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PLOS ONE logoLink to PLOS ONE
. 2021 Oct 14;16(10):e0258618. doi: 10.1371/journal.pone.0258618

Do patients’ characteristics influence their healthcare concerns?—A hospital care survey

George G A Pujalte 1, Isaac I Effiong 1, Tais G O Bertasi 1,*, Raphael A O Bertasi 1, Susannah S Rothstein 1, Ryan Cudahy 1, Lorenzo O Hernandez 1, Timothy M Davlantes 1
Editor: Sharon Mary Brownie2
PMCID: PMC8516281  PMID: 34648582

Abstract

Background

Hospital performance is often monitored by surveys that assess patient experiences with hospital care. Certain patient characteristics may shape how some aspects of hospital care are viewed and reported on surveys.

Objective

The aim of the study was to examine factors considered important to patients and determine whether there were differences in answers based on age, gender, or educational level.

Methods

Cross-sectional study based on a hospital survey developed via literature review and specialist recommendations. This study included randomly selected patients 18 years or older who were recently admitted to the hospital or admitted more than 50 days before the survey was being applied. Survey domains included age, gender, educational level, factors considered important for the health care in a hospital setting and sources of information about hospital quality used by each subject. Answers description and statistical analysis using Fisher exact test were performed.

Results

The survey was applied to 262 patients who were admitted under different services. The most important concern reported was the risk of getting a hospital-acquired infection (67.18%), followed by understanding explanation from the doctors’ plans (64.12%) and doctors’ ability to listen carefully (58.78%). Women are more concerned about their risk of falling (p = 0.03). Patients older than 65 years find important that the doctors explain everything in a way they can easily understand (p = 0.02), while lower educated patients consider most if the doctor treats them with courtesy and respect (p = 0.0027).

Conclusion

Patient characteristics have an effect on how hospital care is perceived. Regardless of the characteristics of the population, the risk of getting an infection was the main concern overall, so it is important that hospitals promote actions to prevent it and share them with patients.

Introduction

Standardized survey instruments and data collection methodologies are often used to measure and publicly report patients’ assessments of hospital care. The Agency for Healthcare Research and Quality and the US Centers for Medicare & Medicaid Services monitor such surveys and may publicly report hospital-level results [1]. Hospital surveys use standardized questions and administration protocols, permitting an assessment of patients’ experiences of hospital care as well as the ability to monitor changes in hospital performance over time [2].

The main purposes of hospital surveys are to facilitate objective and meaningful comparisons of hospitals on topics that consumers deem important, create incentives for hospitals to improve quality of care, and enhance public accountability in health care by increasing the availability and transparency of information [3]. Topics that patients deem important may vary from hospital to hospital. These topics deserve further study as they have the potential to guide policies and care characteristics. Stakeholders across the health care spectrum consider hospital metrics to be very important markers of the quality of care provided in hospitals [4]. Consumer groups, health care providers, employers, and state and federal governments have made measuring and improving hospital quality of care top priorities [4].

Some factors that affect patient survey scores may not be directly related to hospital performance [5]. Even as hospitals strive to treat everyone equally and surveys are designed to capture responses that would be representative of the overall population, administrators may find it useful to understand why their hospitals are getting specific score trends. The latter may be linked to inherent variabilities in the population that is within the catchment of their hospitals. Education level and age of patients could be factors, for example, in that educated and younger patients may tend to evaluate health care less positively [6, 7]. It is important to understand which aspects of a survey are regarded as essential to patient care by the patient population being surveyed. There may be discordance between what is being surveyed and what is relevant to specific patient populations, and care may be patterned to address what patient populations deem important. The degree to which patients feel respected or have their needs responded to are examples of patient-centered measures. Patients are often the only or best source for such data, which can be generated using standardized, well-developed experience measures that complement measures for technical care quality [8]. Earlier studies have suggested that specific care experiences, such as whether nurses and doctors listened carefully, affected which aspects of hospital surveys are important to survey participants [9, 10].

Standardized surveys are a great instrument to assess the hospital quality. However, further investigation is needed to understand the patients’ concerns behind each response to these surveys. Therefore, the primary aim of this study was to examine hospital care factors considered important to patients and to determine whether there were differences in answers based on age, gender, or education. This study has the potential to allow administrators to adjust aspects of care to reflect what patients in this setting deem to be essential.

Methods

This cross-sectional study was approved by the Institutional Review Board (16–000546). A survey developed via literature review and specialist recommendations was applied in different departments of the tertiary care center where this study was done, during the year of 2016 [11, 12].

Patients were eligible to participate in the study if aged 18 years or older, admitted to the hospital no more than 50 days before data collection, being able to understand the study and to fill out the survey on paper. The survey was conducted personally by six authors of this study in the waiting rooms of all hospital buildings and in patients’ rooms, and in hospital rooms, depending on the setting they are in, at different days of the study period. The interviewers approached the patients randomly as they were coming out of each room, explained the objectives of the survey and the strictly confidential treatment the information would receive. Then, they invited each patient to participate in the survey. A written informed consent of the participants was obtained before collecting any data. The response rate was 64.8%.

