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The authors have addressed all of the reviewers' comments.
Please take into consideration the comments of reviewer 5.
No comment. The authors have addressed all my concerns.
No comment. The authors have addressed all my concerns.
No comment. The authors have addressed all my concerns.
All tasks were addressed by authors.
All tasks were addressed by authors.
All tasks were addressed by authors.
All tasks were addressed by authors.
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Please find attached, the reviewed document. The corrections I made has been accepted. The authors just need to correct the grammar in one or two places e.g on the title instead of practice to, should be practice of. These has been pointed out in the manuscript.
I recruited additional reviewers for this review because I received opposing recommendations from previous reviewers.
The reviewers are unanimous that the manuscript requires another round of revision. Please take into consideration all the reviewers' comments.
The manuscript provides valuable insights into the factors influencing facemask use and disposal among the residents of the Kingdom of Saudi Arabia during the COVID-19 pandemic. Here are my overarching comments based on each section of the manuscript:
ABSTRACT
The abstract is informative and concise. However, the authours may consider restructuring some sentences for better flow and clarity. For example, in the first sentence, consider breaking it into two sentences for easier readability. While the abstract provides a good overview, they may consider adding more specific details about the study design and key findings. They may include information on the sample size and demographic characteristics for a clearer understanding. They should ensure that the keywords listed are highly relevant to the content of the abstract. So, the authours can consider adding specific terms related to facemask use and public behavior.
INTRODUCTION
Background Information: The introduction effectively sets the stage by providing background information on the COVID-19 pandemic and its impact on Saudi Arabia. The authours can add a brief mention of the global context to emphasize the universality of the issue, as there are numerous published articles on this topic globally.
Objectives and Research Questions: They should clearly state the objectives of the study and specify the research questions the study aims to address. This will provide readers with a roadmap for the remainder of the manuscript.
Literature Review: The authors should enhance the literature review by citing relevant studies that support the need for investigating facemask usage during the COVID-19 pandemic. For example, they may consider this article if you find it relevant (doi: 10.1016/j.rcradv.2023.200148). This will strengthen the rationale for their research.
**PeerJ Staff Note:** It is PeerJ policy that additional references suggested during the peer-review process should only be included if the authors are in agreement that they are relevant and useful.
Transition to Methods: The authors can consider adding a brief paragraph at the end of the introduction that serves as a smooth transition to the methods section. This can help readers understand how the study was designed to address the identified gaps.
DISCUSSION
Facemask Use: The authors should delve into the reasons behind the differences in facemask use among age groups. They should also explore potential factors influencing perceptions and behaviors, and consider how these insights can guide public health campaigns.
Sharing Facemasks and Removing Them During Meetings: The authors should discuss the findings related to sharing facemasks and removing them during social or personal meetings. They should explore the implications of these behaviors for infection spread and suggest strategies for targeted education.
Efficacy and Reuse of Medical Facemasks: The authors need to emphasize the importance of knowledge regarding the efficacy and reuse of facemasks, especially given the potential environmental impact of improper disposal. They need to discuss the role of education in promoting responsible facemask use.
Proper Disposal Practices: The authors need to highlight the positive finding that the adult population and participants with higher education tend to dispose of facemasks properly. They should also discuss strategies for extending this knowledge to other demographic groups.
In conclusion, the authors need to provide a more in-depth analysis of the findings and their implications. Consider incorporating relevant literature to support your interpretations (doi: 10.1016/j.rcradv.2023.200148).
**PeerJ Staff Note:** It is PeerJ policy that additional references suggested during the peer-review process should only be included if the authors are in agreement that they are relevant and useful.
Study Design and Settings: The authors need to specify the rationale for selecting Abha City as the study location. They should provide information on why it's representative or unique in the context of facemask use during the pandemic.
Sampling Method: The authors need to elaborate on the decision to use non-probabilistic convenience sampling. They need to acknowledge its limitations and discuss how this might affect the generalizability of the results.
Questionnaire and Data Collection: The authours need to xplain the reasoning behind the selection of the questionnaire items. They need to ensure clarity on how the questions were formulated to address the study objectives.
