Photovoice and Health Perception in a Group of Early-Career Nurses
Round 1
Reviewer 1 Report
Comments and Suggestions for AuthorsDear Authors, the topic of the manuscript is interesting and relevant for nursing.
As a reviewer, I have a few suggestions for improving your manuscript:
- in the introduction section clearly state exsisting gaps in knowledge about this topic.
- some sentance formulations are unclear
- in method section indicate study design, time period of data collection
- it is important to correct the reference list
- the manuscript needs to be proofread
Kind regards.
Comments on the Quality of English Language
The manuscript needs to be proofread.
Author Response
Dear Authors, the topic of the manuscript is interesting and relevant for nursing.
--- We are grateful for the comments and interest in our paper.
As a reviewer, I have a few suggestions for improving your manuscript:
- in the introduction section clearly state exsisting gaps in knowledge about this topic.
--- We have added a new sentence to the first paragraph in the introduction pointing out that little is known regarding the effectiveness of incprorating a photovoice activity into health psychology training for master's level nursing students. In the paragraph about the gaps we have incorporated new literature included (e.g publication of Bandauko, E., & Arku, G., 2023) and reason for including Ajzen's TBP.
- some sentance formulations are unclear
--- Thank you for pointing this out. The third author has edited the revised manuscript and has (hopefully) made unclear sentence formulations more clear now.
- in method section indicate study design, time period of data collection
--- The study design is explained in Materials and method section. The time period of data collection in now in the first paragraph of methodology.
- it is important to correct the reference list
--- We've changed the references list and citation style, based on the Journal requirements
- the manuscript needs to be proofread
--- This revision of our manuscript has been edited and proofread. We appreciate your comment pointing out this need.
Reviewer 2 Report
Comments and Suggestions for AuthorsAbstract:
1. Remove the word "paper" in line 10.
2. Reverse the order of the two sentences in the background, and modify the first sentence as an objective.
3. The sentence in line 12 "The study population was 87 master’s degree nursing nurses at Jagiellonian University…." Need editing of English language to "The study population was 87 nurses in a master’s degree nursing at Jagiellonian University….
4. The research design should be presented.
5. Findings should be in the results section not in the method section
Such as "the mean age was 22.1 (SD=1.1)".
6. The sample size was 87 nurses in the method section vs. 89 in the results section! Why? Accuracy must be observed.
7. You should specify exact percentages and not use general terms such as
"Most", "Some" in line 18 and the result section.
8. The conclusion does not express the findings specifically and is too general, please clarify….
Methods:
1. The methods section requires extensive linguistic editing, such as the first sentence in lines 124-126, and the sentence "Participants chose to remove a total of 40 photos from the research 152 database: 10 each for perception and protective factors, and 20 for risk factors" in lines 152-153.
2. The sample size was 87 nurses in the method section vs. 89 in the results section! Why? Accuracy must be observed.
3. The research design should be indicated.
4. There is a lack regarding the ethics committee's approval and the protocol number in the method section.
5. There is a lack of statistical methods.
Results:
1. The results section requires extensive linguistic editing such as "Two men were in the group and the rest of the group identified themselves as women". Please rewrite this paragraph with the percentage for males and females… add years to the value 22.1in the sentence "The mean age was 22.1…" in line 179.
2. The sample size was 87 nurses in the method section vs. 89 in the results section! Why? Accuracy must be observed.
3. The study database has 227 photos, 79 (each) related to perception and protective factors and 69 related to risk factors. 79 + 69 = 148, what about the rest of the 227 photos?
4. You should specify exact percentages and not use general terms such as "most" students… "The majority"…"some" photos… A "few" students... in lines 181-185 and the other paragraphs in the result section.
Discussion
1. The study was based on self-reporting by the participants, this point should be emphasized in the limitations of the study
2. The conclusion does not express the findings specifically and is too general, please clarify….
Comments on the Quality of English LanguageMinor editing of English language required
Author Response
Remove the word "paper" in line 10.
--- We would like to thank the Reviewier for the valuable comments. The word "paper" is deleted.
