Despite Food Insecurity, University Students Remain Committed to Achieving Their Academic Goals: Cross-Sectional Single-Center Study in Saudi Arabia
Round 1
Reviewer 1 Report
Comments and Suggestions for Authors
The paper is significant as it claims to be the first to examine the prevalence of food insecurity and its determinants among university students in Saudi Arabia. However, it also raises some methodological concerns that must be addressed; otherwise, publication should be reconsidered.
1 - The primary issue pertains to the ethical approval of the study. Any research involving human participants or identifiable personal data carries ethical implications. Even in low-risk studies, factors like data protection, confidentiality, and anonymity must be carefully considered. The previous approval from a Ethical Commission is mandatory and should be mentioned.
2 - The final sample size for the study comprised 338 students, which falls of the required 383 determined by the power sample calculation. This poses a significant limitation, particularly considering that the sampling method was convenience-based, greatly impacting the study's representativeness. It is imperative to explicitly address this issue in the discussion section.
3 - Food insecurity was evaluated by questionnaire. However the work don't mention if the questionnaire was validated for Saudi Arabian population or if the questions where in English or Arabic. If the questionnaire was validated by the author, the methods should be mentioned.
4 - Line 246-248. Other authors don't found significant association between food insecurity and sociodemographic factors. The authors can compare the results with these studies. For example: https://www.mdpi.com/2075-4698/12/6/174
Comments on the Quality of English Language
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Author Response
Comments 1: The primary issue pertains to the ethical approval of the study. Any research involving human participants or identifiable personal data carries ethical implications. Even in low-risk studies, factors like data protection, confidentiality, and anonymity must be carefully considered. The previous approval from a Ethical Commission is mandatory and should be mentioned.
Response 1: We thank the reviewer for this comment. Based on the journal guideline, the ethical approval statement was written in the Institutional Review Board Statement section, after the conclusion section. You can find the the ethical approval statement in line 395-396
Comments 2: The final sample size for the study comprised 338 students, which falls of the required 383 determined by the power sample calculation. This poses a significant limitation, particularly considering that the sampling method was convenience-based, greatly impacting the study's representativeness. It is imperative to explicitly address this issue in the discussion section.
Response 2: We thank the reviewer for his/her valuable feedback. We acknowledge that the final sample size of 338 students is below the required 383 as determined by the power sample calculation. We understand that this cause a significant limitation, particularly in light of the convenience-based sampling method, which may affect the representative of our findings. In the revised manuscript, we have mentioned in the discussion section how the small sample size and convenience sampling method might impact the generalizability of the results and have potential biases. In the limitation of the study, a sentence was added in line 364-368, as follows: “however, similarly low response rates have been reported by other studies conducted to determine food insecurity prevalence among college students. Third, due to the use of convenience sample, the findings cannot be generalized due to selection bias. We have also included suggestions for future research to address these limitations in the discussion section in line 275-281 as follows: “Therefore, further research should aim for random sampling techniques and larger sample size to help identify potential associations that were not significant due to the limited sample size, thereby enhancing the generalizability of the findings and alleviate selection bias. Moreover, qualitative research is required to gain a better understanding of the food security status of students and the factors influencing food insecurity. Also, conducting a longitudinal study can provide better understanding into how food insecurity and its determinants develop over time.”
In addition, we have also included suggestions for future research to address these limitations in the conclusion section in line 378-380 as follows: “Further research that uses random sampling techniques and has a larger sample size should evaluate food insecurity and its associated factors in greater detail and enhance the generalizability of the findings.”
Comments 3: Food insecurity was evaluated by questionnaire. However the work don't mention if the questionnaire was validated for Saudi Arabian population or if the questions where in English or Arabic. If the questionnaire was validated by the author, the methods should be mentioned.
Response 3: We thank the reviewer for this comment. To address this comment,we have added a sentence in the method section in line 75-78 as follows: “The questionnaire was translated into Arabic. A pilot study was conducted with a sample of 15 students and four experts in the field of nutrition and food security to evaluate the questionnaire’s clarity, length, and content and ensure face and content validity.”
Comments 4: Line 246-248. Other authors don't found significant association between food insecurity and sociodemographic factors. The authors can compare the results with these studies. For example: https://www.mdpi.com/2075-4698/12/6/174
Response 4: We thank the reviewer for his/her valuable comment. We appreciate your suggestion to compare our results with studies that did not find a significant association between food insecurity and sociodemographic factors. In response, we have reviewed the study you referenced (https://www.mdpi.com/2075-4698/12/6/174) and included a comparison in the discussion section of our manuscript in line 267-269 as follows: “A study conducted in Portugal found similar results, with no significant association between age, gender, employment status, or education level.”
Also, I would like to confirm that the manuscript has been sent to an English editor for grammar checking and proofreading to ensure the highest quality of language and clarity.
Reviewer 2 Report
Comments and Suggestions for Authors
I think the main thing that needs to be highlighted in this manuscript is that the authors used a nonprobability sample. This is an exploratory study. There is merit to is, since it contributes to efforts to design studies like this using surveys. Past studies have been qualitative in nature, and this adds to the methods toolkit.
The research was prompted by food insecurity concerns during Covid. There could be more discussion about (1) how these findings can inform future planning for pandemics and disasters where people are cut off from institutional resources (e.g. when remote learning cut people off from food services as universities, etc.).