By using a paper questionnaire, data was collected regarding demographic information (age, gender, educational level, ethnicity, Spanish, Hispanic or Latino origin, main language spoke at home) and in which department the survey was conducted. The surveys were completely anonymously with no patient identifiable details.

The participants were requested to answer thirteen questions according to the command. For the first nine questions regarding factors considered important for the health care in a hospital setting, the answers should be chosen between “very important” or “not important”. The latter questions have specific answers options regarding sources of information about hospital quality used by each subject. The survey form template can be accessed in the Appendix (Supplementary material). Finally, the participants were asked to choose from the first nine questions, which of them were considered the most important for them, being able to select more than one for this step.

Descriptive analysis of survey answers is reported as frequency and percentage. In order to compare the answers, participants were divided in 3 subgroups by age (>65 years old and <65years old), gender (men and women) and educational level (<4 years of college and ≥4 years of college) and analyzed using Fisher exact test. Statistical analysis was performed with SPSS (version 1.0.0.1347) for Mac OS. All statistical tests were 2-sided with the alpha level set at .05 for statistical significance.

Results

The survey was answered by 262 patients, comprised of 129 (49.24%) men and 133 (50.76%) women with a median age of 70 years, ranging from 20 to 95 years (mean 67.76 ± 14.54). The majority of the participants described themselves as White (230; 87.79%) with no Spanish, Hispanic or Latino origin (247; 94.27%) and with main language spoke at home being English (257; 98.09%)–Table 1. At least four years of college was completed by 135 participants (51.53%).

Table 1. Demographic information (N = 262).

Age N (%)
Less than 65 years old 93 (35.5)
More than 65 years old 169 (64.5)
Sex
Men 129 (49.2)
Women 133 (50.7)
Ethnic origin or descent
Not Spanish/Hispanic/Latino 247 (94.3)
Puerto Rican 5 (1.9)
Mexican/Mexican American/Chicano 2 (0.8)
Cuban 1 (0.4)
Other Spanish/Hispanic/Latino 3 (1.15)
Missing 4 (1.5)
Main language
English 256 (97.7)
Spanish 1 (0.4)
Chinese 1 (0.4)
English + Spanish 1 (0.4)
Other 3 (1.1)
Educational level
Some high school, but did not graduate 6 (2.3)
High school graduate or GED 34 (13)
Some college or 2-year degree 87 (33.2)
4-year college graduate 64 (24.4)
More than 4-year college degree 71 (27.1)
Ethnicity
White 230 (87.8)
Black or African American 22 (8.4)
Asian 6 (2.3)
American Indian or Alaska Native 1 (0.4)
Missing 3 (1.1)

The department with more participants was Family Medicine (106; 40.46%) followed by Internal Medicine (90; 34.35%)—Fig 1.

Fig 1. Participant frequency according to department (N = 262).

Fig 1

Overall, the risk of getting a hospital-acquired infection was considered the most important concern of patients (176; 67.18%), followed by an understandable explanation of the doctors’ plan (168; 64.12%), and doctors’ ability to listen carefully (154; 58.78%). The risk of falling while in the hospital (40; 15.27%) and chance of returning to the hospital after discharge (78; 29.77%) were considered the two least important concerns among the other questions (Figs 24).

Fig 2. Survey answers according to sex.

Fig 2

Frequency of participants that answered each question as “Very Important” in the hospital care, according to sex. *Statistically significant.

Fig 4. Survey answers according to educational level.

Fig 4

Frequency of participants that answered each question as “Very Important” in the hospital care, according to educational level. *Statistically significant.

Only 49 patients (18.7%) searched information about the hospital on the internet before going to an appointment—24 used only one search tool while 25 used at least two. Google was the most used in overall (51.02%) and as a single tool, followed by the US News and World Report (38.78%) and Healthgrades (36.73%)–Fig 5.

Fig 5. Search tools (%).

Fig 5

Frequency of search engine tools (N = 49). Twenty-five patients chose more than one tool.

At the end of the questionnaire, the participants were asked about their preference in how to view the measures of hospital improvement. The most preferable was a list (64.12%) followed by bar chart (39.69%), line graph (18.32%) and pie chart (14.50%).

Survey answers were compared among the three subgroups (age, gender and educational level). Although in overall the risk of falling while in the hospital was considered one of the least important, when comparing it by gender, 27 (20.3%) women considered it more important compared to 13 (10.08%) men, which was statistically significant (p = 0.03)–Fig 2.

Patients older than 65 years (117; 69.23%) were more concerned if the doctors explained things in a way that they could understand than younger ones (51; 54.84%) (p = 0.02)–Fig 3.

Fig 3. Survey answers according to age.

Fig 3

Frequency of participants that answered each question as “Very Important” in the hospital care, according to age. * Statistically significant.

The respectful doctor’s treatment was considered more important for participants with lower (<4 years of college) than greater educational level (≥4 years of college)– 67 patients (52.76%) vs 46 (34.07%), p = 0.0027, respectively–Fig 4.

