Measuring Nurses’ Knowledge and Awareness of Climate Change and Climate-Associated Diseases: Systematic Review of Existing Instruments

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Thank you for the opportunity to review this manuscript. I have some recommendations:

-       In the material and methods section (page 3, line 132) it is stated that PRISMA-P recommendations are used which is for protocols, however the protocol for this study is already done and published (reference 20). It is appropriate to use the PRISMA 2020 recommendations. 

-       On page 3, line 135, PROMs are mentioned but it is not specified what they are. The first time it appears in the text it should be specified what the initials mean.

-       Page 5 line 206: With what tool is the risk of bias of the included randomized and non-randomized studies assessed? COSMIN? You must specify in this section.

-       The inclusion of the statistical analysis section (page 5, line 209) is not appropriate in this manuscript since meta-analysis is not performed. Table 1 only describes the total sample, sex and age range of the participants (although it is indicated in the statistical analysis section that the mean age will be calculated).

-       In general, Figure 1 does not conform to PRISMA guidelines, for example, the reasons for exclusion (based on the previously established selection criteria) are not given. There are tools for the elaboration of such a flowchart: https://estech.shinyapps.io/prisma_flowdiagram/

-       For large tables divided into several pages you should put the table headers on all pages and specify that it is the continuation of the table on successive pages.

-       Put in table 5 a legend specifying what ---, 1, 2 and 3 correspond to

-       References should all be checked:

o   They appear with capital letters: references 29, ,45, 53....

o   Reference 32: pages are missing, and the link is not correct.

o   Reference 37: pages are missing.

o   Reference 59: PDF?

 

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Dear Authors,

Thank you very much for this interesting paper. The manuscript offers new insights of the topic of climate change and nursing practice. It is well written and appropriately referenced.

Here are some suggested revisions :

Line 18 : There is a repetition « The Appraisal tool for Cross-Sectional Studies ».

Line 24 : What does « 4 » mean before the word « conclusions »?

Line 135 : Explain the meaning of PROM (Patient reported outcome measures)

Line 183: Are you saying that there was no time interval in your search?

Line 247 : You said 14 studies. Adding Australia, that makes 15 studies, not 14. Please check this difference.

Line 589: Here you can cite some studies that have also come to this conclusion, such as: Iira et al., 2024; Neal-Boylan et al., 2019; McDermott-Levy et alé, 2019.

Line 612 : Perhaps mention some weaknesses/limitations of the CHANT tool

Line 642 : Perhaps mention some weaknesses/limitations of the NEPS tool

Line 685 : Add in the section on systematic review limitations, that there are two tools out of eight that could not be evaluated : The Climate Change Instrument and The Nurses’ Environmental Awareness Tool (NEAT)

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

Thank you for the opportunity to read this important work. The initial purpose of this systematic review was to identify current tools used to evaluate nurses' knowledge and attitudes related to climate change and sustainability. The second purpose was to evaluate the strength and reliability of published tools allowing for recommendations for future use. The review utilized well-recognized and validated protocols for evaluation. Overall, the report is well written and provides detailed information to facilitate replication by others. I recommend this report for publication with only a few minor items of clarification and/or correction. I am attaching a document with areas of concern highlighted. These are my areas of concern. I hope these will strengthen the final published report.

1. Please double-check the reference numbers in parenthesis. For example, reference (12) appears to be missing in the text. Reference (33) seems out of order as it appears on line 88. Also, reference (21) seems out of order as it appears on line 215.  I did not find references (42-46) listed in the text. 

2. Page 2 line 47-56 While this is interesting information, it is unclear how these statistics are connected to climate change. These ED statistics may be related to other causes, other than climate change. Please provide information to support the link to climate change. 

3. Readers from outside of Europe may not be familiar with the word "canton." Please clarify this term.

4. Page 3 line 116 - I suggest using another term other than "right". This implies bias. 

5. Page 7 line 245 - indicates that 14 studies were analyzed, but 16 studies are described. Please revise to make this clear for the reader.

6. Line 362 - I would suggest noting the reference earlier in this statement, rather than at the end of the paragraph. It is confusing about which study with school nurses is being referenced. 

7. Table 5 - Reference (24) was used with both the NEPS and the SANS_2, but that is not listed on the table. Please double-check that the correct studies are referenced according to the tools used. 

Comments for author File: Comments.pdf

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

Dear Authors,

Thank you for considering my comments.

Best wishes.