Perceived Severity and Susceptibility towards Leptospirosis Infection in Malaysia

Round 1

Reviewer 1 Report

1. I suggest to the authors to present in the results a table with the frequency distributions. They even quote on line 227 but despite being a qualitative methodology it would be interesting to add this information.
2. At first of the introduction, some infections should be mentioned as examples

Author Response

Responses to Reviewer 1

Reviewer 1 comments:

1. I suggest to the authors to present in the results a table with the frequency distributions. They even quote on line 227 but despite being a qualitative methodology it would be interesting to add this information.

Response:

Thank you for your suggestion. However it is not possible to present the results in a table as the data was not analyzed according to the frequency. To add, respondents were in a group, their responses were not in accordance to their background but rather on the group homogenous background. The paper quoted in line 227 used a survey among its respondents, thus was able to generate its findings according to frequency.

2. At first of the introduction, some infections should be mentioned as examples

Response:

I'm sorry I don't understand what kind of infections are you referring to. As an example to what? Can you please be more specific? Thank you.

Reviewer 2 Report

the manuscript is interesting and well written and presented.

however, the results can be improved.

they can be assessed and analyzed in greater detail by making various correlations such as, for example, correlating some types of responses with the respondents' age.

the age group 18-79 is very wide.

to correlate responses to both urban and urban work activities
rural, social class ... etc.

Author Response

Response to Reviewer 2

Reviewer 2 comments:

the manuscript is interesting and well written and presented.

however, the results can be improved.

they can be assessed and analyzed in greater detail by making various correlations such as, for example, correlating some types of responses with the respondents' age.

the age group 18-79 is very wide.

to correlate responses to both urban and urban work activities
rural, social class ... etc."

Response:

Thank you for kind words and helpful suggestion. As much as I am wanted to follow your suggestion, it is impossible for me to correlate the responses with respondents' age and occupation. The reason being the data collection was conducted via focus group discussion and only audio recordings were available. Therefore we could not identify who actually spoke in the recordings as we do not recognize the voices.

Yes, we included all respondents above the age of 18. The 79-year-old respondent was an active elderly with a sound mind, whom we believe should not be discriminated from the study.

Reviewer 3 Report

TO the authors:

• The presentation must be taken care of as the uniform type letter
• I have not been able to contrast the results as I did not see any representation of the data collected and therefore I cannot understand the motivation to reflect the comments of some of the people surveyed
• I recommend that they reflect in some way and state the type of statistical treatment of the data to compare the areas under study.
• line 61_ "Ultimately, findings from this qualitative study may also be useful in identifying the best methodological designs that may assist in the improvement and development of an appropriate leptospirosis educational program and Supplementary Materials"  but I have not been able to download it, therefore my comments to the authors cannot be made because I have not seen any graph or representation of the results they mention.

Author Response

Responses to Reviewer 3

Reviewer 3 comments:

The presentation must be taken care of as the uniform type letter

I have not been able to contrast the results as I did not see any representation of the data collected and therefore I cannot understand the motivation to reflect the comments of some of the people surveyed

I recommend that they reflect in some way and state the type of statistical treatment of the data to compare the areas under study.

Response:

Thank you for your comments. There is no need to contrast the results as it was not the aim of the study the observe differences between rural and urban respondents. We separated the focus group discussion between rural and urban so that rural respondents would not feel intimidated or uncomfortable by their urban counterparts (which would made them more shy and less active during interview sessions). To be more systematic, we then presented the responses of these two groups using the quotes given. There is no statistical treatment on qualitative data. The data represented the responses of respondents from the two states in Malaysia.

line 61_ "Ultimately, findings from this qualitative study may also be useful in identifying the best methodological designs that may assist in the improvement and development of an appropriate leptospirosis educational program and Supplementary Materials"  but I have not been able to download it, therefore my comments to the authors cannot be made because I have not seen any graph or representation of the results they mention.

Response:

I think you may have understood the meaning of the sentence due to the inappropriate use of the word 'supplementary'. The sentence is referring to the benefit of the study which can be used to develop future health promotional materials. I have omitted the word 'supplementary' and replace it with 'health promotional materials'.

Round 2

Reviewer 3 Report

Thank the authors for their comments. But I have not even had the themes used in his psychological analysis. For this reason I have tried to expand my comments further based on the article referred to in the paper.

I have not seen reflected the phases of analysis, and offer examples to demonstrate the process, According to the article referred to by the authors there are 6, in the results shown they have not been defined.

Normally, at the phase 1, the authors did not show the data with the depth and breadth of the content con el fin de for meanings or patterns. Maybe the autors can show the initial thematic map, showing the main themes. Also, when all data have been initially coded and collated, I am sure that they have a long list of the different codes that you have identified across the data set.

In the case that the analyst re-focuses the analysis at the broader level of themes,  maybe They are classified the different codes into potential themes. But it is not clear at the study.

I suggest that at the study can be developed thematic map, showing the main themes as final analysis.

When the authors have shown an answer, they refer to the fact that the respondents have assigned numbers to reinforce the importance of their choice. But at no time in methodology has this been explained.

When we read the conclusión, “Although some respondents perceived leptospirosis as severe, it may not be enough to influence their preventive health behaviour, suggesting perceived susceptibility should instead be the main focus.” Reference is made to “some”, although the type of study does not refer to an analysis that can be measured, the authors can say what percentage refers to some.

Author Response

Thank the authors for their comments. But I have not even had the themes used in his psychological analysis. For this reason I have tried to expand my comments further based on the article referred to in the paper.

I have not seen reflected the phases of analysis, and offer examples to demonstrate the process, According to the article referred to by the authors there are 6, in the results shown they have not been defined.

Normally, at the phase 1, the authors did not show the data with the depth and breadth of the content con el fin de for meanings or patterns. Maybe the autors can show the initial thematic map, showing the main themes. Also, when all data have been initially coded and collated, I am sure that they have a long list of the different codes that you have identified across the data set.

In the case that the analyst re-focuses the analysis at the broader level of themes,  maybe They are classified the different codes into potential themes. But it is not clear at the study.

I suggest that at the study can be developed thematic map, showing the main themes as final analysis.     

Answer: Thank you for your constructive comments. I have revised my data analysis and changed the thematic analysis to content analysis to better reflect the study outcomes. Please refer to line 115-127. There was no theme presented, because following the recommendation by Morse (2008) in his article Confusing Categories and Themes, themes refer to the  meaning or the essence of the experience for the participant. None of our study respondents have experienced leptospirosis, what was asked of them are mainly their opinions which do not carry any meanings. Hence we decided to go with categories. We have added a mapping (similar to that of thematic mapping) of the process, please refer to Figure 1 and 2. 

When the authors have shown an answer, they refer to the fact that the respondents have assigned numbers to reinforce the importance of their choice. But at no time in methodology has this been explained.

Answer: Yes I agree. I have included the explanation regarding this issue. Please see line 103-106.

When we read the conclusión, “Although some respondents perceived leptospirosis as severe, it may not be enough to influence their preventive health behaviour, suggesting perceived susceptibility should instead be the main focus.” Reference is made to “some”, although the type of study does not refer to an analysis that can be measured, the authors can say what percentage refers to some.

Answer: I have to disagree. Please understand that qualitative research does not rely on numbers and percentages as the aim is not to prove/disprove a claim/hypothesis. The results of a qualitative inquiry are not generalizable to the population. We also did not keep track the number of times a certain point was mentioned, so it is impossible to provide the percentage. Thank you.

Author Response File: Author Response.pdf