The main significant finding is that income is correlated with food insecurity, that is not surprising. A number of other variables were not significant. More discussion of what was not significant and how future research designs can be modified to examine these facets of the food insecurity question could be added.
Also, more discussion of future research can be added. Would a retrospective study of Covid and post-Covid reveal changes in food insecurity, etc. How can this study be replicated with a random sample, or more importantly a stratified sample that weighted groups that under-enrolled in this study?
Basically, this is a pilot study, but it can provide some methodological insights, but he design limitations should be acknowledged more fully. The authors should also discuss how studying food insecurity populations is difficult, but using an institutionally based population, like college students, can allow for this type of survey research to be designed in a more systematic manner. The authors could identify other institutional settings where similar research could be conducted (primary schools, senior and other congregated housing, etc).
Comments on the Quality of English Language
There is some type-editing needed, but the English is generally good.
Author Response
Comments 1: I think the main thing that needs to be highlighted in this manuscript is that the authors used a non-probability sample. This is an exploratory study. There is merit to is, since it contributes to efforts to design studies like this using surveys. Past studies have been qualitative in nature, and this adds to the methods toolkit.
The research was prompted by food insecurity concerns during Covid. There could be more discussion about how these findings can inform future planning for pandemics and disasters where people are cut off from institutional resources (e.g. when remote learning cut people off from food services as universities, etc.).
Response 1: We thank the reviewer for his/her valuable comment. We appreciate your suggestion to discuss how our findings can inform future planning for pandemics and disasters. To address this comment, we have added a sentence in the discussion section in line 317-328 as follows: “Therefore, universities and colleges must prepare for future pandemics and disasters. It is critical to plan strategies that address food insecurity among university students. For instance, universities could establish annual screening, especially for new students, to develop interventions that could better support vulnerable university students such as food assistance programs and educational courses on budgeting and obtaining an affordable nutritious diet. Universities could also establish food banks to ensure that students do not face food insecurity during crises when institutional resources become unavailable. Incorporating these recommendations into future planning can help alleviate the impact of pandemics and disasters on food security among university students and ensure they receive the assistance needed to maintain their health and well-being during crises.”
Comments 2: The main significant finding is that income is correlated with food insecurity, that is not surprising. A number of other variables were not significant. More discussion of what was not significant and how future research designs can be modified to examine these facets of the food insecurity question could be added.
Response 2: We thank the reviewer for his/her insightful feedback. We acknowledge that our study's main significant finding is the correlation between income and food insecurity, which aligns with existing literature. However, several other variables did not show a significant association with food insecurity in our sample. To address this comment, we have added a sentence in the discussion section in line 275-281 as follows: “Therefore, future further research should aim to use for random sampling techniques and gather a larger sample size to help identify potential associations that were not significant due to the limited sample size, thereby enhancing the generalizability of the findings and alleviate selection bias. Moreover, qualitative research is required to gain a better understanding of the food security status of students and the factors influencing food insecurity. A Also, conducting a longitudinal study may can provide a better understanding into how food insecurity and its determinants develop over time.”
Comments 3: Also, more discussion of future research can be added. Would a retrospective study of Covid and post-Covid reveal changes in food insecurity, etc. How can this study be replicated with a random sample, or more importantly a stratified sample that weighted groups that under-enrolled in this study?
Response 3: We thank the reviewer for his/her insightful feedback. To address this comment,we have added a sentence in the discussion section in line 275-281 as follows: “. Therefore, future further research should aim to use for random sampling techniques and gather a larger sample size to help identify potential associations that were not significant due to the limited sample size, thereby enhancing the generalizability of the findings and alleviate selection bias. Moreover, qualitative research is required to gain a better understanding of the food security status of students and the factors influencing food insecurity. A Also, conducting a longitudinal study may can provide a better understanding into how food insecurity and its determinants develop over time.”
Comments 4: Basically, this is a pilot study, but it can provide some methodological insights, but he design limitations should be acknowledged more fully. The authors should also discuss how studying food insecurity populations is difficult, but using an institutionally based population, like college students, can allow for this type of survey research to be designed in a more systematic manner. The authors could identify other institutional settings where similar research could be conducted (primary schools, senior and other congregated housing, etc).
Response 4: We thank the reviewer for his/her insightful feedback. We acknowledge the design limitations of our study, particularly the use of a convenience sample and the relatively small sample size, which may affect the generalizability of our findings. To address this comment,we have added a sentence in the discussion section in line 364-368 as follows: “However, similar low response rates have been reported by other studies conducted to determine the food insecurity prevalence in college students (53,54, and 55). Finally, the findings cannot be generalized to university students across Saudi Arabia due to potential selection bias from using convenience sampling.”
We appreciate your suggestion regarding the identification of other institutional settings where similar research could be conducted. However, we would like to clarify that the primary focus of our study is on the university student population. Our aim was to address food insecurity specifically within this demographic due to its unique characteristics and challenges.
While expanding the research to include other settings such as primary schools, senior housing, and other congregated housing is indeed valuable, it is beyond the scope of our current study. We believe that future research could certainly explore these areas to provide a more comprehensive understanding of food insecurity across different populations.
I would like to confirm that the manuscript has been sent to an English editor for grammar checking and proofreading to ensure the highest quality of language and clarity.
Round 2
Reviewer 1 Report
Comments and Suggestions for Authors
I have reviewed the responses provided by the authors and the revised version, and I find it satisfactory.
Reviewer 2 Report
Comments and Suggestions for Authors
The authors addressed my comments.