Statistical Analysis: The authours need to provide a brief explanation of why binomial logistic regression analysis was chosen. They should discuss any assumptions made and how they align with the study's objectives.
In summary, the manuscript's findings appear valid within the context of the study design and acknowledged limitations. The transparent reporting of limitations adds credibility to the study, and the insights gained contribute meaningfully to the understanding of facemask-related behaviors during the COVID-19 pandemic. Here is my point-by-point or detailed analysis of the validity of the manuscript:
Study Design and Sample: The cross-sectional questionnaire-based design is suitable for capturing a snapshot of attitudes and practices during a specific period. Convenience sampling might limit the generalizability of the findings to a broader population, and it's acknowledged as a limitation in the manuscript.
Data Collection and Questionnaire: The use of a web-based platform for data collection is relevant, given the constraints posed by the pandemic. The questionnaire's development based on established guidelines and literature enhances its content validity.
Demographic Characteristics: The demographic characteristics of the sample, such as age, gender, and education, are well-detailed. However, the manuscript acknowledges the limitations of regional differences within Saudi Arabia.
Statistical Analysis: The use of binomial logistic regression for statistical analysis is appropriate for assessing the relationship between demographic variables and facemask-related behaviors.
Limitations: The manuscript appropriately acknowledges limitations, such as the non-probabilistic sampling method, small sample size, potential bias in self-reported data, and the need for cautious interpretation due to the study design.
Consistency and Clarity: The findings are presented in a clear and concise manner, enhancing the manuscript's readability.
This article is crafted in proficient and clear English, maintaining a consistent tone of clarity and professionalism throughout. It not only meets the language requirement by being written in English but also employs unambiguous and technically accurate language. Additionally, the article adheres to professional standards of courtesy and expression. Successfully integrating relevant literature references, the article provides ample field background and context, thereby enhancing its credibility and clearly situating itself within the broader field of knowledge. Conforming to an acceptable format with standard sections, as specified in our Instructions for Authors, the article ensures a structured presentation. The figures included are directly relevant to the content, offering sufficient resolution for effective comprehension. Each figure is appropriately described and labeled, contributing to reader clarity. In alignment with our data-sharing policy, the article fulfills the requirement by providing all relevant raw data. This commitment to transparency adds to the overall integrity of the research presented. Furthermore, the article is self-contained, serving as an appropriate unit of publication. It presents all results pertinent to the hypothesis without unnecessary subdivision, ensuring a comprehensive and coherent body of work.
This research systematically investigates the knowledge and practices associated with facemask use and disposal in a community context, effectively addressing a crucial knowledge gap. The study not only upholds rigorous ethical standards but also employs a robust methodology, ensuring the provision of ample information for reproducibility.
However, a notable concern arises in the "Materials and Methods" section, specifically regarding data collection. There is a lack of detailed information on whether the authors systematically examined the obtained data for completeness, accuracy, clarity, and consistency. It is crucial to ascertain whether measures were taken to validate the collected responses and if questionnaires with incomplete responses were deemed invalid.
To enhance transparency and address this issue, it is recommended that the "Questionnaire and data collection" section be expanded to explicitly discuss the process of data validation. This should include details on how the completeness, accuracy, clarity, and consistency of the collected data were assessed. Additionally, clarification on the handling of questionnaires with incomplete responses is essential to ensure the overall reliability of the study results.
The chosen study design employed by the authors may have certain limitations, as acknowledged by the authors themselves. The transparent acknowledgment of these limitations adds credibility and demonstrates a reasonable justification for acceptance. The statistical results are sound, and the figures and tables are appropriate for an academic study. The discussion and conclusion sections are well-articulated, contributing to the overall strength of the study.
Your study provides valuable insights into the factors influencing proper facemask usage among the public. The primary concern in this study is the relatively small sample size, posing challenges in accurately representing the broader population in the city. Nevertheless, it's commendable that you have conscientiously addressed all of my concerns in the study's limitations section, which serves as sufficient justification for the constraints faced in this research.