The way to view measurements of hospital improvement was compared: men have a preference to line graphs (30; 23.26%) compared to women (18; 13.53%)–p = 0.042, while participants with higher educational level (≥4 years of college) preferred bar (34; 25.19%) and line (63; 46,67%) charts compared to those with lower educational levels (14; 11.02% and 41; 32.28%)–p-values 0.03 and 0.017, respectively. Although it was not statistically significant comparing within subgroups, the most preferred view was as a list, regardless of the gender and educational level.

In regards to which tool was used to search information of the hospital, comparing their respective subgroups, participants younger than 65 years old used more Healthgrades® (p = 0.19) and US News and World Report® (p = 0.09), while participants with higher educational levels chose Medicare/Hospital Compare® (p = 0.14). There were no other statistical differences between the subgroups for other questions (p>0.05).

Discussion

This study revealed that getting an infection was the most important concern (67.18%) reported by patients. Acquiring an infection while receiving health care is also known as “health care-associated Infections” (HAI) [13]. Although their incidence have been decreasing in the last few years [14], particularly due to measures to prevent urinary tract and surgical site infections, at least one in 31 hospitalized patients (3.2%) develops HAI every day [15]. Perhaps, due to the HAI’s high incidence, it is a primary concern for patients. The US Center for Disease Control and Prevention reported that nearly 1.7 million hospitalized patients acquire HCAIs while being treated for other health issues and that more than 98,000 patients (one in 17) die due to these, every year [16]. This concern may be also associated to the fact that HCAIs are frequently reported in the media happening to known people and patients may consider their chance of getting an infection while being in the hospital directly related to other things they care about also, such as cleanliness of the hospital, level of care that the nurses give, and appropriateness of medications, such as antibiotics. Therefore, evidence-based prevention strategies adopted by health care settings, such as hand hygiene, early catheter removal, and reduction of unnecessary antibiotic prescription [17], could be shared with the patients in attempts to address their concerns regarding getting an infection.

The following two most important concerns reported in this study were regarding the doctors’ ability to properly explain a therapeutic plan (64.12%) and to listen carefully to the patients (58.78%). Effective doctor-patient communication is essential in delivering high-quality health care, since more accurate information is necessary for diagnosing, adherence to therapeutic plans, decreased length of hospital stay, and many other positive factors that impact the clinical outcomes are associated to patients’ reports of good doctor-patient communication [18]. However, considering communication as satisfactory is not always mutual. A survey with 807 patients and 700 orthopedic surgeons showed a discrepancy in the perception of a good communication as more doctors (75%) tended to be satisfied compared to patients (21%) [19].

Many factors justified the barriers for good communications such as a high amount of doctors’ workload, patient’s anxiety and unrealistic expectations, doctor’s avoidance behavior and resistance from the patients [18]. Therefore, aside from measures to overcome the barriers cited above, continuous and comprehensive communication training should also be established as studies showed that communication skills training increases the patients’ satisfaction [20, 21].

Patients older than 65 years seem to be more worried if doctors explain things in a way they could understand. Cognitive decline can affect the information process and jeopardize the doctor-patient communication. Yet, more important is to consider that older patients often have more comorbidities which lead to more complex medical explanations and situations [22], which support the need for more comprehensive communication training.

The interaction between patients and doctors is likely to differ according to the patients’ educational level [23], since this specific population has a higher focus in the emotional area of the consultation compared to patients with higher educational level [24]. The survey used in this study revealed an association between lower educational level (<4 years of college) and concerns regarding the respect of doctor’s treatment (p = 0.027). It is proposed that lower educated patients feel more comfortable talking about the affective side of the doctors’ relationship compared to higher educated people, which is more focused on the problem/treatment directions area [24]. Hence, the understanding of patient’s needs are essential for delivering a high-quality healthcare.

Every year, around 700 thousand falls occur in US hospitals [25], with falling reported as one of the most common complications in hospitals [26]. Although there is no difference in the frequency of falls among genders [27], this study showed that women are more concerned about this aspect than men. Therefore, hospital initiatives to avoid falls in high-risk patients must be perceived as an institutional priority for a hospital to provide optimal patient care, especially by female patients [28].

A few patients (18.7%) searched hospital information in the internet prior to their visit. Among those, patients who had 4 years or more of college preferred Hospital Compare to obtain information about hospitals. Within this platform, more than 4,000 Medicare-certified hospitals in the US are rated in terms of quality of care, making it easier to compare and contrast hospitals. Federal agencies, accrediting organizations, employers, physicians, hospitals, and consumer organizations helped develop the system with the US Centers for Medicare & Medicaid Services [29]. The website presents information on parameters regularly measured by Medicare such as surgical complications, healthcare-associated infections and patient’s experiences with each hospital. The presentation of some data includes graphics and bar charts, which may make it more attractive or understandable to individuals with more years of education who prefer to view information in the form of line and bar charts, as showed by this study. This preference may be due to their ability to better interpret information presented in this manner [30].

This study is subject to the usual limitations of cross-sectional studies. The sample size may not be broad enough to create generalizable information, so larger studies should further explore these specific aspects. One of the limitations of this study is that respondents with longer discharge dates from the hospital may have recall bias. However, the authors felt that what respondents felt were important to them would remain relatively constant compared to their actual ratings of their hospital stay. For example, respondents may rate their nursing care low or high depending on how they may recall their experience, but the level of importance they place on “nursing care,” per se, as part of hospitalization, should stay relatively the same.

