Green Dental Environmentalism among Students and Dentists in Greece
Round 1
Reviewer 1 Report
I would first like to commend the authors for their efforts in this work. I have noted a number of methodological and presentation issues that need to be addressed in the paper:
1.) Abstract and in lines 176ff: The response rate is very low in this study. Especially for dentists 1.94%. Can this sample be somehow considered as representative of all dentists/students? The authors need to explain how they have made sure that this is the case. Otherwise, the study suffers in that the findings can in no way be considered as representative of the categories of participants it studies. In essence, it will be only a presentation of the views of a fraction of members from the studied group (and not necessarily a representative one at that).
2.) In the abstract - line 24: p=.057. Can this specific result be deemed as adequately statistically significant?
3.) The introduction should include a clearly stated Research Question that the authors focus on in this research. As it stands, the RQ is missing. You need to add it so that the reader can understand what you focus on in this study.
4.) The paper completely lacks a background section through which specific hypotheses can be correspondingly supported. A lack of hypotheses makes the study exploratory in its nature. However, from the introduction, one can see that existing work can help the authors support hypotheses. Therefore, I suggest that the authors add a background section right after the introduction. Within this section, they should add existing insight from published sources, with a focus on Pro-Environmental behaviour in workplace environments. I suggest the inclusion of the following paper in your work:
(a.) Since you mention energy-saving, a lot has been said with regards to organizational energy-saving and it importance in office buildings so far. A recent review on this matter that focuses on energy conservation in specific and the ways in which it can be utilized at work, which you can cite in your research is “Kotsopoulos, D., 2022. Organizational Energy Conservation Matters in the Anthropocene. Energies, 15(21), p.8214".
(b.) Another study that focuses on water conservation is "Akamani, K., 2014. Challenges in the transition toward adaptive water governance. Water conservation: Practices, challenges and future implications, pp.165-178", that you can cite for water conservation.
(c.) Other studies have focused on sustainability in general, such as e.g. "Goucher, N.P. and Michaels, S., 2004. Creating organizational knowledge for the transition to sustainability. In Proceedings of the 2002 Berlin Conference on the Human Dimensions of Global Environmental Change (pp. 346-351)". You can utilize it as a reference for further pro-environmental organizational processes.
5.) In lines 124ff, the authors explain that the validity of the questionnaires they employ was confirmed by 3 experts. However, the process of developing questionnaires from scratch is much more complicated under normal circumstances. In any case, the themes of the questions utilized should be rooted in theory / existing published sources before proceeding to develop the items themselves and pass them on to experts. A reference to review with regards to the methodology of developing questionnaires can be the following: "Mackenzie, S. B., Podsakoff, P. M., & Podsakoff, N. P. (2011). Construct Measurement and Validation Procedures in MIS and Behavioral Research : Integrating New and Existing Techniques. MIS Quarterly, 35(2), 293–334". Moreover, example papers of developing a questionnaire from scratch which you can review include:
(a) "Jackson, S. A., & Marsh, H. W. (1996). Development and validation of a scale to measure optimal experience: The Flow State Scale. Journal of Sport & Exercise Psychology, 18, 17–35. https://doi.org/10.1080/15298860309027", and "Snyder, C. R., Hoza, B., Pelham, W. E., Rapoff, M., Ware, L., Danovsky, M., … Stahl, K. J. (1997). The development and validation of the Children’s Hope Scale. Journal of Pediatric Psychology, 22(3), 399–421. https://doi.org/10.1093/jpepsy/22.3.399"
(b) "Tims, M., Bakker, A. B., & Derks, D. (2012). Development and validation of the job crafting scale. Journal of Vocational Behavior, 80(1), 173–186. https://doi.org/10.1016/j.jvb.2011.05.009".
6.) In line 154, the authors state that "Data analysis included descriptive statistics and thematic analysis". They should explain in more detail the process they followed, also citing references on methodology which they have considered in the process of building their analysis strategy (i.e. which guidelines they have adopted from existing methodology literature).
