comments focused on strengthening the scholarly framing and interpretation:

1. Position the work better within digital health communication literature and articulate transferable scientific insights beyond a project report.

2. Soften claims about “unmet needs” or professional group targeting, as platform analytics cannot reliably infer motivations or identities.

3. Move beyond descriptive reporting; discuss comparative content performance or provide more structured interpretation of longitudinal data (e.g., Figure 2).

4. Better integrate digital health communication theory throughout, not just briefly in the introduction.

Other minor comments include grammatical and typographical fixes, formatting inconsistencies, an unrelated reference (#10) should be corrected, improved figure legends, and language polishing by a native English speaker.

We hope the comments will be addressed timely and adequately for consideration and publiucation.

Please submit your revised manuscript by Jul 04 2026 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

-->

• A 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.

As the corresponding author, your ORCID iD is verified in the submission system and will appear in the published article. PLOS supports the use of ORCID, and we encourage all coauthors to register for an ORCID iD and use it as well. Please encourage your coauthors to verify their ORCID iD within the submission system before final acceptance, as unverified ORCID iDs will not appear in the published article. Only    the individual author can complete the verification step; PLOS staff cannot    verify ORCID iDs on behalf of authors.

We look forward to receiving your revised manuscript.

Kind regards,

Sulemana Bankuoru Egala (PhD)

Academic Editor

PLOS One

Journal Requirements:

If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise.

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.

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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 #3: All comments have been addressed

Reviewer #4: All comments have been addressed

Reviewer #6: All comments have been addressed

Reviewer #7: 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 #3: Yes

Reviewer #4: Yes

Reviewer #6: Yes

Reviewer #7: Yes

**********

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

Reviewer #3: Yes

Reviewer #4: Yes

Reviewer #6: Yes

Reviewer #7: 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 #3: Yes

Reviewer #4: Yes

Reviewer #6: Yes

Reviewer #7: 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 #3: Yes

Reviewer #4: Yes

Reviewer #6: Yes

Reviewer #7: 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 #3: The revised manuscript has improved substantially compared with previous versions. The authors have responded carefully and constructively to the major concerns raised during the earlier review rounds, particularly by refining the conceptual framing from “awareness” to “visibility” and “reach,” which is more consistent with the descriptive nature of the available platform metrics.

The manuscript now presents a clearer and more balanced interpretation of the findings. The authors appropriately acknowledge that platform analytics cannot directly measure cognitive engagement, knowledge acquisition, or behavioral change. The expanded discussion of methodological limitations, including the heterogeneity of platform metrics, lack of standardized benchmarking, absence of a pre-intervention baseline, and limited comparability across platforms, significantly strengthens the scientific transparency of the study.

The restructuring of the Methods section has also improved readability, especially the clearer distinction between content production and analytical procedures. In addition, the public availability of anonymized aggregated data through Zenodo enhances the transparency and reproducibility of the work.

Although the study remains primarily descriptive and lacks inferential statistical analyses, the authors now position the manuscript appropriately as an exploratory and hypothesis-generating contribution within digital health communication research. The expanded discussion addressing algorithmic bias, sustainability of engagement, echo-chamber effects, and the limitations of platform-derived demographic indicators further improves the manuscript’s scholarly value.

The topic itself is socially relevant and underexplored. The manuscript documents an extensive and sustained multi-platform communication initiative focused on long-term invasive mechanical ventilation, a field that remains underrepresented in public health communication. The findings may provide useful practical insights for future digital communication strategies in specialized healthcare domains.

Only minor editorial polishing may still be beneficial prior to publication, particularly with regard to small grammatical inconsistencies and formatting details. Overall, however, I believe the manuscript is now suitable for publication.

Reviewer #4: SOCIAL MEDIA ACTIVITIES TO ENHANCE THE VISIBILITY OF LONG-TERM INVASIVE VENTILATION: A CONTENT AND VISIBILITY ANALYSIS FROM THE PRIVENT STUDY

The manuscript addresses an important and underexplored topic, namely the use of social media and digital communication strategies to enhance the visibility of long-term invasive mechanical ventilation (IMV) and ventilator weaning. The PRiVENT project represents a substantial multi-platform communication effort conducted over several years and involving different stakeholder groups. The topic is socially relevant and the manuscript provides valuable practical insights into digital health communication in a highly specialized medical field.

The revised version has improved considerably compared with earlier versions, particularly through the more appropriate use of the terms “visibility” and “reach” instead of “awareness,” which better reflects the descriptive nature of the available data. The authors also provide a more balanced discussion of the study limitations.

However, several issues still require further refinement before publication.

Major comments

1. Clarification of scholarly contribution

Although the manuscript documents a meaningful communication initiative, the scientific contribution remains somewhat unclear. The study is primarily descriptive and resembles a project report in several sections. The authors should further strengthen the positioning of the manuscript within the broader digital health communication literature and more explicitly explain what transferable scientific insights can be derived from this work beyond reporting platform metrics and content dissemination activities.

2. Overinterpretation of platform metrics

The manuscript has improved substantially in avoiding unsupported claims; however, some statements still imply audience needs or audience composition without direct evidence. For example, statements suggesting that the observed access patterns indicate an “unmet need” or that specific professional groups were reached should be softened further. Platform analytics and view counts cannot reliably establish user motivations, informational needs, or professional identities. More cautious wording such as “may suggest” or “could reflect” would be more appropriate.