Manuscript was well written.
Study was supported with sufficient literature.
The research question should be stated in an unambiguous manner.
The title can be modified: see the comment on the manuscript.
Authors should check table 1 and ensure that the variables add up to 100%.
The study design was appropriate, the aim and the objective of the study was addressed.
The sampling technique was adequately described. However, the authors need to clearly show that they actually meant pilot study and not pre-test so as to apply the appropriate terminology (line 181). Please see my comment in the manuscript.
Findings are valid and they addressed the objectives.
I commend the authors for a detailed literature review. Nevertheless, they will need to make some corrections as pointed out above and in the body of the manuscript.
I would like to thank you for your efforts. However, the manuscript needs more effort (as suggested by reviewer 1).
Please take into consideration all the comments provided by reviewer 1 in the last revision.
Dear Authors,
I appreciate your efforts in addressing the comments I've provided over time.
However, I have concerns that the writing is not progressing in the direction I had hoped for, and for this reason, I'm hesitant to provide more comments as they may not be effectively addressed.
I wish you all the best as you continue to work on this manuscript, whether here or elsewhere.
Refer to my earlier comments
Refer to my earlier comments
Non at this time
I would thank the authors for their efforts to improve the quality of the manuscript. However, as recomeded by reviewer 1, the manuscript needs more efforts and it is not yet suitable for publication in its current form.
As an example, in the first sentence with a reference of 2020 even that of 2021 was outdated.
Revise
I'd like to point out that I've utilized the document with tracked changes to create my report.
Lines 1 and 2: The current title of this study is still unclear. I recommend considering an alternative title for better clarity. For example: “Examining Factors Influencing Public Knowledge and Adherence to Proper Face Mask Usage During the COVID-19 Pandemic: A Cross-Sectional Study.
Lines 38 to 44
-Addressing the tense issue requires further attention particularly in sections where it has been overlooked. For example, consider the following statement: “Since the use of facemasks is an unfamiliar practice among the public, ensuring the proper use of facemasks and predictors associated with suboptimal use is essential”. In this case, “Is” should be replaced with “was”. The same tense adjustments are needed in other sections of the manuscript where changes are necessary. This tense inconsistency contributes to the manuscript’s difficulty in being accessed, as the findings are presented considerably after the main context (the pandemic). Nonetheless, making these changes will lead to improvement.
-In addition, the entire manuscript also requires minor language edits. For instance, on line 38, “had a” should be replaced with “had an”
-Also, there is confusion surrounding the statement: “Since the use of facemasks is an unfamiliar practice among the public, ensuring the proper use of facemasks and predictors associated with suboptimal use is essential.” Please provide clarification, as this statement is unclear.
-Line 44 and 45: The tense in this statement needs to be adjusted. The original sentence is: "The current study aimed to assess the factors determining facemask use among the general public." This needs to be revised. For instance, it could be phrased as: "This study assessed the factors that determined face mask use among the general public."
-Line 58 to 60: The conclusion remains uncertain and lacks a clear resolution. It is important to provide context and emphasize the significance of this uncertain conclusion as a fitting ending.
-Line 60 t0 63: How does this study offer valuable insights? Please clarify this point.
-Line 57: The conclusion section of the abstract still lacks essential content, primarily because it doesn't clearly elucidate the significance of this study in the context of current times and the future concerning face masks. I continue to recommend incorporating additional information to enhance this segment. To illustrate, the authors might consider expanding the statement: "Thus, the prevention of such future endemics requires preparedness from health care agencies and the general public," by highlighting how this study's findings, specifically related to face masks, can hold benefits for the future. This aspect has already been partly addressed in the introduction section, which could be drawn upon for enhancement.
Furthermore, the use of the term "current" can be misleading. Please refer back to my previous comment for suggested improvements to this particular section.
-Line 262: I am not comfortable with the use of terms such as “subjects” and I think that this should be addressed in the revision of the manuscript.
-Line 75: For example, consider this aspect: please revisit my observation about the tense employed throughout the manuscript. I kindly ask you to refer back to my second comment and ensure that my request is consistently addressed across the entire manuscript.