7.) In lines 161-163, the authors mention that they employed a 5-point Likert scale, where 1 = "extremely insignificant", 2= "relatively insignificant", 3= "neutral", 4= "important" and 5= "extremely important". This scale seems unbalanced, as "relatively insignificant" should be balanced by "relatively important", and not "important". In other words, the scale employed is not a correct Likert scale, as it lacks balance and the numbers cannot be correctly (quantitatively) mapped to the terms anchored on them.
8.) The authors need to also include a figure that outlines their research methodology (research steps and analysis steps) in the "materials and methods" section, to make it more clear what process they follow. It is quite tedious to comprehend what methods they have used for what purpose and the steps they follow in their research and analysis of results as it stands, based on the info in this section.
9.) In lines 168ff, the authors mention"a series of independent variables on knowledge, perceptions, and importance of factors on ESD", without including sample items. Moreover, I would like to stress that one-item scales are hardly appropriate to accurately measure abstract notions such as "knowledge" of a subject. Multi-item scales should be preferred to be adopted from the literature as needed in most situations, so that the validity of the collected answers is increased.
10.) Based in the statistical analysis of the sample characteristics we see that the sample was indicatively predominantly female subjects (>60%), plus more characteristics. Is this sample representative of the general population in the specific school, or is this sample not a representative sample? You need to provide a comparison of your sample characteristics to the characteristics of the general population. The same applies for both samples (students and doctors) in your study.
11.) The statistical relationships outlined in the results section (with numbers) should also be depicted in a figure, so that the reader can explore with more ease what the study has brought forth with regards to the connections between the constructs employed in the study. Simple "boxes and arrows" figures provide a better overview than having to read through the document and mentally review the combination of all results mentioned.
12.) In lines 249 and 253 the authors mentioned "(Data not shown)". Why have they elected not to show this data. It would be preferable to include this data also as with other data presented in the paper in my opinion (unless there is a compelling issue to not include it in the paper, which they need to explain).
13.) Figure 1 is very hard to follow (by the way the caption is not in caption text style). I really cannot comprehend it with all those ellipses and crossings between lines. Moreover, no lines or insight on the statistical significance is provided. I suggest that the authors follow my previous remark and build a proper figure outlining the statistical results revealed in their study.
14.) In lines 268ff the authors offer a few paragraphs that contain qualitative insight on the collected free-form comments of the participants. However, they should add some indicative statements that the participants provided for each one of the outlined findings. The most indicative comments, or the most often mentioned, are preferable to include here, along with the number of occurrences (how many times a specific comment was found in the statements of the participants / how many deemed it important).
15.) The discussion should outline the theoretical implications and practical implications separately in my view, so that dentists and researchers in this field can each find their most relative insight collected neatly.
16.) The limitations should be included in section 5 (conclusions) and not a separate chapter. More importantly, more limitations should be added, based on the way the questionnaires were developed (see my comments on questionnaire development), and on the issue of sample size and representativeness (see my comments on sample). Additional suggestions for future work should be included based on these additional limitations accordingly also.
17.) The questionnaire (in the appendix) has probably been translated from Greek (the language in which it has been administered to the Greek participants in the study). Many errors in phrasing and words used exist in the appendices. Please check and correct as needed so that English speakers can fully understand what you meant in the original Greek items.
Author Response
Dear reviewer,
We have added a pdf file with our corrections/additions/comments. Thank you for your time and effort to review our work.
The authors
Author Response File: 
Author Response.pdf
Reviewer 2 Report
This is an interesting work focusing on green dental environmentalism. The topic is quite interesting and the authors also provide a novel perspective of view. However, it is believed that the manuscript can be improved by a better theoretical development. Here are some more detailed comments and suggestions:
1. The authors can benefit from a more comprehensive review of the recent studies. This can help the manuscript to highlight the research gaps it addresses.
2. It would be ideal if the authors can provide a more solid theory development process with convincing academic evidence
3. The sample size in this study is small. The authors should provide evidence to proof the number of valid data is suffice for analysis.
Please improve some minor points of academic writing
Author Response
Dear reviewer,
We have added a pdf file with our corrections/additions/comments. The manuscript has been almost rewritten.
Thank you for your time and effort to review our work!
