PONE-D-21-22371

Effects of a Social Support Family Caregiver Training Program on Changing Blood Pressure and Lipid Levels among Elderly at risk of Hypertension in a Northern Thai Community

PLOS ONE

Dear Dr. Seangpraw,

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PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

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

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

Reviewer #1: Partly

Reviewer #2: Yes

Reviewer #3: Partly

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: No

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

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: 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: This randomized interventional study evaluates the effects of a Social Support Family Caregiver Training Program (SSFCTP) on changing blood pressure and lipid levels among elderly at risk of hypertension. This is an interesting study.

My major concern is that in intervention arm, the authors conducted not only SSFCTP but also weight management, alcohol consumption, smoking, physical activity, taking medication, BP and cholesterol control, and self-regulation. How the authors purify the SSECTP effect in this setting?

Reviewer #2: This paper was a clinical trial study in a northern Thai community. This study was showed that elderly people at risk of hypertension increased knowledge about hypertension using SSFCTP and importance of caregivers.

Although this manuscript is interesting and meaningful, there are some concerns in it.

Major comments

1) The most serious concern is a short-term study in 12 weeks. We would like to know odds ratio or hazard ratio for morbidity of hypertension. Increasing knowledge about hypertension keeps blood pressure good, and prevent of hypertension will be make it decreased. This paper should focus on blood pressure.

2) Are there any clinical implications in your study? I think SSFCTP is a meaningful program. But SSFCTP has several contents such as knowledge, efficacy, and behavior. Which content was a most important for health and blood pressure?

3) Table4 and Table5 were so complicated. These tables should be represented in figures as you emphasized variables.

Minor comments

In line at 477, the paper was written TSSFCP. Does it mean SSFCTP?

Reviewer #3: Present study corresponds to two arm parallel group randomized controlled trial. I have several reservations about the study which needs further explanations.

1. It looks like two groups (treatment and control) are collected from two entirely different village/region. This mean the effect due to particular location cannot be eliminated. This is true randomization authors must explain why this is done and the possible weakness of the findings.

2. Elderly and caregiver are they belong to the same family, or they are chosen at random is not clear. If they are form same family they from a dyad which must be accounted for during statistical modelling.

3. The most serious concern is the power analysis presented in the paper (line 134-140). It states a two-sample t-test is used to power the study. Yet the main analysis proposed is RMANOVA. Repeated measure ANOVA is the correct model for longitudinal design, however, same model must be used for power analysis, which is not done. The paper also report pre-post type design for which t-test can be used for power analysis, but then RMANOVA should not be used for data analysis. More importantly region effect and dyad effect (if true) should be part of the model building. From the table 3 reporting it is clear RMANOVA is the right model but the study is not powered properly.

4. What about missing data and multiple testing issues, which is not addressed sufficiently. Please clearly stated which one is/are primary outcome/s. In table 3 multiple interaction term is tested, which means multiple testing correction must be used as otherwise type-1 error rate will be inflated. This may indicate the study is under-powered.

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

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Effects of a Social Support Family Caregiver Training Program on Changing Blood Pressure and Lipid Levels among Elderly at risk of Hypertension in a Northern Thai Community

PONE-D-21-22371R1

Dear Dr. Seangpraw,

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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Kind regards,

Yoshihiro Fukumoto

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 #1: All comments have been addressed

Reviewer #2: 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 #1: (No Response)

Reviewer #2: Yes

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

Reviewer #1: (No Response)

Reviewer #2: 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 #1: (No Response)

Reviewer #2: 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 #1: (No Response)

Reviewer #2: 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 #1: (No Response)

Reviewer #2: (No Response)

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

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No