Nursing Students’ Perceptions of a Novel Education Approach to Prevention and Control of Healthcare-Associated Infections: Insights from PrevInf Pilot Study

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Study was well presented but there are some suggested actions for change:

- Introduction section - there is no indication anywhere in this section how HAIs are taught to Nursing students (i.e. is it currently embedded in other modules alongside general hygiene control or something else?). This would help contextualise the current study

- Lines 62/63: "To the best of our knowledge, there is currently no standardized curriculum designed and validated for nursing students in Southeast Asian countries" - do the authors mean "standardized curriculum" for HAIs only or more generally? 

- The PrevInf Theoretical Model is not justified very well but no matter - I don't see the point of the sentence: "The lecture followed the key elements of the PrevInf theoretical model and (Figure 1)"

- Figures 1 and 2 - both columns are listed with "Cambodia" but presumably one should be "Vietnam"?

- Figures 1 and 2 - it is not clear how the M-scores were calculated - using which rating scale (e.g. 1-10)? This makes it difficult to understand whether the scores in this study are actually 'high' or 'low'

- Discussion - Lines 185-202 - none of this narrative is related to the results and discussion and should be revised and more focus placed on discussing key results and their implications. Some of the inferences made in the discussion were not well linked to the results - e.g.  "Nevertheless, statistically significant differences were found between students from Cambodian and Vietnamese HEIs, with the former presenting lower scores of agreement with statements concerning the pre-selected teaching materials, instructions, and strategies used by the nursing educators." - where does it mention pre-selected teaching materials?

Comments on the Quality of English Language

English language quality is adequate with no apparent spelling mistakes or grammatical errors

Author Response

Dear Reviewer, thank you for reading and for the comments and suggestions you made. Your comments deserved our attention, as mentioned below.

"Introduction section - there is no indication anywhere in this section how HAIs are taught to Nursing students (i.e. is it currently embedded in other modules alongside general hygiene control or something else?). This would help contextualise the current study"

Thanks for your suggestion. We made changes that we believe will help understand the problem.

Lines 62/63: "To the best of our knowledge, there is currently no standardized curriculum designed and validated for nursing students in Southeast Asian countries" - do the authors mean "standardized curriculum" for HAIs only or more generally? 

Thanks for the comment. We have made changes to the text that help to clarify this aspect.

The PrevInf Theoretical Model is not justified very well but no matter - I don't see the point of the sentence: "The lecture followed the key elements of the PrevInf theoretical model and (Figure 1)"

Thanks for the comment. We added a sentence that explains the essential aspects of the PrevInf theoretical model.

Figures 1 and 2 - both columns are listed with "Cambodia" but presumably one should be "Vietnam"?

Thank you very much for highlighting this important aspect. We have corrected the column header corresponding to Vietnam.

Figures 1 and 2 - it is not clear how the M-scores were calculated - using which rating scale (e.g. 1-10)? This makes it difficult to understand whether the scores in this study are actually 'high' or 'low'

Thanks for your comment. The explanation of the scales is in the methods section, sub-section study variables and instruments. However, to facilitate understanding of the mean values and standard deviations, information was included in the table title.

Discussion - Lines 185-202 - none of this narrative is related to the results and discussion and should be revised and more focus placed on discussing key results and their implications. Some of the inferences made in the discussion were not well linked to the results - e.g.  "Nevertheless, statistically significant differences were found between students from Cambodian and Vietnamese HEIs, with the former presenting lower scores of agreement with statements concerning the pre-selected teaching materials, instructions, and strategies used by the nursing educators." - where does it mention pre-selected teaching materials?

We removed "pre-" so as not to create confusion.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

I sincerely appreciate your article and its contribution to the continuous improvement of nursing education. After thoroughly analyzing the study, I provide the following considerations to further improve it.

Here are some suggestions to improve your article:

The introduction could emphasize the global relevance of healthcare-associated infections (HAIs) and their impact. It would be beneficial to highlight the importance of formal education and training in HAI prevention and control to develop a resilient healthcare workforce. Furthermore, it may be worth mentioning the paucity of evidence on the effectiveness of current educational approaches, especially in these settings, and emphasizing the crucial role of nursing students in the prevention and control of HAIs and the need to improve their training in this field.

The lack of a standardized curriculum for HAI training in countries could be justified and further highlighted, despite it being an important region for nursing professionals globally.

Materials and Methods. Provide more detailed information about the participating institutions, including their location, sample size, student profile, and any other relevant details that may influence the implementation of the study.

Improve the rationale for institution selection: Explain why the specific institutions mentioned in Cambodia and Vietnam were selected to conduct the pilot study, highlighting how they relate to the study objectives and target population.

Below are some proposals to improve data analysis based on the objectives of the study:

Correlation between questionnaire scores and performance in simulation scenarios, as it could help evaluate the effectiveness of theoretical training in relation to the practical application of the knowledge acquired.

Use regression analysis to explore the influence of various variables, as it could help identify factors that influence students' perception and understanding of the topic.

