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Peer-Review Record

Assessing Population Well-Being in Saudi Arabia: A Comprehensive National Survey Using the WHO-05 Index and Self-Rated Health Metrics

Healthcare 2025, 13(3), 310; https://doi.org/10.3390/healthcare13030310

by Abdulaziz Alahmadi¹

, Yasir Almuzaini²

, Majed Alosaimi¹, Ahmed Alahmari³

, Fahad Alamri⁴

, Haytham Sheerah⁵

, Mariyyah Alburayh^4,*

and Anas Khan⁶

Reviewer 1:

Renhau Li

Reviewer 2: Anonymous

Reviewer 3:

Imran Aslan

Healthcare 2025, 13(3), 310; https://doi.org/10.3390/healthcare13030310

Submission received: 5 November 2024 / Revised: 12 December 2024 / Accepted: 15 December 2024 / Published: 3 February 2025

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

1.In the abstract, in the Result section, concerning the participants’ descriptive statistics, “In total, 39562 participants responded to our survey (male 65.1% vs female 34.9%). 30.6% 27 were between 31 and 40 years old, with most of the population being Saudi nationals (83.8%).” would be better put in the Method section.

2.In the abstract, lines 31-32, “Independent predictors for good well-being include … being unemployed.” However, in the line 35, “employment, … were the protective factors of good well-being.” These two sentences were conflicting. The authors should recheck the analysis outcomes and related writing.

3.Figure 3 was not necessary. Delete it would be better.

4.It was better to use the sample to present the information of reliability and validity of WHO-5 and SRH.

5.Under Table 3, the denotation ‘The odds ratios were calculated referenced by the "good well-being” group’ would be misunderstanding. Did the author want to express that the odds was calculated on basis of "good well-being” relative to “poor well-being” ? Besides, It was better to express that the reference group for categorical or ordinal predictors as “Ref.”.

6.The title of Table 3 and 4 “Univariate and multivariate analyses” was misunderstanding. For only one dependent variable, using “univariate or not need to report univariate” Besides, for at least two predictors, using “multiple,” such as “multiple logistic regression.” Furthermore, please denote under the Tables which variables were controlled for AOR. Finally, please to denote these factors “age group, gender, nationality,…Region of residence” were simultaneously put into the logistic regression or separately (with which controlled variables?).

7. Under Table 4, please denote how to separate the two groups “healthy” and “unhealthy”

Author Response

Reviewer comments:
1. In the abstract, in the Result section, concerning the participants’ descriptive statistics, “In total, 39562 participants responded to our survey (male 65.1% vs female 34.9%). 30.6% 27 were between 31 and 40 years old, with most of the population being Saudi nationals (83.8%).” would be better put in the Method section.

3.Figure 3 was not necessary. Delete it would be better.

4.It was better to use the sample to present the information of reliability and validity of WHO-5 and SRH.

7. Under Table 4, please denote how to separate the two groups, “healthy” and “unhealthy”

Authors Comments:

Comments 1 and 2:

The abstract has been revised

Comment 3:

Figure 3 was deleted as per the comments

Comment 4:

Validity and reliability have been added as highlighted for WHO-5. However, SRH was not measurable using a reliability test.

Comments 5 and 6:

The titles of Tables 3 and 4 have been revised. The enter method was used to adjust for multiple confounders, where all variables were added to the model. This information is added in the footnote of each table.

Comment 7:

The criteria for self-rated health status are presented in the methodology-measures section.

Reviewer 2 Report

Comments and Suggestions for Authors

Dear authors,

Thank you so much for your work. The manuscript presents an interesting topic. However, the authors are required to address several issues before the article is deemed suitable for publication. I wish the authors well in their efforts and offer the following concerns for their consideration.

1- The introduction section should be thought of as the “visiting card” of the study, making the purpose and contribution of the investigation clear. However, in its current state, the introduction does not serve its purpose given that it is not entirely clear what this study adds to the literature, why it is essential, what is already known in general terms, and how authors intend to contribute. In particular, the authors should briefly introduce the relationship between the variables (well-being and self-rated health metrics). The authors should clarify the literature gap in the introduction, explain why they have chosen these variables (provide a clear description of the problem), state the study's main aim, and state how the authors intend to contribute.

2- I suggest that the authors remove the information related to scales in the introduction section, especially: “This measure provides participants with an opportunity to evaluate their own health from a personal standpoint. Participants typically respond to a straightforward question, such as "In general, how would you rate your health?", using a 5-point scale with options ranging from 'excellent' to 'poor' (7).”

3- The objectives defined should be properly justified. For example, why did the authors decide to establish a relationship between socio-demographic variables and well-being? On the other hand, given that this is a study of the well-being of adults in general, why was other personal information about the participants not considered? For example, the participant's marital status and number of children.

4- The use of a subheading about outcome utilization is very confusing. I suggest the authors consider removing this subheading.

5- The relationship between the variables should be presented in a specific section called a literature review or hypothesis development.

6- Since this is a quantitative study, it is not clear why the authors chose not to define hypotheses. This option should be duly justified.

7- Authors should provide information about the period of data collection and how participants were contacted.

8- The authors should provide information about the Cronbach alphas of the scales.

9- Authors must provide the results of scale validation (convergent and discriminant analyses), as well as descriptive statistics of the scales and correlation analysis between variables. The authors present descriptive statistics of the items, not of the scales under study (well-being and self-rated health metrics).

10- The authors did not perform confirmatory factor analysis, this issue must be justified or presented as a limitation of the study.

11- The authors did not mention the procedures used to minimize the common method bias. This is a critical issue that should be addressed.

12- Authors should present a more robust discussion section that reflects the relationship between well-being and self-rated health metrics.

13- The authors should add and substantiate the theoretical and practical contributions of the study. On the other hand, authors should provide a clear description of the limitations of the study and how they can be addressed in future studies.

Author Response

Reviewers comments:

1- The introduction section should be thought of as the "visiting card" of the study, making the purpose and contribution of the investigation clear. However, in its current state, the introduction does not serve its purpose given that it is not entirely clear what this study adds to the literature, why it is essential, what is already known in general terms, and how authors intend to contribute. In particular, the authors should briefly introduce the relationship between the variables (well-being and self-rated health metrics). The authors should clarify the literature gap in the introduction, explain why they have chosen these variables (provide a clear description of the problem), state the study's main aim, and state how the authors intend to contribute.

2- I suggest that the authors remove the information related to scales in the introduction section, especially: "This measure provides participants with an opportunity to evaluate their own health from a personal standpoint. Participants typically respond to a straightforward question, such as "In general, how would you rate your health?", using a 5-point scale with options ranging from 'excellent' to 'poor' (7)."