- In instances like on Line 77 and elsewhere as necessary, I kindly request that you incorporate references to substantiate essential statements like the one presented here. This requirement also extends to the other sections of the manuscript where references might be absent.
-Line 86 and in similar instances throughout the text, I would like to draw your attention back to my latest comment regarding the necessity of including references to support statements. I kindly ask you to ensure that suitable citations are added throughout this entire paragraph.
-Line 107: It appears that this statement lacks the inclusion of the word “could” somewhere. Specifically, it should read “pandemic could…”
-Line 109 Vs 107: I’m puzzled by the authors’ usage of the terms “pandemic” and “endemic”. I kindly request the authors to provide clarification on this matter.
-Regarding the study as a whole: My primary concern revolves around the fact that despite the authors discussing the evaluation of proper face mask usage, this specific aspect was not actually examined within this study. It is imperative for the authors to address this particular issue in the study's limitations section. In addition to this, the study also might not have assessed the proper disposal of facemasks. Therefore, it is essential for the authors to include an additional statement addressing these limitations in the study limitations section.
-Line 114 to 117: This approach to the study is a step in the right direction. However, I believe there’s room for further refinement in this approach. I recommend that the authors explore ways to enhance this section. Similarly, the next section that discusses the effective management of used facemasks could also benefit from further improvement.
-Lines 219 to 222: The issue I'm referring to in my previous comment stems from this particular point. The study did not assess the "correct wearing of facemasks." I kindly request that this omission be acknowledged in the limitations section, accompanied by a comment discussing the potential implications of this absence on the reported study findings.
-Lines 250 to 255: Refer to my comment for Lines 219 to 222
I appreciate the authors' dedication to enhancing the manuscript. Given that you are reporting in a post-COVID-19 context, I hope you recognize the significance of presenting your findings with a clear demonstration of their relevance both presently and in the future.
Regarding the reference used in line 68, update it to suit the time of publication.
Line 205, equality is not well written.
Unify the phrase covid-19 throughout the scientific article. Sometimes I find a short phrase, see line 238.
The confidence interval provided on line 243 is invalid.
In the paragraph “Proper disposal technique” the statistical ranges are incorrect because the value does not fall within the confidence range.
The reason for the small sample size has not yet been mentioned. How do I choose this size, which is considered very small?
On the first page. When mentioning the results, especially with regard to the odds ratio, the statistical confidence interval must be established, as it is necessary for the researcher to ensure that the statistical test range matches.
The same thing applies to the statistical significance percentage. The level of significance must be mentioned and attached to the statistic of interest so that there is consistency and clarity in the presentation.
In the "Limitations" paragraph, it is necessary to mention appropriate statistical solutions to overcome these obstacles, such as proposing Bayesian theory as a corrector for ratios and fields due to its use of prior information.
The introduction needs to be extended.
The authors should precise that they study the practice of face mask wearing (and the related factors) and the knowledge about the face mask use (correct also in table 3 ). They should also define what do they define as "proper" and "improper".
Conversely, the discussion is too long and contains multiple unnecessary details. In addition, the limitations of the study should be included (especially when one knows that the sample size is just 198).
At last and not at all, the abstract and the conclusion should be revised and adapted to the results of the study.
**PeerJ Staff Note:** Please ensure that all review and editorial comments are addressed in a response letter and any edits or clarifications mentioned in the letter are also inserted into the revised manuscript where appropriate.
**Language Note:** The review process has identified that the English language must be improved. PeerJ can provide language editing services - please contact us at copyediting@peerj.com for pricing (be sure to provide your manuscript number and title). Alternatively, you should make your own arrangements to improve the language quality and provide details in your response letter. – PeerJ Staff
No comment
-The title of the study, "Appropriate Handling of Face Masks by the Public During the COVID-19 Pandemic: A Cross-Sectional Study," appears to lack coherence with the main aim, which is to "Assess the Factors Determining Facemask Use Among the General Public." I recommend reconsidering the title to better align it with the main research objective.