It would be beneficial to expand on the study results, as they are currently very limited, as the information provided may not be sufficient to obtain a comprehensive understanding of the effects of the intervention.

A possible improvement in the discussion would be to delve into the underlying reasons for these differences between students from the two countries, such as cultural differences, educational systems, or students' previous experiences. Furthermore, further research could be suggested to explore the effectiveness of different educational approaches in improving students' competence in the prevention and control of HAI, with the aim of informing future educational interventions in the region, for example.

The mentioned limitations are consistent with the discussion presented in the study. The need for more in-depth research is recognized to adequately assess students' perceptions of educational intervention in Vietnam and Cambodia. This suggests an awareness that the results observed in the current study may not fully represent the overall effectiveness of the intervention.

Conclusions: These conclusions support the perceived effectiveness of the educational intervention in the study and reinforce the idea that PrevInf has the potential to promote a deeper understanding of the topic among nursing students. Although they could be expanded if statistical analyzes are carried out, expanding and improving the results.

I hope I was able to help improve and contribute to your article.

Author Response

Dear Reviewer, thank you for reading and for the comments and suggestions you made. Your comments deserved our attention, as mentioned below.

I sincerely appreciate your article and its contribution to the continuous improvement of nursing education. After thoroughly analyzing the study, I provide the following considerations to further improve it.

We are glad you enjoyed our article.

The introduction could emphasize the global relevance of healthcare-associated infections (HAIs) and their impact. It would be beneficial to highlight the importance of formal education and training in HAI prevention and control to develop a resilient healthcare workforce. Furthermore, it may be worth mentioning the paucity of evidence on the effectiveness of current educational approaches, especially in these settings, and emphasizing the crucial role of nursing students in the prevention and control of HAIs and the need to improve their training in this field. The lack of a standardized curriculum for HAI training in countries could be justified and further highlighted, despite it being an important region for nursing professionals globally.

Thanks for the comments. We have made improvements to the introduction that focus on the aspects you highlighted.

Materials and Methods. Provide more detailed information about the participating institutions, including their location, sample size, student profile, and any other relevant details that may influence the implementation of the study.

Thanks for your comment. The location of each university has been added. Participants are undergraduate students, as mentioned in the "sample and recruitment" section. The sample size was not calculated.

Improve the rationale for institution selection: Explain why the specific institutions mentioned in Cambodia and Vietnam were selected to conduct the pilot study, highlighting how they relate to the study objectives and target population.

Thanks for your comment. We clarify that the institutions where the study was carried out are higher education institutions that are part of the consortium.

Correlation between questionnaire scores and performance in simulation scenarios, as it could help evaluate the effectiveness of theoretical training in relation to the practical application of the knowledge acquired.

Thanks for the sugestion. Unfortunately, the way the data was collected does not allow this type of analysis to be carried out.

Use regression analysis to explore the influence of various variables, as it could help identify factors that influence students' perception and understanding of the topic.

Thanks for the sugestion. This project is being replicated in other higher education institutions and we intend, when we have a geographically broader sample, to carry out this analysis.

It would be beneficial to expand on the study results, as they are currently very limited, as the information provided may not be sufficient to obtain a comprehensive understanding of the effects of the intervention.

A possible improvement in the discussion would be to delve into the underlying reasons for these differences between students from the two countries, such as cultural differences, educational systems, or students' previous experiences. Furthermore, further research could be suggested to explore the effectiveness of different educational approaches in improving students' competence in the prevention and control of HAI, with the aim of informing future educational interventions in the region, for example.

Unfortunately, there are no studies that compare the two populations (Cambodia and Vietnam) regarding cultural differences, educational systems or health training, which could contribute to a deeper analysis regarding the possible genesis of these results. However, we considered your suggestion very relevant and therefore included it in the Limitations section.

The mentioned limitations are consistent with the discussion presented in the study. The need for more in-depth research is recognized to adequately assess students' perceptions of educational intervention in Vietnam and Cambodia. This suggests an awareness that the results observed in the current study may not fully represent the overall effectiveness of the intervention.

Thank you for your valuable insight regarding the study limitations. We agree that the results may not clearly indicate the effectiveness of the intervention, however, in this stage, our goals are not focused in the evaluation of the effectiveness of the intervention but on what kind of results emerge from the intervention.

Conclusions: These conclusions support the perceived effectiveness of the educational intervention in the study and reinforce the idea that PrevInf has the potential to promote a deeper understanding of the topic among nursing students. Although they could be expanded if statistical analyzes are carried out, expanding and improving the results.

Thanks for the comment. As we mentioned previously, the way the data was collected does not allow to correlations analysis to be carried out, and project is being replicated in other higher education institutions and we intend, when we have a geographically broader sample, to carry regression analysis.

I hope I was able to help improve and contribute to your article.

Once again we thank you for your comments and suggestions. In fact, the article became much better with the improvements made.

Author Response File: Author Response.pdf