This study only includes participants in one hospital with a specific patient population. Results, therefore, may not apply to other hospitals. Although the missing data for each question is only less than two participants, the data should be interpreted with caution and should not be generalized. Moreover, patients would only respond to specific questions and were not able to write other concerns that were not included in the questionnaires. As a result, more in-depth studies could be done to focus on broader factors in hospitals. Lastly, physicians conducted surveys, which may have influenced the responses.

Another limitation of this study is that it was done prior to the COVID-19 pandemic. It is largely unknown how such a pandemic may affect what patients find important in terms of their hospital stays. However, the authors felt it would not be far-fetched to think that the following factors may be of heightened importance in patients’ minds given this pandemic: 1) Caregivers in full personal protective equipment (PPEs) when appropriate; 2) Cleanliness measures they perceived in their rooms, such as more frequent cleanings, wiping; and 3) Witnessed handwashing behaviors in health care workers in the hospital. These considerations certainly deserve attention in future studies, especially given the current pandemic and the possibility that pandemics can recur.

The topics approached in the questionnaire are ultimately related to the patient experience during their visit to the hospital. A systematic review including 40 studies showed a positive association between the three domains of quality: clinical effectiveness, patient safety and patient experience. Although there is no causal effect among them, by analyzing the strengths and weakness of patient experience, as in this study, allow the provisioning of a better patient experience, which consequently will increase the likelihood of improvement in patient safety and clinical effectiveness, which are the pillar of quality in healthcare [31].

Surveys are routinely given to patients after receiving care in a hospital, but which aspects of care are most important to them has not been widely studied. Age, gender, and level of education showed to have an effect on how hospital care is perceived. Regardless of the characteristics of the population, the risk of getting an infection was the main concern overall, so it is important that hospitals promote actions to prevent it and share them with the patients. Knowledge of what different groups of patients prefer may assist hospital administrators in making institutional improvements.

Supporting information

S1 Appendix. Survey applied.

(DOCX)

S2 Appendix. Raw data collected.

(DOCX)

Acknowledgments

The authors would like to acknowledge Tara Brigham, Victoria Clifton, Zhuo Li, and Alison Dowdell, for their assistance in preparing this abstract.

Presentations

Partial results of this study were presented at the 17th Annual Southern Hospital Medicine Conference (October 2016).

Data Availability

All relevant data are within the manuscript and its Supporting Information files.

Funding Statement

The authors received no specific funding for this work.

