A conceptual model on caregivers’ hesitancy of topical fluoride for their children

Donald L. Chi; Darragh Kerr; Daisy Patiño Nguyen; Mary Ellen Shands; Stephanie Cruz; Todd Edwards; Adam Carle; Richard Carpiano; Frances Lewis

doi:10.1371/journal.pone.0282834

Peer Review History

Original SubmissionDecember 29, 2022
6 Feb 2023 Decision Letter - Boyen Huang, Editor PONE-D-22-35556A conceptual model on caregivers’ hesitancy of topical fluoride for their childrenPLOS ONE Dear Dr. Chi, 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 23 2023 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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Note that it is not acceptable for the authors to be the sole named individuals responsible for ensuring data access. We will update your Data Availability statement to reflect the information you provide in your cover letter. 5. 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 If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references.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 If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.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: Dear Dr. Chi, Thank you for submitting your manuscript to PLOS ONE. I enjoyed reading your work. Please see the reviewers' comments and respond accordingly. Regards, Boyen Huang [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: 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 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: No ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Could not access Appendix A as referred to in the text. Received no response from Plos One when requested this. Definitions are required of methods used and references citations need to corrected. See other comments on attached feedback. Reviewer #2: This is a well-written article on an important topic in clinical dentistry. The methods are sound and the data are presented well. It was an enjoyable read. The authors state that some carers have conspiracy theory type views, whereas others’ hesitancy could really be consistent with clinical guidelines anyway. What will help the general reader is a clear statement of the current guidelines for topical fluoride application, presumably from Reference 46 or the American Dental Association or equivalent bodies. Furthermore, what is the current practice with fluoride application at the study site? Is topical fluoride recommended for all children? Do clinicians take steps that are necessary to prevent fluorosis? The text in the two paragraphs of the Discussion on reshaping dental practitioner behavior (p22-23) cover important contents and should appear earlier on. A long explanation (discussion) carries the risk of such important messages being lost in the details. Some of the text on future studies could appear much later. A more succinct explanation could also help to keep readers interested. An important area to explore would be mapping carer’s attitude with clinical data on caries risk and provider’s recommendation for topical fluoride application. I realise this is probably out of the scope of the current project, in which case the limitation should be acknowledged in the Discussion section. I have made some more relatively minor suggestions below. P3, last paragraph: The sentence ‘Patients have also increasingly scrutinized providers for promoting treatments that generate income [33]’ could be better expressed using the term ‘overtreatment’. It is not only patients but also the general public, academics and regulatory bodies that are scrutinizing overtreatment, so the sentence could be better written as, “There is also an increasing scrutiny over overtreatment ….”. P5: [9, 35-36] P17, Domain 5: … to question its necessity… P19: Non-US readers may not understand what AIAN means, so please use its full form with abbreviation in brackets the first time it appears in text. Alternatively, if it does not appear elsewhere in the text, please just use the full form. P21: Please simplify this sentence as it is a bit too long, “Such an approach might be interpreted by some caregivers as being insensitive, but mis-specified education could also come across as dismissive or make hesitant caregivers feel like they are being pressured to accept fluoride, leading to reactance.” References: Please ensure formatting consistency, e.g., sentence case or first letter capitalization for title, and inclusion or exclusion of publication date. Reference 41 – please insert web-link. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. Attachments Attachment Submitted filename: PONE-D-22-35556_reviewer.pdf https://doi.org/10.1371/journal.pone.0282834.r001
Revision 1
10 Feb 2023 Author Response Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ________________________________________ 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: 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 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: No We are not able to share the qualitative interview scripts because the data contain potentially identifying or sensitive patient information. We have provided institutional contact information to which data requests may be sent. ________________________________________ 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ________________________________________ 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Could not access Appendix A as referred to in the text. Received no response from Plos One when requested this. Definitions are required of methods used and references citations need to corrected. See other comments on attached feedback. We apologize for this oversight. Both Appendix A and B have been provided as Supplementary Table 1 and Supplementary Table 2. Revisions have been made to address concerns related to the Methods section and reference citations. We have