Teachers’ Knowledge and Experiences after the Implementation of an Eating Disorder Prevention Program in the Physical Education Classroom

Round 1

Reviewer 1 Report (New Reviewer)

Comments and Suggestions for Authors

I appreciate the opportunity to review the article titled "Teachers' Knowledge and Experiences after the Implementation of an Eating Disorders Prevention Program in the Physical Education Classroom."

The authors address an important issue—eating disorders in adolescents—and present various objectives for the paper. However, I would like to offer some constructive feedback to enhance the overall clarity and impact of the study:

1. Abstract vs. Article Clarity:
• The abstract seems to articulate the paper's aim more effectively than the article itself. Clarifying the research objectives within the article could strengthen its impact.
• "This article focuses on what teachers learned about the prevention of eating disorders through the program, Psychology for Nutrition and Physical Activity" [lines 8-9].
• "The objective of the study was to investigate whether physical education could contribute to the prevention of eating disorders and whether what was learned in the classroom could be transferred to other areas of life. In particular, we wanted to find out whether physical education offered the possibility of generating scientifically proven skills that reinforce the prevention of this type of pathology. And, above all, we wanted to observe whether the teachers could and were willing to adopt changes to their classroom practice in order to teach these skills." [lines 297-303].
2. Language Clarity:
• Several sentences throughout the paper are scrambled and challenging to understand. Please review and rephrase for clarity.
• Address spelling errors and grammatical issues throughout the paper.
• Examples:
• p.2, ll 68-69: Language must be addressed. "...objectives secondary are: ..."
• p.2, ll 74: Spelling error "Fouth"
3. Precision in Pronoun Usage:
• The use of pronouns like "they are" and "these disorders" needs more precision. Be explicit about the subjects.
• Examples: "they are…" [p.1,ll 30], "and it is here…" [p1, ll 31], "these disorder…" [p2, ll 62]
4. Program Details:
• The paper lacks details, especially regarding the P-NAF program. Introduce and explain the program, including its purpose, duration, and those involved.
5. Research Objectives Clarity:
• Clearly define the research objectives. The paper mentions different aims; however, it seems the only achievable goal is observing teachers' willingness to adopt changes.
• "The objective of the study was to investigate whether physical education could contribute to the prevention of eating disorders and whether what was learned in the classroom could be transferred to other areas of life. In particular, we wanted to find out whether physical education offered the possibility of generating scientifically proven skills that reinforce the prevention of this type of pathology. And, above all, we wanted to observe whether the teachers could and were willing to adopt changes to their classroom practice in order to teach these skills." [lines 297-303].
• This objective cannot be met by the present paper. There is no assessment of ED symptoms in students, no longitudinal data linking the program to any outcome in the student population over time. As far as I can see, the only achievable aim is stated in the last sentence "And, above all, we wanted to observe whether the teachers could and were willing to adopt changes to their classroom practice in order to teach these skills." Please comment on your goal and clearly state what you did and were able to do.
6. Specify Prevention Context:
• Specify what prevention the authors are referring to when they mention "teaching about prevention requires specific training."
• p.2, ll 61: The authors state "... teaching about prevention requires specific training…". What prevention are the authors talking about? Please be more specific.
7. Definition of Terms:
• p.2, ll 64: The authors state "... lack of teacher training and a poor relationship between the professions…". What is a poor relationship? How is it assessed?
8. Clarity on Intervention and Policies:
• p2., ll 66: Another aim of the paper is stated: "Therefore, our work responds to a general call for social and educational policies aimed at the preparation of effective interventions." However, this paper does not conclude or prepare any interventions.
9. Clarification on "Life Skills":
• p.2, ll 68. What life skills are meant?
10. Participant Section Clarification:

• p.3., ll 91-93: The authors state that "Our participants may have concurred on the development …" Did they? What do the authors mean by this?
• p.2. Section Participant: The authors state "based on the information needs detected in the first questionnaire..." However, no first questionnaire is mentioned anywhere, nor are the results of that questionnaire mentioned in the results section. Please comment.