Reverse the order of the two sentences in the background, and modify the first sentence as an objective.
--- We've done it, as suggested.
The sentence in line 12 "The study population was 87 master’s degree nursing nurses at Jagiellonian University…." Need editing of English language to "The study population was 87 nurses in a master’s degree nursing at Jagiellonian University….
--- corrected, as suggested
The research design should be presented.
--- The study design is now explained in the Materials and Method section.
Findings should be in the results section not in the method section. Such as "the mean age was 22.1 (SD=1.1)".
--- We moved this phrase of Abstract to the Results section.
The sample size was 87 nurses in the method section vs. 89 in the results section! Why? Accuracy must be observed.
--- we've corrected that in the whole manuscript. Thank you for that remark.
You should specify exact percentages and not use general terms such as
"Most", "Some" in line 18 and the result section.
--- where possible, we've added the number and percentages
Methods:
1. The methods section requires extensive linguistic editing, such as the first
sentence in lines 124-126, and the sentence "Participants chose to remove a total
of 40 photos from the research 152 database: 10 each for perception and
protective factors, and 20 for risk factors" in lines 152-153.
--- The third author, a native English speaker and a former editor, has edited the manuscript to increase the clarity of word use and decrease repetition (we hope)! We are prepared to continue this editing process if so advised.
2. The sample size was 87 nurses in the method section vs. 89 in the results section!
Why? Accuracy must be observed.
--- We've corrected that in the whole manuscript. Thank you for that remark.
3. The research design should be indicated.
--- The study design is explained in the Materials and Method section.
4. There is a lack regarding the ethics committee's approval and the protocol
number in the method section.
--- The ethical information can be found in Institutional Review Board Statement statement section.
5. There is a lack of statistical methods.
--- The reason is, that the Photovoice methodology based on qualitative data, as explained in the methodology section
Results:
1. The results section requires extensive linguistic editing such as "Two men were
in the group and the rest of the group identified themselves as women". Please
rewrite this paragraph with the percentage for males and females… add years to
the value 22.1in the sentence "The mean age was 22.1…" in line 179.
--- we've modfied this part of manuscript, as suggested.
2. The sample size was 87 nurses in the method section vs. 89 in the results section!
Why? Accuracy must be observed.
--- We've corrected that in the whole manuscript. Thank you for that remark.
3. The study database has 227 photos, 79 (each) related to perception and
protective factors and 69 related to risk factors. 79 + 69 = 148, what about the
rest of the 227 photos?
--- The study database has 227 photos, 79 (each) related to perception and protective factors and 69 related to risk factors—this is explained in the Methodology section.
4. You should specify exact percentages and not use general terms such as "most"
students… "The majority"…"some" photos… A "few" students... in lines 181-
185 and the other paragraphs in the result section.
--- We've added the percentages where it was possible.
Discussion
1. The study was based on self-reporting by the participants, this point should
be emphasized in the limitations of the study
--- This information has been added as a limitation. Thank you for this valuable remark.
The conclusion does not express the findings specifically and is too general, please clarify….
--- We have provided a new conclusion that we hope responds to the author's guideline to give a conclusion when the discussion section is long and complex. We moved the prior conclusion up to the end of the discussion section.
Minor editing of English language required
--- The paper has been edited throughout for English language use.
Reviewer 3 Report
Comments and Suggestions for AuthorsThank you for the opportunity to review this manuscript. Photovoice can be a valuable teaching and learning technique. I commend the authors for using this strategy. The stated purpose was to analyze and compare issues related to taking pictures for a course assignment and assess the effectiveness of a photovoice activity adapted to clinical education for master's degree nursing students.
However, in this manuscript, it is difficult to discern if the purpose was met. There seems to be a mismatch in the analysis related to Azjen's theory of planned behavior vs. the stated purpose of "issues" and "effectiveness" of the photovoice activity.
Analysis: section last paragraph: How do the 3 forms of analysis answer the purpose or research question?
