The Development and Testing of the Hippocratic Heart Failure Self-Care Scale

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors The conclusions are as follows: -Originality / Novelty - Average The paper has a similar theme to a previous paper published by the same authors in Healthcare. Brokalaki, H.; Chatziefstratiou, A.A.; Fotos, N.V.; Giakoumidakis, K.; Chatzistamatiou, E. The Development and Validation of the "Hippocratic Hypertension Self-Care Scale." Healthcare 2023, 11, 2579. https://doi.org/10.3390/healthcare11182579 -Significance of Content – Average Although the data is correctly analyzed and interpreted, the article does not shine. -Quality of Presentation – Average Even though the ideas are expressed clearly, concisely, and logically, the way of data presentation chosen by the authors, with most of the results presented in tables and short paragraphs for discussion and conclusions, make the paper not attractive to the reader. The References paragraph is poorly done. -Scientific Soundness – Average The study design is appropriate for answering the aim, and the results are stated clearly. Unfortunately, the study's limitations are not presented in the Discussion paragraph. -Interest to the readers – Average Although the topic should attract readers with different specialties, the fact that the discussion paragraph is not more developed reduces the interest of potential readers. Despite the good work done, there is still some room for improvement, as follows: 1. In the Discussion paragraph, the limitations of the study should be considered. 2. The References paragraph must be revised. I think the authors must expand the documentation and consider other articles. Of course, depending on the articles analyzed, the Introduction, Materials and Methods, or Discussion paragraphs will be updated with new information. The authors should consider the following articles as a suggestion (which is not mandatory). Philbin, E.F. (1999), Comprehensive Multidisciplinary Programs for the Management of Patients with Congestive Heart Failure. Journal of General Internal Medicine, 14: 130-135. https://doi.org/10.1111/j.1525-1497.1999.tb00009.x Jaarsma T, Hill L, Bayes-Genis A, La Rocca HB, Castiello T, Čelutkienė J, Marques-Sule E, Plymen CM, Piper SE, Riegel B, Rutten FH, Ben Gal T, Bauersachs J, Coats AJS, Chioncel O, Lopatin Y, Lund LH, Lainscak M, Moura B, Mullens W, Piepoli MF, Rosano G, Seferovic P, Strömberg A. Self-care of heart failure patients: practical management recommendations from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2021 Jan;23(1):157-174. doi: 10.1002/ejhf.2008.

Author Response

Dear reviewer,

I am writing to thank you for your fruitful comments that contribute to the improvement of the submitted manuscript. Below, please find attached a step-by-step response to your valuable comments. Once again, many thanks.

Dear reviewer,

I am writing to thank you for your fruitful comments that contribute to the improvement of the submitted manuscript. Below, please find a step-by-step response to your valuable comments. Once again, many thanks.

Comment 1: The conclusions are as follows: -Originality / Novelty - Average The paper has a similar theme to a previous paper published by the same authors in Healthcare. Brokalaki, H.; Chatziefstratiou, A.A.; Fotos, N.V.; Giakoumidakis, K.; Chatzistamatiou, E. The Development and Validation of the "Hippocratic Hypertension Self-Care Scale." Healthcare 2023, 11, 2579. https://doi.org/10.3390/healthcare11182579 -Significance of Content – Average Although the data is correctly analyzed and interpreted, the article does not shine. -Quality of Presentation – Average Even though the ideas are expressed clearly, concisely, and logically, the way of data presentation chosen by the authors, with most of the results presented in tables and short paragraphs for discussion and conclusions, make the paper not attractive to the reader. The References paragraph is poorly done. -Scientific Soundness – Average The study design is appropriate for answering the aim, and the results are stated clearly. Unfortunately, the study's limitations are not presented in the Discussion paragraph. -Interest to the readers – Average Although the topic should attract readers with different specialties, the fact that the discussion paragraph is not more developed reduces the interest of potential readers.

Response: Dear Reviewer, thank you a lot for your kind suggestions.

Comment 2: In the Discussion paragraph, the limitations of the study should be considered.

Response: We added the following paragraph to address the limitations of the present study: Our study had some limitations. The Hippocratic heart-failure self-care scale is a self-administered tool; therefore, information bias could affect the results. Also, due to the lack of a gold-standard tool, the research team couldn't conduct ROC analysis.