11. Co-author Comments and Spelling:
• p.3, ll 111-113: There still seem to be co-author comments in brackets in the text. Please revise.
• p.3, ll 113: I agree with the comment in the brackets: "The ‘second’ does not make sense". Please revise.
• p.3, l 114: Refers to the research objectives, which are not clearly stated above. Please revise.
12. Interviewer vs. Interviewee Clarification:
• p.4 first paragraph: There seems to be some confusion between the words interviewer (person conducting the interview) and interviewee (person being interviewed). Please check.
13. Specific Disorder Identification:
• p.4, ll. 130: The authors talk about this disorder, but it is unclear which disorder they are talking about. Please be more precise.
14. Clarity on Research Aim:
• p.4, ll 132: Again, a research aim is given "we wanted to find out whether applying the P-NAF program actually decreased the risk of developing eating disorder." This is surprising as the authors did not interview the students at risk of developing an eating disorder, no longitudinal data are reported, so this research question cannot be answered in this study.
15. Examples of Factors:
• p. 4, ll 138-142: Please give examples of genetic, emotional, and social factors of interest.
16. Clear Communication on Prevention:
• p.4, ll 146: Again the prevention of eating disorders is mentioned. There are many eating disorders, are they all prevented with the same interventions? How does that work?
• p.4, ll146-150: The sentence is unclear to me. What are the authors trying to say?
17. Consensus Clarification:
• p. 4, ll 157: The authors state that they reached a strong consensus. What does this mean? Are there numbers to report? Also, the authors state that they "believe that this exercise (?) greatly increased the reliability of our data." How do you know this? Please be more specific.
18. Results Section Detailing:
• p.4 Results: What exactly do the four blocks contain? I would advise the authors to keep in mind that good research should be replicable. Please give the readers more information about what intervention/program you did and how exactly it worked.
• Qualitative Analyses should be described in more detail.
19. Teachers' Awareness of Eating Disorders:
• p5. I was wondering if teachers actually know what (clinical) eating disorders look like, or are they just reproducing stigmatizing views, or what the general public might know.
20. Misalignment of Quotes and Objectives:
• The results section does not answer the research objectives stated earlier in the paper. The quotes do not answer the questions, and the conclusions drawn are not clear.
21. Clarification on Teachers' Beliefs:
• p.5, ll 181.182: It states “most teachers linked self-esteem to body image”: Where did this statement come from? What does most teachers mean?
22. Identification of Eating Disorders:
• p.5, ll 185: How do teachers know if students have developed an eating disorder? Are they clinicians? Is this a stigmatizing view that is being explored?
23. Interpretation of Quotes:
• p.5, ll 187-188: What does this quote tell the reader?
24. Clarity on Desired Outcomes:
• P.5, ll 194: The authors talk about desired outcomes and how teachers point out that they have not been achieved; again, what are desired outcomes? How do teachers know whether they are being met or not, what time perspective are we talking about?
25. Stigmatization Caution:
• Be cautious of strong stigmatizing views in the quotes. Consider the impact on individuals with eating disorders. Recommendations: Crocker, A. F., & Smith, S. N. (2019). Person-first language: Are we practicing what we preach? Journal of Multidisciplinary Healthcare, 12, 125–129. https://doi.org/10.2147/JMDH.S140067
26. Context of Teacher Quote:
• p. 6, ll 207-208: This quote sounds to me more like a personal experience of the teacher rather than an observation in the field. Please comment.
27. Clarification on Social Skills:
• p.6. What social skills are the authors talking about?
28. Specificity on Topic:
• p.6, ll 224: What topic are the authors talking about? Please be more specific.
29. Results Section Heading Clarification:
• Results section 3.3. The information given does not fit the heading.
30. Quote Context Clarification:
• p.7, ll 271-272: Is the quote about eating disorders? What happens to "us"?
31. Observation of Workshops:
• p.8, ll 278-279: The authors state: "We did see the workshops on healthy eating because teachers observed poor eating habits among students.” What does this mean?
32. Discussion Section Aim Clarification:
• Discussion: Cave: First paragraph, the research aims are not clear.
33. Language Review:
• Please check the language carefully.
34. Clarification:
• p.8, ll 318: The authors state that “… lack of knowledge…. was general among interviewees.” What does general mean?
35. Discussion Alignment with Results:
• Clearly align the discussion with the study results. Thoroughly revise for coherence and relevance. Ensure the research aims are clear.
36. Slogan-Like Sentence:
• First paragraph p9 ll 321-330: I did not see this in the results section. The sentence in lines 328-329 reads like a slogan. Please revise.
37. Additional Information in Second Paragraph:
• Second paragraph p 9: What did the studies find? Please provide more information.
38. Location of Information in Results Section:
• P. 9 ll 345-352: Where did the authors present this information in the Results section?