References

  • 1.Goldstein E, Farquhar M, Crofton C, Darby C, Garfinkel S. Measuring hospital care from the patients’ perspective: an overview of the CAHPS Hospital Survey development process. Health Serv Res. 2005;40(6 Pt 2):1977–95. Epub 2005/12/01. doi: 10.1111/j.1475-6773.2005.00477.x ; PubMed Central PMCID: PMC1361247. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2.Giordano LA, Elliott MN, Goldstein E, Lehrman WG, Spencer PA. Development, implementation, and public reporting of the HCAHPS survey. Med Care Res Rev. 2010;67(1):27–37. Epub 2009/07/30. doi: 10.1177/1077558709341065 . [DOI] [PubMed] [Google Scholar]
  • 3.Goldstein E, Elliott MN, Lehrman WG, Hambarsoomian K, Giordano LA. Racial/ethnic differences in patients’ perceptions of inpatient care using the HCAHPS survey. Med Care Res Rev. 2010;67(1):74–92. Epub 2009/08/05. doi: 10.1177/1077558709341066 . [DOI] [PubMed] [Google Scholar]
  • 4.Committee on Redesigning Health Insurance Performance Measures Performance Improvement Programs Board on Health Care Services & Institute of Medicine of the National Academies. Performance measurement: Accelerating improvement (pathways to quality health care). Washington, DC: National Academies Press; 2006. [Google Scholar]
  • 5.Elliott MN, Zaslavsky AM, Goldstein E, Lehrman W, Hambarsoomians K, Beckett MK, et al. Effects of survey mode, patient mix, and nonresponse on CAHPS hospital survey scores. Health Serv Res. 2009;44(2 Pt 1):501–18. Epub 2009/03/26. doi: 10.1111/j.1475-6773.2008.00914.x ; PubMed Central PMCID: PMC2677051. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6.Elliott MN, Swartz R, Adams J, Spritzer KL, Hays RD. Case-mix adjustment of the National CAHPS benchmarking data 1.0: a violation of model assumptions? Health Serv Res. 2001;36(3):555–73. Epub 2001/08/03. ; PubMed Central PMCID: PMC1089242. [PMC free article] [PubMed] [Google Scholar]
  • 7.Zaslavsky AM, Zaborski LB, Ding L, Shaul JA, Cioffi MJ, Cleary PD. Adjusting Performance Measures to Ensure Equitable Plan Comparisons. Health Care Financ Rev. 2001;22(3):109–26. Epub 2001/04/01. ; PubMed Central PMCID: PMC4194711. [PMC free article] [PubMed] [Google Scholar]
  • 8.Anhang Price R, Elliott MN, Zaslavsky AM, Hays RD, Lehrman WG, Rybowski L, et al. Examining the role of patient experience surveys in measuring health care quality. Med Care Res Rev. 2014;71(5):522–54. Epub 2014/07/17. doi: 10.1177/1077558714541480 ; PubMed Central PMCID: PMC4349195. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9.Cleary PD, Lubalin J, Hays RD, Short PF, Edgman-Levitan S, Sheridan S. Debating survey approaches. Health Aff (Millwood). 1998;17(1):265–8. Epub 1998/02/10. doi: 10.1377/hlthaff.17.1.265 . [DOI] [PubMed] [Google Scholar]
  • 10.Cleary PD. Satisfaction may not suffice! A commentary on ’A patient’s perspective’. Int J Technol Assess Health Care. 1998;14(1):35–7. Epub 1998/03/24. doi: 10.1017/s0266462300010503 . [DOI] [PubMed] [Google Scholar]
  • 11.Al-Abri R, Al-Balushi A. Patient satisfaction survey as a tool towards quality improvement. Oman Med J. 2014;29(1):3–7. Epub 2014/02/07. doi: 10.5001/omj.2014.02 ; PubMed Central PMCID: PMC3910415. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12.Riiskjaer E, Ammentorp J, Kofoed PE. The value of open-ended questions in surveys on patient experience: number of comments and perceived usefulness from a hospital perspective. Int J Qual Health Care. 2012;24(5):509–16. Epub 2012/07/27. doi: 10.1093/intqhc/mzs039 . [DOI] [PubMed] [Google Scholar]
  • 13.Collins AS. Preventing Health Care-Associated Infections. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Advances in Patient Safety. Rockville (MD)2008. [PubMed] [Google Scholar]
  • 14.Centers for Disease Control and Prevention [June 06, 2020]. Available from: https://www.cdc.gov/hai/data/portal/index.html.
  • 15.Magill SS, O’Leary E, Janelle SJ, Thompson DL, Dumyati G, Nadle J, et al. Changes in Prevalence of Health Care-Associated Infections in U.S. Hospitals. N Engl J Med. 2018;379(18):1732–44. Epub 2018/11/01. doi: 10.1056/NEJMoa1801550 . [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 16.Mimoz O, Lucet JC, Kerforne T, Pascal J, Souweine B, Goudet V, et al. Skin antisepsis with chlorhexidine-alcohol versus povidone iodine-alcohol, with and without skin scrubbing, for prevention of intravascular-catheter-related infection (CLEAN): an open-label, multicentre, randomised, controlled, two-by-two factorial trial. Lancet. 2015;386(10008):2069–77. Epub 2015/09/22. doi: 10.1016/S0140-6736(15)00244-5 . [DOI] [PubMed] [Google Scholar]
  • 17.Boev C, Kiss E. Hospital-Acquired Infections: Current Trends and Prevention. Crit Care Nurs Clin North Am. 2017;29(1):51–65. Epub 2017/02/06. doi: 10.1016/j.cnc.2016.09.012 . [DOI] [PubMed] [Google Scholar]
  • 18.Ha JF, Longnecker N. Doctor-patient communication: a review. Ochsner J. 2010;10(1):38–43. Epub 2011/05/24. ; PubMed Central PMCID: PMC3096184. [PMC free article] [PubMed] [Google Scholar]
  • 19.Tongue JRE H.R.; Forese L.L. Communication Skills for Patient-Centered Care. The Journal of Bone & Joint Surgery. 2005;87-A(3):652–58. [Google Scholar]
  • 20.Harms C, Young JR, Amsler F, Zettler C, Scheidegger D, Kindler CH. Improving anaesthetists’ communication skills. Anaesthesia. 2004;59(2):166–72. Epub 2004/01/17. doi: 10.1111/j.1365-2044.2004.03528.x . [DOI] [PubMed] [Google Scholar]
  • 21.Bensing JM, Sluijs EM. Evaluation of an interview training course for general practitioners. Soc Sci Med. 1985;20(7):737–44. Epub 1985/01/01. doi: 10.1016/0277-9536(85)90064-4 . [DOI] [PubMed] [Google Scholar]
  • 22.van Vliet LM, Lindenberger E, van Weert JC. Communication with older, seriously ill patients. Clin Geriatr Med. 2015;31(2):219–30. Epub 2015/04/29. doi: 10.1016/j.cger.2015.01.007 . [DOI] [PubMed] [Google Scholar]
  • 23.Verlinde E, De Laender N, De Maesschalck S, Deveugele M, Willems S. The social gradient in doctor-patient communication. Int J Equity Health. 2012;11:12. Epub 2012/03/14. doi: 10.1186/1475-9276-11-12 ; PubMed Central PMCID: PMC3317830. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24.Aelbrecht K, Rimondini M, Bensing J, Moretti F, Willems S, Mazzi M, et al. Quality of doctor-patient communication through the eyes of the patient: variation according to the patient’s educational level. Adv Health Sci Educ Theory Pract. 2015;20(4):873–84. Epub 2014/11/28. doi: 10.1007/s10459-014-9569-6 . [DOI] [PubMed] [Google Scholar]
  • 25.Currie L. Fall and Injury Prevention. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Advances in Patient Safety. Rockville (MD)2008. [PubMed] [Google Scholar]
  • 26.LeLaurin JH, Shorr RI. Preventing Falls in Hospitalized Patients: State of the Science. Clin Geriatr Med. 2019;35(2):273–83. Epub 2019/04/02. doi: 10.1016/j.cger.2019.01.007 ; PubMed Central PMCID: PMC6446937. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 27.de Souza AB, Rohsig V, Maestri RN, Mutlaq MFP, Lorenzini E, Alves BM, et al. In hospital falls of a large hospital. BMC Res Notes. 2019;12(1):284. Epub 2019/05/28. doi: 10.1186/s13104-019-4318-9 ; PubMed Central PMCID: PMC6533691. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 28.Cumbler EU, Simpson JR, Rosenthal LD, Likosky DJ. Inpatient Falls: Defining the Problem and Identifying Possible Solutions. Part II: Application of Quality Improvement Principles to Hospital Falls. Neurohospitalist. 2013;3(4):203–8. Epub 2013/11/08. doi: 10.1177/1941874412470666 ; PubMed Central PMCID: PMC3810825. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 29.Hospital Compare. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid [cited 2020 07 June]. Available from: www.medicare.gov/hospitalcompare.
  • 30.Bakker CJ, Koffel JB, Theis-Mahon NR. Measuring the health literacy of the Upper Midwest. J Med Libr Assoc. 2017;105(1):34–43. Epub 2017/01/18. doi: 10.5195/jmla.2017.105 ; PubMed Central PMCID: PMC5234462. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31.Doyle C, Lennox L, Bell D. A systematic review of evidence on the links between patient experience and clinical safety and effectiveness. BMJ Open. 2013;3(1). Epub 2013/01/08. doi: 10.1136/bmjopen-2012-001570 ; PubMed Central PMCID: PMC3549241. [DOI] [PMC free article] [PubMed] [Google Scholar]