3. Limited analytical depth

The analysis remains largely descriptive. While the limitations of platform-specific metrics are acknowledged, the manuscript would benefit from additional analytical depth where feasible. Even within a descriptive framework, the authors could further discuss comparative performance across content categories or provide more structured interpretation of longitudinal developments shown in Figure 2. At present, the manuscript relies heavily on absolute numbers without deeper contextual interpretation.

4. Theoretical framing

The introduction would benefit from stronger integration of digital health communication theory. The manuscript briefly refers to digital engagement and health information seeking, but these concepts are not sufficiently developed throughout the paper. A clearer theoretical framing would strengthen the academic value of the study and help contextualize the findings within existing communication research.

Minor comments

1. Several grammatical inconsistencies and typographical issues remain throughout the manuscript and should be carefully proofread.

2. There are occasional formatting inconsistencies, including spacing and punctuation issues.

3. A clear reference mismatch appears in reference 10 (“Partial crowns as bridge abutments”), which seems unrelated to the topic of the manuscript and should be corrected.

4. Some figure legends could be improved for clarity and readability.

5. The manuscript would benefit from minor language polishing by a native English speaker or professional editing service.

Overall assessment

Overall, this manuscript addresses a relevant and specialized topic and provides useful practical insights into digital communication strategies in the field of long-term invasive mechanical ventilation. While the study remains primarily descriptive and has limited analytical depth, the revisions have substantially improved the manuscript’s balance and transparency. With additional clarification of the scholarly contribution, careful reduction of residual overinterpretation, and minor editorial corrections, the manuscript would be suitable for publication.

Reviewer #6: The manuscript has improved, particularly in aligning the claims with the available data and in clarifying that platform metrics reflect visibility and reach rather than awareness, knowledge change, or behavioral impact. The study remains mainly descriptive, and its theoretical and methodological contribution is limited by the absence of standardized platform metrics, inferential analysis, and direct measures of audience engagement or outcomes. However, the topic is important, underrepresented, and socially meaningful. The manuscript provides useful documentation of a structured, multi-platform communication effort in the field of long-term invasive mechanical ventilation, with practical relevance for digital health communication, patients, relatives, and healthcare professionals.

Reviewer #7: The use of social media in PRiVENT to raise awareness of long-term invasive

ventilation

I thank the authors of this work for the important task provided with the PRIVENT project, about information spreading on long-term invasive mechanical ventilation.

I have seen the work and its progress across the multiple revisions. The authors have done a great job improving the content a lot by following the reviewers' suggestions in this 4-stage revision.

I think that now the manuscript is ready for acceptance and publication.

**********

-->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 #3: Yes:    Alexander Adrian Saragi

Reviewer #4: No

Reviewer #6: Yes:    chen jinghao

Reviewer #7: 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.]

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NAAS will assess whether your figures meet our technical requirements by comparing each figure against our figure specifications.

-->

Attachments

Attachment

Submitted filename: Plos One social media.docx

Social media activities to enhance the visibility of long-term invasive ventilation: A content and visibility analysis from the PRiVENT study

PONE-D-25-24730R5

Dear Dr. Franziska Trudzinski,

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,

Sulemana Bankuoru Egala (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 #3: All comments have been addressed

Reviewer #6: All comments have been addressed

Reviewer #7: 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 #3: Yes

Reviewer #6: Yes

Reviewer #7: Yes

**********

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

Reviewer #3: Yes

Reviewer #6: Yes

Reviewer #7: Yes

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

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

Reviewer #3: Yes

Reviewer #6: Yes

Reviewer #7: Yes

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-->5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.-->

Reviewer #3: Yes

Reviewer #6: Yes

Reviewer #7: Yes

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-->6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)-->

Reviewer #3: Thank you for the thorough revision of the manuscript and for carefully addressing the comments raised during the previous review rounds.

The revised version demonstrates substantial improvement in several important areas. The authors have strengthened the theoretical framing of digital health communication, clarified the scientific contribution of the study, and adopted more cautious interpretations regarding platform analytics and audience characteristics. The discussion now better reflects the descriptive nature of the available data and appropriately acknowledges the limitations associated with visibility and reach metrics.

I also appreciate the additional contextual interpretation of longitudinal trends, the improved figure legends, correction of the reference inconsistencies, and the overall enhancement of language clarity and manuscript organization. The availability of an anonymized dataset through a public repository further improves transparency and reproducibility.

While the study remains primarily descriptive, the manuscript now provides a valuable real-world example of how a coordinated multi-platform communication strategy can be implemented in a highly specialized healthcare setting. The conclusions are appropriately aligned with the presented evidence and avoid unsupported claims regarding awareness or behavioral impact.

Overall, I believe that the authors have adequately addressed the concerns raised in previous review rounds. The manuscript is technically sound, clearly presented, and suitable for publication in its current form.

I have no further comments.

Reviewer #6: The manuscript has undergone several rounds of revision, and the current version shows clear improvement. The authors have adequately addressed the major concerns raised previously. I do not have further substantive comments.

Reviewer #7: The use of social media in PRiVENT to raise awareness of long-term invasive

ventilation

I thank the authors of this work for the important task provided with the PRIVENT project, about information spreading on long-term invasive mechanical ventilation.

I have seen the work and its progress across the multiple revisions. The authors have done a great job improving the content a lot by following the reviewers' suggestions in this 5-stage revision.

I think that now the manuscript is ready for acceptance and publication.

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-->7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

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Reviewer #3: Yes:    Alexander Adrian Saragi

Reviewer #6: Yes:    chen jinghao

Reviewer #7: No

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