Comments on the Quality of English Language

Language quality must be improved.

Author Response

See attached file

Author Response File: Author Response.pdf

Reviewer 2 Report (New Reviewer)

Comments and Suggestions for Authors

I appreciate the opportunity to receive this manuscript. The work done by the researchers is evident; However, I make some observations for improvement that I leave for consideration.

On line 34 there is a ().

On line 67, mention as the objective of this research OBSERVE is somewhat limiting or short for the work carried out, I recommend changing it.

In participants. I recommend describing the selection process in detail. Was it intentional to select 6 women and 6 men? Was it intentional to have 6 public and 6 private school teachers? Why was the years of experience not relevant for the selection?

In the data analysis, line 146 mentions the most experienced researchers: how many participated? Perhaps it would be good to describe a little of your experience in some section of the methodology.

I recommend that the conclusions respond to the objectives set in the study.

It would be advisable to add future lines of research

Author Response

See attached file

Author Response File: Author Response.docx

Reviewer 3 Report (New Reviewer)

Comments and Suggestions for Authors

It is a topic of relevance today, however it is recommended to complement future research with a perception scale so that it is a mixed study (qualitative and quantitative).

Author Response

Thank you very much for your consideration,
we will keep your proposal in mind in the future.

Round 2

Reviewer 1 Report (New Reviewer)

Comments and Suggestions for Authors

Dear authors,

I would like to commend you for successfully addressing all of my previous comments and for providing a more in-depth discussion and interpretation of the results from the existing literature. However, I kindly request your attention to some formal aspects of the paper that I believe could be improved upon.

1.      Abstract ll.8: PE is not yet introduced.

2.      Despite the authors stating that they have had a native English speaker check the paper, there are still some grammatical errors that may impede the reader's understanding of the paper. I will provide some examples for clarity, as the paper's readability may affect its potential impact.

·         Example in the Abstract: ll. 8-14:

·         Example Method section    “Among the 112 characteristics of the participants, we highlight that 6 women and 6 men.” (Also, please consider consulting the APA Manual regarding the presentation of numbers.)

·         l. 149 “…effective program ef that could…” Could you clarify the meaning of "ef"?

·         ll. 219-221, The sentence appears to be unclear.

·         ll. 260-261

·         ll. 347 -350

3.      p.1, ll 16.18: “The results show that physical education teachers are  poorly trained in eating disorders.” Could you clarify what it means to be trained in eating disorders? Does it refer to recognizing them, understanding them, or treating them? Please provide more specific details.

4.      p.1, ll. 20-21 “… skills in transmitting it” Could you clarify what "it" refers to? The language used is somewhat unclear.

5.      Is this paper primarily focused on the interviews or on the program? Could you provide clarity on this in the Abstract? If the paper is about the program, perhaps you could also include some information about the program itself.

6.      l. 52: It appears that a closing quotation mark is missing.