Decision Letter 0

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Do Patients’ Characteristics Influence Their Healthcare Concerns? – A Hospital Care Survey

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Academic Editor

PLOS ONE

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Additional Editor Comments 

Reviewers have offered a significant number of recommendations to strengthen your paper. Please respond in full to each suggestion offered

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: Partly

Reviewer #3: Partly

**********

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

Reviewer #1: Yes

Reviewer #2: I Don't Know

Reviewer #3: Yes

**********

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

Reviewer #3: 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

Reviewer #3: 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: 1. if a linelist of the potential samples were made to select study samples at random.

2. could all the tables and figures have a title on the top of each.

3. could there be chance of recall bias particularly for aged respondents while the interview was done 50 or more days after discharge from the hospital.

4. The demographic information table (table 1) could contain information of distribution of respondents by gender and age group.

Reviewer #2: It is not possible to interpret the findings in the absence of information on the randomization process and the response rate to the survey, both overall and in terms of key characteristics of the repondents

Reviewer #3: This is an interesting study, but there are some concerns that need to be addressed.

After reading the introduction, I was unsure whether the authors disagree with using the CAHPS for reporting hospital quality or not. Although the CAHPS/CMS aggregates measures for hospital reporting (e.g., hospital compare), researchers could request the data to understand more granular level information and patterns (e.g., patient characteristics). Link: https://hcahpsonline.org/globalassets/hcahps/survey-instruments/mail/qag-v16.0-materials/2021_survey-instruments_english_mail.pdf

I would encourage the authors to review sections of the introduction. For example: “Some factors that affect patient survey scores may not be directly related to hospital performance. [5] Characteristics of different patient populations may make certain parts of the survey more relevant than others. Hospitals may have very little control on the education level and age of patients who present for care. It is known that more educated and younger patients tend to evaluate health care less positively.” I would hope that hospitals “want” to treat everyone equally. Surveys are designed to get a range of responses that would be representative of the overall population.

The authors mentioned “A survey developed via literature review and specialist recommendations was applied in different departments of our tertiary care center during the year of 2016.” More information about how the survey questions were developed is needed. What article(s) or literature was used to develop the questions?

It is unclear to me why the patients needed to be recently admitted to the hospital or admitted more than 50 days before the survey was being applied. Explaining this range may be important. In addition, what does it mean to be recently admitted?

More details are needed about “The investigators randomly approached the patients in different hospital departments to solicit their participation.” Are these the authors in the paper, RAs, others? How many investigators were conducting the surveys? Why were participants approached randomly? I would assume that the investigators were hoping for some representation. How many people declined to participate?

In the discussion, the authors mentioned that “‘Acquiring an infection while receiving health care is also known as “health care-associated Infections” (HAI) [11]’” They may need to expand about how common these infections are and provide some explanations as to why they believe this was the top concern.

The authors also mentioned that “physicians conducted the surveys, which may have influenced the responses.” How do the authors believe that this may have influenced the responses?

Finally, these data are somewhat dated. The authors may need to include a paragraph in the discussion about how the current epidemic may have changed/influences or make these survey more relevant.

**********

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: Yes: Dr. Md. Ziaur Rahman

Reviewer #2: No

Reviewer #3: 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.