The authors
Author Response File: Author Response.pdf
Round 2
Reviewer 1 Report
I would like to first congratulate the authors for their efforts towards improving the paper. However, I found that some of my previous round’s comments have not been adequately covered. I provide my more detailed comments for further improving the paper hereunder:
1.) Sections 2 and 3 should be placed as sub-sections within the same section. I.e. rename section 2 to "Background", and within this section place two sub-sections: 2.1. Pro-environmental behaviors, and 2.2. Theories on proenvironmental behavior.
2.) There are many cases where the reference made is placed after the end of the corresponding statement (after the "."). You need to move the endpoint "." right after the references. E.g , in line 134, "environmental sustainability. [35]" --> "environmental sustainability [35].". Please check the document for such cases, as I have found many throughout (you need to check from the beginning to the end for such cases).
3.) Please check the numbering of all chapters. E.g., Materials and Methods will be nr. 3 after the proposed changes, etc.
4.) In line 195, you state that your study was carried out "in undergraduate students". Please check the grammar. I do believe that the correct way to state this is "with undergraduate students". Moreover, I think that it would be best to start off this section by explaining that two categories of participants participated in your study (both students and dentists). This will make it clearer what the case is here.
5.) In lines 205-207, you mention that "In our survey we used piloted online questionnaires for dental students and dentists, 205 designed according to the most common theories of pro-environmental behavior 206 mentioned before.[12-18,35,44-58]". However, you do not explain how (and if) each question in the questionnaire corresponds to specific constructs of these theories, nor do you form a research model accordingly, based on the insight from these theories. In other words, you need to explain exactly how each question in the questionnaire was developed, which (if any) references you used to develop it (and how). Even for your choice of demographic characteristics you need to explain if they were selected arbitrarily, or based on insight from the literature.
6.) In line 231, you state that "an independent panel of three professors reviewed and revised the survey questions to be relevant to the topic and expressed correctly". You need to explain in more detail the process followed (e.g. you sent them the questions independently, they provided their comments, you revised them, then you conducted a focus group, or any other process you followed to finalize the items used in your study).
7.) In line 233: "All questions were obligatory" --> "Answering all questions was obligatory"
8.) You need to add a figure in the "Materials and Methods" section, where you graphically depict your research model (the variables you have included in your research and the connections investigated between them).
9.) You note in line 265 that "historically the vast majority (over 60%) do not respond to research-driven initiatives". However, according to the provided statistics earlier, your response rate is not even close to 40% of the ones who (according to your own statement) tend to answer to questionnaires. Why has only 1.94% answered to your questionnaire (and not 40%), and what does that mean for the validity of your findings? Further to this, you also need to check the representative (or not) nature of your sample, by comparing the demographics of your sample to the demographics of the total population of both categories of participants (i.e., you need to compare both your samples to the total population of each of the two categories).
10.) In line 274, you mention that "The scale of the study has good reliability 274 (Cronbach's alpha =0.706)." and go on to explain why calculating this score has no meaning. This is an openly contrasting statement. If there are no scales tested and all items are independently measuring different constructs, calculating an alpha score makes no sense.
11.) In table 2 you need to explain what the p value means here. I'm guessing you performed t-tests between the groups? You need to explain exactly the process before the table, and also explain in the table legend what the results are (e.g. descriptive statistics and t-test results). Same comment applies to Table 3.
12.) In line 331, is p=0.057 adequate to justify statistical significance?
13.) In lines 358-366 you mention several p values over the 0.05 threshold. Do these p-values justify statistical significance?
14.) Figure 2 is a nice inclusion, but you need to re-organize the text so that it can be enlarged and visually more compelling. As explained in my previous round comments, you need to produce a "boxes and arrows" model that presents the connections explained, along with the statistics that support them (based on your findings. Moreover, please check that whatever changes you make to your results based on reviewing my comments with regards to p-values assessment, are also transfered to this figure.
15.) In the conclusion, I am missing a separate discussion of the theoretical and practical contributions of your results. You need to add a few sentences for each one. I.e., how can future researchers utilize your findings?, and how can future practitioners in the field use your findings?
16.) The limitations offered in the conclusion need to be enriched. For instance you need to explain more in detail the limited sample size, issue with representative nature of your sample (small fraction of the group participated in the research), research conducted in just one country, etc. Please review your study design shortcomings and add limitations accordingly. Based on all the accrued limitations, you need to also provide suggestions for future research that will overcome these limitations (e.g. suggest that a future research be conducted in an international setting instead of just Greece, etc.).