Comment 2: The References paragraph must be revised. I think the authors must expand the documentation and consider other articles. Of course, depending on the articles analyzed, the Introduction, Materials and Methods, or Discussion paragraphs will be updated with new information. The authors should consider the following articles as a suggestion (which is not mandatory). Philbin, E.F. (1999), Comprehensive Multidisciplinary Programs for the Management of Patients with Congestive Heart Failure. Journal of General Internal Medicine, 14: 130-135. https://doi.org/10.1111/j.1525-1497.1999.tb00009.x Jaarsma T, Hill L, Bayes-Genis A, La Rocca HB, Castiello T, Čelutkienė J, Marques-Sule E, Plymen CM, Piper SE, Riegel B, Rutten FH, Ben Gal T, Bauersachs J, Coats AJS, Chioncel O, Lopatin Y, Lund LH, Lainscak M, Moura B, Mullens W, Piepoli MF, Rosano G, Seferovic P, Strömberg A. Self-care of heart failure patients: practical management recommendations from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2021 Jan;23(1):157-174. doi: 10.1002/ejhf.2008.

Response: We added the suggested references and expanded the discussion section.

Best regards

On behalf of all authors,

Prof. Konstantinos Giakoumidakis

Reviewer 2 Report

Comments and Suggestions for Authors

Dear Editor,

The article is interesting. The introduction of self-assessment scale represents a practical part of modern medical era since the focus is mainly on the patient amid personalized medicine. However, many pitfalls are found in daily applicability of these scales.

Here are my points:

1.    Abstract. It is not clear whether the scale has been applied in your native language for enrolled patients or there is already a validation study with associated translation?

2.    Introduction This is not clear since the entire population (in numbers) is not specified. Maybe you use the rate (percent)

“As reported by the American Heart Association, the prevalence 33 of CHF among Americans aged 20 and older was approximately 6 million between 2013 34 and 2016.”

3.    The first section at Methods is study design followed by studied population followed by the assessments

4.    Results

Please use “mean age of 70 years”. Please add to the mean value the standard deviation

The table is supposed to help the presentation within the main text, not the other way.

 

5.    Discussion. Please introduce the limits of the study and further expansion and correction in this particular matter

 

This is a clinical study that aimed to assess the developing and consequent validation of the self-care assessment tool, namely the Hippocratic heart 15 failure self-care scale (HHFSCS).

The most important in terms of original and relevant profile is the use of HHFSC scale in adults diagnosed with heart failure coming from a specific population, namely a Greek medical center (General Hospital) from Athens.

The gap is represented by the assessment of quality of life which varies among different diseases, conditions, and applied therapies, including of cardiologic type.

Compared with other published this research adds to the subject area:

1.               Developing the Hippocratic heart-failure self-care scale.

2.               Assessing the reliability of the Hippocratic heart-failure self-care scale.

3.               Investigating the factorial structure of the Hippocratic heart-failure self-care scale.

4.               Evaluating the structural estimation modeling approach of the Hippocratic heart-failure self-care scale using explanatory factor analysis (EFA).

This study marks the first attempt to develop a comprehensive tool for evaluating self-care behaviors in patients with heart failure, which holds significant potential for integration into both research and clinical practice. Further studies with a larger population or even controls from two different populations should be useful.

Test-retest reliability results suggest that the Hippocratic heart-failure self-care scale is stable over time, indicating its potential for long-term monitoring and assessment of  patient self-behaviors. This is further supported by the strong agreement between measurements observed in the Bland & Altman Method Scatter Plot and the Cohen Kappa statistic.

The conclusions are consistent with the results section. The authors answered to each of the main questions that were hypothesized at the beginning of the study.

References are appropriate

 

 

Thanks

Well done!

Thank you

Author Response

Dear reviewer,

I am writing to thank you for your fruitful comments that contribute to the improvement of the submitted manuscript. Below, please find attached a step-by-step response to your valuable comments. Once again, many thanks.

Dear reviewer,

I am writing to thank you for your fruitful comments that contribute to the improvement of the submitted manuscript. Below, please find a step-by-step response to your valuable comments. Once again, many thanks.

Comment 1: Dear Editor, The article is interesting. The introduction of the self-assessment scale represents a practical part of modern medical era since the focus is mainly on the patient amid personalized medicine. However, many pitfalls are found in daily applicability of these scales.

Response: Dear Reviewer, Thank you a lot for your constructive comments.

Comment 2: Abstract. It is not clear whether the scale has been applied in your native language for enrolled patients or there is already a validation study with associated translation?

Response: We clarified in the Abstract that the scale has been applied in the Greek language.