PLoS One. 2021 Oct 14;16(10):e0258618. doi: 10.1371/journal.pone.0258618.r002

Author response to Decision Letter 0


28 Jul 2021

Reviewer's Responses to Questions

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: Partly

Reviewer #3: Partly

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

Reviewer #1: Yes

Reviewer #2: I Don't Know

Reviewer #3: Yes

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

Reviewer #3: 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

Reviewer #3: Yes

The authors appreciate the reviewers’ availability and great suggestions. We made several edits to the manuscript and included Appendix 2 with the raw data collected with the survey answers.

Reviewer's Comments to the Author

REVIEWER 1:

1. If a linelist of the potential samples were made to select study samples at random.

The authors appreciate your comment. The randomization process was included in the Methods section and is described below in the answer for the 1st comment from Reviewer 2.

2. Could all the tables and figures have a title on the top of each.

Thank you for your suggestion. We included a title on the top of the figures and table.

3. Could there be chance of recall bias particularly for aged respondents while the interview was done 50 or more days after discharge from the hospital.

The authors appreciate your comment. We have indicated this possibility in the limitations section.

4. The demographic information table (table 1) could contain information of distribution of respondents by gender and age group.

Thank you for your suggestion. We added the age and sex information on Table 1.

REVIEWER 2:

1. It is not possible to interpret the findings in the absence of information on the randomization process and the response rate to the survey, both overall and in terms of key characteristics of the respondents

The authors appreciate your comment. The randomization process was included in the Methods section. The authors of the study were the investigators who approached patients in waiting rooms in all the Mayo buildings, in hospital rooms, and patient rooms, depending on the setting they are in, at various days of the study period. They asked if patients were recently hospitalized if they were in the waiting room or patient room. A total of 142 patients declined participating in the study, with a response rate of 64.8%. Consent was obtained for those interested and study survey was given.

Participants were approached randomly to maximize experience breadth. For example, if only patients in one building were approached, only patients admitted into specific services (e.g. Family Medicine, Internal Medicine, Rehabilitation Medicine) would be surveyed. The authors wanted to cover all experiences from admission into all services offered in the hospital, as much as possible and hoped that by spreading out in this manner, there would be good representation of all types of patient admission.

REVIEWER 3:

This is an interesting study, but there are some concerns that need to be addressed.

1. After reading the introduction, I was unsure whether the authors disagree with using the CAHPS for reporting hospital quality or not. Although the CAHPS/CMS aggregates measures for hospital reporting (e.g., hospital compare), researchers could request the data to understand more granular level information and patterns (e.g., patient characteristics). Link: https://hcahpsonline.org/globalassets/hcahps/survey-instruments/mail/qag-v16.0-materials/2021_survey-instruments_english_mail.pdf

Thank you for your comment and for the link. The authors agree that it was not clear whether we disagree with using the CAHPS for reporting hospital quality. Therefore, we included some sentences at the end of the Introduction section to make it clearer and to explain that the aim of our study is to understand in more detailed the patients’ concerns behind each response to those surveys.

2. I would encourage the authors to review sections of the introduction. For example: “Some factors that affect patient survey scores may not be directly related to hospital performance. [5] Characteristics of different patient populations may make certain parts of the survey more relevant than others. Hospitals may have very little control on the education level and age of patients who present for care. It is known that more educated and younger patients tend to evaluate health care less positively.” I would hope that hospitals “want” to treat everyone equally. Surveys are designed to get a range of responses that would be representative of the overall population.

The authors appreciate your comment. We have changed the introduction to make our message clearer.

3. The authors mentioned “A survey developed via literature review and specialist recommendations was applied in different departments of our tertiary care center during the year of 2016.” More information about how the survey questions were developed is needed. What article(s) or literature was used to develop the questions?

Thank you for your suggestion. We included the references of the literature used to develop the survey.

4. It is unclear to me why the patients needed to be recently admitted to the hospital or admitted more than 50 days before the survey was being applied. Explaining this range may be important. In addition, what does it mean to be recently admitted?

Thank you for your comment. Recently admitted means admitted within 1-2 weeks. The survey from Mayo Clinic usually arrives more than 50 days after patients are admitted. The reason for this is unclear but may be because surveyors want to determine what remains in patients’ recollections after such a period of time has elapsed.

5. More details are needed about “The investigators randomly approached the patients in different hospital departments to solicit their participation.” Are these the authors in the paper, RAs, others? How many investigators were conducting the surveys? Why were participants approached randomly? I would assume that the investigators were hoping for some representation. How many people declined to participate?

The authors of the study were the investigators who approached patients in waiting rooms in all the Mayo buildings, in hospital rooms, and patient rooms, depending on the setting they are in, at various days of the study period. They asked if patients were recently hospitalized if they were in the waiting room or patient room. Consent was obtained for those interested and study survey was given.