also made revisions based on comments on the PDF. Thank you very much for the careful review. Reviewer #2: This is a well-written article on an important topic in clinical dentistry. The methods are sound and the data are presented well. It was an enjoyable read. The authors state that some carers have conspiracy theory type views, whereas others’ hesitancy could really be consistent with clinical guidelines anyway. What will help the general reader is a clear statement of the current guidelines for topical fluoride application, presumably from Reference 46 or the American Dental Association or equivalent bodies. Furthermore, what is the current practice with fluoride application at the study site? Is topical fluoride recommended for all children? Do clinicians take steps that are necessary to prevent fluorosis? Thank you for this clarifying point. The relevant part of the Discussion section has been expanded to make it clear that the American Academy of Pediatric Dentistry recommends topical fluoride for children at risk for caries (and not all children). Language was included that almost all clinics offer topical fluoride to all children. Topical fluoride is not recommended for all children. Fluorosis is related to chronic ingestion of fluoride, and therefore the topical fluoride provided during medical and dental visits is not considered a risk factor. The text in the two paragraphs of the Discussion on reshaping dental practitioner behavior (p22-23) cover important contents and should appear earlier on. A long explanation (discussion) carries the risk of such important messages being lost in the details. Some of the text on future studies could appear much later. A more succinct explanation could also help to keep readers interested. We agree the discussion points about reshaping providers’ behaviors is important. However, we wanted to place these points after discussing the main findings related to the conceptual model, which was the primary aim of the study. Therefore, placement of these paragraphs was not altered. We agree parts of the discussion section could be cut to reduce wordiness and keep readers interested. These changes are reflected in the revised paper. An important area to explore would be mapping carer’s attitude with clinical data on caries risk and provider’s recommendation for topical fluoride application. I realise this is probably out of the scope of the current project, in which case the limitation should be acknowledged in the Discussion section. Unfortunately, we do not have clinical data on the children. But this is an excellent point and is the topic of future investigations. This is included as a study limitation. I have made some more relatively minor suggestions below. P3, last paragraph: The sentence ‘Patients have also increasingly scrutinized providers for promoting treatments that generate income [33]’ could be better expressed using the term ‘overtreatment’. It is not only patients but also the general public, academics and regulatory bodies that are scrutinizing overtreatment, so the sentence could be better written as, “There is also an increasing scrutiny over overtreatment ….”. We agree. This has been fixed as suggested. P5: [9, 35-36] This has been fixed. P17, Domain 5: … to question its necessity… Done. P19: Non-US readers may not understand what AIAN means, so please use its full form with abbreviation in brackets the first time it appears in text. Alternatively, if it does not appear elsewhere in the text, please just use the full form. Great point. This has been revised. P21: Please simplify this sentence as it is a bit too long, “Such an approach might be interpreted by some caregivers as being insensitive, but mis-specified education could also come across as dismissive or make hesitant caregivers feel like they are being pressured to accept fluoride, leading to reactance.” This has been broken into 2 sentences. References: Please ensure formatting consistency, e.g., sentence case or first letter capitalization for title, and inclusion or exclusion of publication date. Done. Reference 41 – please insert web-link. Done. ________________________________________ 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0282834.r002
24 Feb 2023 Decision Letter - Boyen Huang, Editor A conceptual model on caregivers’ hesitancy of topical fluoride for their children PONE-D-22-35556R1 Dear Dr. Chi, 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 for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Boyen Huang, DDS, MHA, 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 #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? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ****** 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 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 ****** 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: Yes Reviewer #2: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Thank you to the authors for addressing the reviewers concerns. This article is now worthy of publication and will challenge clinicians to provide evidence based and holistic care rather than the seemly current approach to apply fluoride to all. Reviewer #2: (No Response) ****** 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 ******** https://doi.org/10.1371/journal.pone.0282834.r003
Formally Accepted
28 Feb 2023 Acceptance Letter - Boyen Huang, Editor PONE-D-22-35556R1 A conceptual model on caregivers’ hesitancy of topical fluoride for their children Dear Dr. Chi: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. 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. If we can help with anything else, please email us at plosone@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 Dr Boyen Huang Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0282834.r004

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