Results: The results do not support the conclusions that the students critically thought about or reflected on their own health-related beliefs or represent aspects of Azjen's theory of planned behavior. The vast majority appeared to depict only typical socially pervasive beliefs about what is healthy and what is not. Perhaps there is more evidence of this in analyzing the captions or the actual discussions the students had with each other, but this evidence is not provided.
Discussion: In the discussion section, there are many unsupported or unsubstantiated statements, either regarding the results of this study or citations of other research evidence. Here are a few examples: line 343 "appeared to facilitate a more profound understanding." and line 345 "generated insights into their own health behaviors". Line 353 "first step in reflecting on behavioral control and rethinking daily habits." Lines 368-374 seem to be more of future questions and not discussion points and are not clearly tied to the results. Line 400 - results did not support any discussion of social determinants of health.
Comments on the Quality of English Language
This manuscript would benefit from an English language editor to increase the clarity of word use and decrease repetition.
Author Response
Thank you for the opportunity to review this manuscript. Photovoice can be a valuable teaching and learning technique. I commend the authors for using this strategy. The stated purpose was to analyze and compare issues related to taking pictures for a course assignment and assess the effectiveness of a photovoice activity adapted to clinical education for master's degree nursing students.
--- We want to thank the Reviewier for the valuable comments. We believe the Photovoice methodology might be an effective tool in clinical teaching.
However, in this manuscript, it is difficult to discern if the purpose was met. There seems to be a mismatch in the analysis related to Azjen's theory of planned behavior vs. the stated purpose of "issues" and "effectiveness" of the photovoice activity.
--- We've explained our intention to include Ajzen's TPB in the Introduction.
Analysis: section last paragraph: How do the 3 forms of analysis answer the purpose or research question?
--- We've explained in briefly in the Methodology section.
Results: The results do not support the conclusions that the students critically thought about or reflected on their own health-related beliefs or represent aspects of Azjen's theory of planned behavior. The vast majority appeared to depict only typical socially pervasive beliefs about what is healthy and what is not. Perhaps there is more evidence of this in analyzing the captions or the actual discussions the students had with each other, but this evidence is not provided.
--- We agree that group of the students is based on a stereotypical perception of health and its components. However, there are some exceptions, like the comments, that is mentioned in the text "We will die in this job". For us, it illustrates critical insight. In discussing each figure, we have added new content on social perception and critical thinking demonstrated (or not explained) in the photo and caption. We hope these additions will better show a relationship (or lack of relationship) between course concepts and the students' work for the photovoice activity. We have deleted some repetition of Azjen's TPB, and have added new content that we hope better shows the alignment of photovoice as a course activity, TPB and student learning.
Discussion: In the discussion section, there are many unsupported or unsubstantiated statements, either regarding the results of this study or citations of other research evidence. Here are a few examples: line 343 "appeared to facilitate a more profound understanding." and line 345 "generated insights into their own health behaviors". Line 353 "first step in reflecting on behavioral control and rethinking daily habits." Lines 368-374 seem to be more of future questions and not discussion points and are not clearly tied to the results. Line 400 - results did not support any discussion of social determinants of health.
--- We support our conclusions by the previous literature and, during the editing process for this revision, we have attempted to remove or tone down some of the statements that appear to inflate the study's fimdings. For example, the phrase in question on line 343 has been deleted and the sentence now reads: The photovoice method engaged students and appeared to facilitate deeper understanding of topics covered during the course than could have been accomplished by imparting content without an active learning component (now lines 480-482).
We moved this paragraph to Future research part of the manuscript.
Line 400- We considered it as a suggestion for the Future research, it is now better explained.
This manuscript would benefit from an English language editor to increase the clarity of word use and decrease repetition.
The third author, a native English speaker and a former editor, has edited the manuscript to increase the clarity of word use and decrease repetition (we hope)! We are prepared to continue this editing process if so advised.
Round 2
Reviewer 3 Report
Comments and Suggestions for AuthorsThank you to the authors for their very thorough responses and revisions based on the reviewer's comments. The entire manuscript is much improved. It is clearer and easier to read and the discussion and conclusions are appropriate and based on the results.