7.      l. 59: The authors mention "the skills that prevent eating disorders." Could you provide some examples of these skills for better understanding?

8.      In the Materials and Methods section, you describe the P-NAF program. Thank you for including this information. However, it might be beneficial to explicitly state that detailed results regarding the program are described elsewhere. Otherwise, it may seem unusual for results to be presented at the beginning of the methods section.

9.      ll. 95 -97. Please consider mentioning the positive feedback received for your study in the strengths and limitations section. Additionally, could you kindly provide more details about how the qualitative part of the study was conducted?

10.  Spelling errors Please review the text for any spelling errors.

·          Examples: l. 102 "And"; l. 111 "DEs"

·         Spelling error in l. 331 “specifically”

·         Spelling error in l. 337 “each”

·         l. 340 What is TCA?

·         Spelling error l. 356 “les”

·         Spelling error l. 391 “la adult life”

11.  Please review the APA Manual regarding the structure of sentences. Sentences should not typically begin with a number (l.111).

12.  There are still some errors in the usage of "interviewer" and "interviewee." For instance, l. 135 mentions "each interviewer," which may need to be revised to "each interviewee."

13.  l. 150 : Could you clarify what the EF classroom refers to?

14.  l. 206 : It seems that the beginning of the sentence is missing.

15.   ll. 298-306 : It is unclear how this text relates to the headline. Could you provide clarification?

Comments on the Quality of English Language

 Despite the authors stating that they have had a native English speaker check the paper, there are still some grammatical errors that may impede the reader's understanding of the paper. I will provide some examples for clarity, as the paper's readability may affect its potential impact.

·       ·         Example in the Abstract:  ll. 8-14:

·         Example Method section    “Among the 112 characteristics of the participants, we highlight that 6 women and 6 men.” (Also, please consider consulting the APA Manual regarding the presentation of numbers.)

·         l. 149 “…effective program ef that could…” Could you clarify the meaning of "ef"?

·         ll. 219-221, The sentence appears to be unclear.

·         ll. 260-261

·         ll. 347 -350

Author Response

Comments and Suggestions for Authors

Dear authors,

I would like to commend you for successfully addressing all of my previous comments and for providing a more in-depth discussion and interpretation of the results from the existing literature. However, I kindly request your attention to some formal aspects of the paper that I believe could be improved upon.

1. Abstract ll.8: PE is not yet introduced.

Introduced

2. Despite the authors stating that they have had a native English speaker check the paper, there are still some grammatical errors that may impede the reader's understanding of the paper. I will provide some examples for clarity, as the paper's readability may affect its potential impact.

• Example in the Abstract:  ll. 8-14:
• Example Method section    “Among the 112 characteristics of the participants, we highlight that 6 women and 6 men.” (Also, please consider consulting the APA Manual regarding the presentation of numbers.)

As apa recommends a letter for numbers above 10, the 6 was changed to six.   

1. 149 “…effective program ef that could…” Could you clarify the meaning of "ef"?

Changed the acronym EF to PE

• ll. 219-221, The sentence appears to be unclear.

Added end of sentence, to better understand it

• ll. 260-261

The word perfect has been introduced, which improves the wording.

• ll. 347 -350

The sentence has been changed to make it easier to understand.

3. p.1, ll 16.18: “The results show that physical education teachers are  poorly trained in eating disorders.” Could you clarify what it means to be trained in eating disorders? Does it refer to recognizing them, understanding them, or treating them? Please provide more specific details.

We have pointed out that it affects both detection and treatment.

4. p.1, ll. 20-21 “… skills in transmitting it” Could you clarify what "it" refers to? The language used is somewhat unclear.

Introduced

5. Is this paper primarily focused on the interviews or on the program? Could you provide clarity on this in the Abstract? If the paper is about the program, perhaps you could also include some information about the program itself.

The wording in the ABSTRACT has been modified.