17.) I also revert to some of my previous-round comments that I believe have not been covered. For instance, "The authors need to also include a figure that outlines their research methodology (research steps and analysis steps) in the "materials and methods" section, to make it more clear what process they follow. It is quite tedious to comprehend what methods they have used for what purpose and the steps they follow in their research and analysis of results as it stands, based on the info in this section.". --> I still think that you need to develop a figure with the above-mentioned specifications.
18.) Regarding the explanation presented on why the authors opted to utilize single-item scales, they should also include it within the methodology section of the paper (and not just in the response letter). I.e., they should add their own statement from the response letter "Regarding the use of single-item scales vs multi-item scales there are arguments for both sides. In this survey the single item approach was used with some validation questions to establish the accuracy of the responses given in some topics. According to researchers single item scales are reliable as multi-scale items and can be used in surveys.
Ang, L., & Eisend, M.(2018). Single versus multiple measurement of attitudes: A meta-analysis of advertising studies validates the single-item measure approach. Journal of Advertising Research, 58(2), 218–227.https://doi.org/10.2501/JAR-2017-001 ", in the methoodology section, explaining why their own context justifies the connection made to the findings of this specific study cited.
19.) The authors need to also incorporate their explanation on the gender disparity (offered as part of answering my previous round comment #10), within the results section of their paper. I.e., they should add the text offered in the response letter within the main body of the paper: "Authors answer= Indeed there is a general consensus that there is a gender disparity in participating in online surveys with women participating more than men (Becker, 2022). In addition, there is evidence from other research protocols within the dental schools of Greece that the ratio of responding male to female dental students and dentists is 0.4, namely participation to online surveys ranges between 65-70% in women and 25-30% in men. As the topic of the present survey is a very specific professional issue, we believe that the participation rates observed in our study are comparable with those observed in similar surveys addressing dental students and practicing dentists.
Antoniadou, M.; Masoura, E.; Devetziadou, M.; Rahiotis, C. Ethical Dilemmas for Dental Students in Greece. Dent. J. 2023, 11, 118. https://doi.org/10.3390/dj11050118
Becker R. Gender and Survey Participation. An Event History Analysis of the Gender Effects of Survey Participation in a Probability-based Multi-wave Panel Study with a Sequential Mixed-mode Design methods, data, analyses | Vol. 16(1), 2022, pp. 3-32 DOI: 10.12758/mda.2021.08".
20.) The questionnaire in the appendix still has some issues with grammar & spelling. E.g., Line 628: lives --> live, Line 637: "I don't answer" --> something like “I will not provide an answer”, or "I prefer not to answer", etc. Please check the expressions.
21.) I am also puzzled by the fact that the authors refer to “green dental offices” in the introduction of the questionnaire and some of the questions, without providing a brief explanation of what “green dental offices” are to the participants. How did they make sure that all participants conceive of the term “green dental office” and what it entails in the same way without providing an explanation?
Some improvement needs to be made by carefully proofreading the manuscript. I have provided some details through my comments also.
Author Response
Dear reviewer,
We have uploaded a relevant word file
Thank you
the Authors
Author Response File: Author Response.pdf
Round 3
Reviewer 1 Report
I would like to commend the authors for the improvement to the paper. Some notes for further improvement:
Some of the figures look hard to read because they are small. I suggest you enlarge them (I believe that you are allowed to utilize the left-hand side border especially for figures in the paper), or move them to a separate landscape-oriented page and enlarge them (e.g., Figure 1, Figure 2, Figure 3, Figure 4, Figure 5).
In p.14, figure 5 has no legend (you need to add the legend).
In line 325 you mention that "we assume our sample has good reliability". I would leave this out. You don't need to check reliability if you are only using single-item scales as you explain in your next sentence.
Some further proof-reading is needed in the document. Please re-read and make changes as needed (e.g., in line 226 "were taken part" --> "took part" or simply "participated", in line 352 "2 sided" --> "2-sided").
Author Response
Dear reviewer,
He have made all suggested corrections to our paper.
Thank you for your time and effort to improve our work.
The authors
Author Response File: Author Response.pdf