Participants were approached randomly to maximize experience breadth. For example, if only patients in one building were approached, only patients admitted into specific services (e.g. Family Medicine, Internal Medicine, Rehabilitation Medicine) would be surveyed. The authors wanted to cover all experiences from admission into all services offered in the hospital, as much as possible and hoped that by spreading out in this manner, there would be good representation of all types of patient admission. A sentence was included in the Methods section to make it clearer. A total of 142 patients declined participating in the study (the response rate was included in the Results section)

6. In the discussion, the authors mentioned that “‘Acquiring an infection while receiving health care is also known as “health care-associated Infections” (HAI) [11]’” They may need to expand about how common these infections are and provide some explanations as to why they believe this was the top concern.

Thank you for your suggestion. The authors included a few sentences in the Discussion section about the frequency of HAIs and why we believe this was a top concern for the patients.

7. The authors also mentioned that “physicians conducted the surveys, which may have influenced the responses.” How do the authors believe that this may have influenced the responses?

The authors believe that having physicians conducting the surveys may have influenced who they gave surveys to. For example, physicians may not want to give the surveys to patients they took care of. However, the authors/investigators tried not to be affected by this factor when giving out the surveys.

8. Finally, these data are somewhat dated. The authors may need to include a paragraph in the discussion about how the current epidemic may have changed/influences or make this survey more relevant.

The authors appreciate this interesting comment. We included a comment about this in the discussion section.

Attachment

Submitted filename: Response to Reviewers.doc

Decision Letter 1

Sharon Mary Brownie

18 Aug 2021

PONE-D-20-24334R1

Do Patients’ Characteristics Influence Their Healthcare Concerns? – A Hospital Care Survey

PLOS ONE

Dear Dr.Tais Garcia de Oliveira Bertasi,

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 September 20. 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 rebuttal 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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We look forward to receiving your revised manuscript.

Kind regards,

Sharon Mary Brownie

Academic Editor

PLOS ONE

Journal Requirements:

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.

Editor Comments 

Reviewers have requested some additional information and improvements in your methods section. Please pay careful attention to what is requested and respond appropriately.

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: (No Response)

**********

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: Partly

**********

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

Reviewer #1: Yes

Reviewer #2: I Don't Know

**********

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: No

**********

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: The respondent selection criteria regarding hospital admission as mentioned."recently admitted or admitted more the 50 days before the survey was applied" is not clear. If data was collected from patients admitted a week before or 90 days before data collection. Should it not be a range e.g. admitted 10 - 50 days before data collection.

Reviewer #2: This version does not address my previous comments. Simply stating that patients were approached randomly does not adequately describe the randomisation process. Further, the response rate according to key characteristics is not provided. It could be that the response rate varied significantly by race, education, age gender etc, so introducing potential biases. This information is required for a determination of the validity of the findings

**********

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: Yes: Dr. Md. Ziaur Rahman, Epidemiologist and Public Health Specialist

Reviewer #2: Yes: Prof Ian Ring

[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.

PLoS One. 2021 Oct 14;16(10):e0258618. doi: 10.1371/journal.pone.0258618.r004

Author response to Decision Letter 1


23 Sep 2021

REVIEWER #1:

The respondent selection criteria regarding hospital admission as mentioned, "recently admitted or admitted more the 50 days before the survey was applied" is not clear. If data was collected from patients admitted a week before or 90 days before data collection, should it not be a range (e.g. admitted 10 - 50 days before data collection)?

The authors agree with your comment. The methodology section was rewritten in agreement with your recommendation.

REVIEWER #2:

This version does not address my previous comments. Simply stating that patients were approached randomly does not adequately describe the randomisation process. Further, the response rate according to key characteristics is not provided. It could be that the response rate varied significantly by race, education, age gender, etc., so introducing potential biases. This information is required for a determination of the validity of the findings.

The authors appreciate your comment. The methodology section was rewritten to address the previous comment. Regarding the response rate, as it is possible to see on the appendix showing all data, the maximum of missing answers for each of the nine questionnaire questions were from two participants; this fortunately would not make a statistically significant difference when accounting for race, education, age, and gender. However, the reviewer made a great point, and the potential bias is now included in the limitations section.

Attachment

Submitted filename: Response to Reviewers.doc

Decision Letter 2

Sharon Mary Brownie

4 Oct 2021

Do Patients’ Characteristics Influence Their Healthcare Concerns? – A Hospital Care Survey

PONE-D-20-24334R2

Dear Dr. Tais Garcia de Oliveira Bertasi,

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,

Sharon Mary Brownie

Academic Editor

PLOS ONE

Editor Comments 

Reviewer comments have been fully addressed.

Reviewers' comments:

Acceptance letter

Sharon Mary Brownie

7 Oct 2021

PONE-D-20-24334R2

Do Patients’ Characteristics Influence Their Healthcare Concerns? – A Hospital Care Survey

Dear Dr. Bertasi:

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

Professor Sharon Mary Brownie

Academic Editor

PLOS ONE

Associated Data

    This section collects any data citations, data availability statements, or supplementary materials included in this article.

    Supplementary Materials

    S1 Appendix. Survey applied.

    (DOCX)

    S2 Appendix. Raw data collected.

    (DOCX)

    Attachment

    Submitted filename: Response to Reviewers.doc

    Attachment

    Submitted filename: Response to Reviewers.doc

    Data Availability Statement

    All relevant data are within the manuscript and its Supporting Information files.


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