6. l. 52: It appears that a closing quotation mark is missing.

Introduced

7. l. 59: The authors mention "the skills that prevent eating disorders." Could you provide some examples of these skills for better understanding?

Introduced

8. In the Materials and Methods section, you describe the P-NAF program. Thank you for including this information. However, it might be beneficial to explicitly state that detailed results regarding the program are described elsewhere. Otherwise, it may seem unusual for results to be presented at the beginning of the methods section.

Inserted references 19 and 20 again, at the end of the paragraph

9. ll. 95 -97. Please consider mentioning the positive feedback received for your study in the strengths and limitations section. Additionally, could you kindly provide more details about how the qualitative part of the study was conducted?

Added positive feedback in the limitations section.

In addition to what is provided in the method section, appendix A has been provided with the structure of the interviews.

10. Spelling errors Please review the text for any spelling errors.

• Examples: l. 102 "And"; Corrected is and  l. 111 "DEs" Corrected id ED
• Spelling error in l. 331 “specifically” deleted the word e
• Spelling error in l. 337 “each” Corrected
• l. 340 What is TCA?

TCA is the acronym, in Spanish, for ED. Changed in three places where it appeared.

• Spelling error l. 356 “les” Deleted les
• Spelling error l. 391 “la adult life” Corrected

11. Please review the APA Manual regarding the structure of sentences. Sentences should not typically begin with a number (l.111).

The wording has been slightly changed.

12. There are still some errors in the usage of "interviewer" and "interviewee." For instance, l. 135 mentions "each interviewer," which may need to be revised to "each interviewee."

Changed

13. l. 150 : Could you clarify what the EF classroom refers to?

Changed EF to PE.

14. l. 206 : It seems that the beginning of the sentence is missing.

We have removed (,) from the beginning of the sentence.

15. ll. 298-306 : It is unclear how this text relates to the headline. Could you provide clarification?

Introduced in the first testimony, beginning of sentence. And in the following testimony, last clarification.

This manuscript is a resubmission of an earlier submission. The following is a list of the peer review reports and author responses from that submission.

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The article focuses on what teachers learned about eating disorder prevention through the Psychology for Nutrition and Physical Activity program.

In principle, the topic is interesting, although the article lacks any type of scientific rigor.   Regarding the introduction, it is necessary to clearly define an eating disorder, we are talking about overweight, we are talking about inadequate diet, we are talking about anorexia.   On the other hand, the methodology, as a final degree project, which is what it seems, can be useful, but not for a scientific article.   The idea is that a large sample is used to be able to draw scientific conclusions.   On the other hand, the methodology of structured interviews is not valid, since science does not advance based on opinions.  

The project presented says it contains a quantitative part, we recommend presenting that study, instead of this one.

Reviewer 2 Report

Comments and Suggestions for Authors

Review Results

Manuscript entitled: Teachers' knowledge and experiences after the implementation of an eating disorders prevention program in the Physical Education classroom

This manuscript focuses on what teachers learned about the prevention of eating disorders through the program, Psychology for Nutrition and Physical Activity by conducting semi-structured interviews of physical education teachers (6 women and 6 men) from five educational institutions in southern Spain. The results showed that physical education teachers are poorly trained in eating disorders as indicated by the authors. However, the authors concluded that their experimental program was effective in its objectives and that it should be presented more widely to physical education teachers who work directly with young people. I really appreciated in reading this manuscript. However, there are some considerations in which the authors should pay attention to as follows:

Page 3, Line 115: We received approval from the ethics committee of the University of Almería (UALBIO2022/038), … Please indicate the date of approval.

Page 2, Line 65-74: The authors indicated five main objectives of their study. Unfortunately, the current version of this manuscript does not answer all five main objectives as the author indicated. In order to improve this manuscript, the authors should add more contents by indicating all answers to those five major objectives as indicated.

After answering the concern, this manuscript will be appropriate for publishing in Education Science.