Comment 3: Introduction This is not clear since the entire population (in numbers) is not specified. Maybe you use the rate (percent)“As reported by the American Heart Association, the prevalence 33 of CHF among Americans aged 20 and older was approximately 6 million between 2013 34 and 2016.”

Response: The report of the American Heart Associated did not mention the prevalence of heart failure into percent, however we also present the prevalence of heart failure between 2009-2012 in order to indicate the increased rate of heart failure.

Comment 4: The first section at Methods is study design followed by studied population followed by the assessments

Response: We reformat the Methods section.

Comment 5: Results. Please use “mean age of 70 years”. Please add to the mean value the standard deviation. The table is supposed to help the presentation within the main text, not the other way.

Response: We rephrase the sentence as ¨The demographic characteristics of the participants are shown in Table 2. Demographic characteristics of the sample indicated that 52.8% were women with a mean age of 70 years (SD=46.43).¨

Comment 6: Discussion. Please introduce the limits of the study and further expansion and correction in this particular matter.

Response: We added the following paragraph to address the limitations of the present study: Our study had some limitations. The Hippocratic heart-failure self-care scale is a self-administered tool; therefore, information bias could affect the results. Also, due to the lack of a gold-standard tool, the research team couldn't conduct ROC analysis. Also, we added some further expansion in discussion section.

Comment 8: The conclusions are consistent with the results section. The authors answered to each of the main questions that were hypothesized at the beginning of the study.

Response: Thank you a lot for your comment.

Comment 9: References are appropriate

Response: Thank you a lot for your comment.

 

Best regards,

On behalf of all authors,

Prof. Konstantinos Giakoumidakis

Author Response File: Author Response.docx

Reviewer 3 Report

Comments and Suggestions for Authors

The article is structured according to the rules recommended by the Journal and presents coherence between the objective of the study, the discussion and the conclusion. A relevant bibliography was consulted. However, it needs small corrections.

Suggestions:

-       To replace the objectives contained in lines 120 to 124 with: Evaluate the psychometric proprieties of the Hippocratic heart-failure self-care scale through the reliability and exploratory factor analyses (EFA).

-       Table 1 formatting

-       There appears to be an error in reference [17] on line 175

-       Correct the 1st line in table 2 by replacing N with n given that this is a sample and not a population

-       Remove last row from table 2

-       In the last line of the table 3, the need for the following text is not understood: a Mean (standard deviation) and Hb: Hemoglobin, HCT: Hematocrit, CRP: C-reactive protein, BNP: Brain Natriuretic Peptide, BMI: Body Mass Index.

-       The title of table 4 is not correctly placed (line 300)

Author Response

Dear reviewer,

I am writing to thank you for your fruitful comments that contribute to the improvement of the submitted manuscript. Below, please find attached a step-by-step response to your valuable comments. Once again, many thanks.

Dear reviewer,

I am writing to thank you for your fruitful comments that contribute to the improvement of the submitted manuscript. Below, please find a step-by-step response to your valuable comments. Once again, many thanks.

Comment 1: The article is structured according to the rules recommended by the Journal and presents coherence between the objective of the study, the discussion and the conclusion. A relevant bibliography was consulted. However, it needs small corrections.

Response: Dear Reviewer, thank you a lot for your comments.

Comment 2: To replace the objectives contained in lines 120 to 124 with: Evaluate the psychometric proprieties of the Hippocratic heart-failure self-care scale through the reliability and exploratory factor analyses (EFA).

Response: We rephrased the line 120 to 124  as you mentioned.

Comment 3: Table 1 formatting

Response: We checked the table for any grammatical issue.

Comment 4: There appears to be an error in reference [17] on line 175

Response: We added the correct citation: Cronbach LJ. Coefficient alpha and the internal structure of tests. Psychometrika. 1951;16(3):297–334.

Comment 5:  Correct the 1st line in Table 2 by replacing N with n given that this is a sample and not a population

Response: We replaced N with n.

Comment 6: Remove last row from table 2

Response: We deleted the last row.

Comment 7: In the last line of the table 3, the need for the following text is not understood: a Mean (standard deviation) and Hb: Hemoglobin, HCT: Hematocrit, CRP: C-reactive protein, BNP: Brain Natriuretic Peptide, BMI: Body Mass Index.

Response: We rephrased the text in the last row of Table.

Comment 8: The title of Table 4 is not correctly placed (line 300)

 

Response: We placed appropriately the title of Table 4.

 

Best regards,

On behalf of all authors,

Prof. Konstantinos Giakoumidakis