-Introduction section of the abstract: The tense used in the introduction section of the abstract is in the present tense, while it should be in the past tense to reflect completed research. For example, "One of the important checkpoints in containing the spread of infection is the appropriate use of facemasks, which is believed to provide the desired level of protection and preserve the community" should be revised to "One of the important checkpoints in containing the spread of infection was the appropriate use of facemasks, which was believed to provide the desired level of protection and preserve the community." Additionally, consider including a paragraph in the introduction highlighting the significance of the findings beyond the pandemic, as this could enhance the impact of the study's results.
-Results section of the abstract: In the results section of the abstract, the tense used is in the present tense instead of the past tense. To accurately report completed research, sentences like "A positive approach to the use of face masks is observed among males and high-income groups" should be revised to "A positive approach to the use of face masks was observed among males and high-income groups." Additionally, avoid using terms like "negligible," as they might be difficult to quantify or measure precisely.
- Conclusion section of the abstract: This section appears somewhat vague in its current form. It is important to focus on the predictors explored in this study to develop interventional strategies to improve the rational use and disposal of facemasks, the authors should consider highlighting the most critical predictors that require attention. This will provide a clearer and more insightful conclusion. For example, they could emphasize, “identifying the key predictors influencing face mask use among different demographic groups, such as males and high-income individuals, is crucial for the development of targeted interventional strategies to enhance the rational use and proper disposal of face masks.”
***Language and Reporting: Considering that the reporting is being done at the present time, the language in the manuscript should be modified to fit the past tense to reflect completed research. Moreover, it would be beneficial to include a paragraph in the introduction that highlights the significance of the study's findings post-COVID-19. This will help ensure the relevance and impact of the research beyond the pandemic period. By addressing these issues, the manuscript's abstract and title will become clearer, more cohesive, and better suited for publication.
-Addressing language and reporting throughout the paper. This issue of language and reporting is something that needs to be addressed in the other sections of the paper. For example, the last paragraph of the introduction currently reads: "Therefore, the factors affecting individuals’ willingness and consistency to comply with the guidelines for facemask use need to be explored. However, to the best of our knowledge, there is a scarcity of studies investigating the factors associated with suboptimal use of facemasks. Hence, the objective of this study was to explore the factors determining facemask use among individuals during the COVID-19 pandemic." To ensure consistency, the paragraph should be revised to: "Therefore, the factors affecting individuals’ willingness and consistency to comply with the guidelines for facemask use needed to be explored. However, to the best of our knowledge, there was a scarcity of studies investigating the factors associated with suboptimal use of facemasks. Hence, the objective of this study was to explore the factors determining facemask use among individuals during the COVID-19 pandemic."
-Limitations and Generalizability: While the discussion touches on implications for public health, it would be beneficial to explicitly discuss the limitations of the study. Addressing potential biases or limitations in data collection, sample selection, or data analysis can help readers better interpret the findings. Additionally, the authors should discuss the generalizability of the results beyond the study's specific population and context.
-Causality and Associations: The discussion occasionally makes statements that imply causality, but the study's cross-sectional nature only allows for the identification of associations. It's important to be cautious in attributing causal relationships based on observational data.
-Recommendations and Public Health Interventions: While the discussion highlights the importance of awareness campaigns, it would be valuable to provide more specific recommendations for public health interventions. For instance, suggesting targeted educational programs or hygiene promotion strategies could enhance the paper's practical implications.
-Clarity in Interpretation: Some parts of the discussion could benefit from clearer interpretation and explanations. For example, the paragraph on the age group of 50 years and above having "improper disposal techniques" (lines 284-286) could be further clarified to elaborate on specific disposal practices that need improvement.
No comment
1)how do you calculate the sample size, 198 observation is statistically sufficient ؟
2)on page 133 there is a fault in OR or in their interval.
1) The abstract must contain numbers from the statistical analysis.
2) the results are not clear in the summary.
3) The basis for dividing the age variable into heterogeneous categories seems unclear.
1) the absence of numbers in the conclusion.
2) Recommendations are needed in the conclusion.
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