Preventive Behaviors Among Higher Education Students in Response to COVID-19: The Role of Risk Perception

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Thank you for the opportunity to review this submission on an interesting and valuable topic. Please use the annotated manuscript to view specific comments and suggestions.

Comments for author File: Comments.pdf

Comments on the Quality of English Language

A number of suggestions have been made in the attached document for English language editing.

Author Response

 

Dear Reviewer,

Thank you for the opportunity to review our manuscript entitled “Factors influencing the behavior of higher education students in response to COVID-19”. We are pleased to collaborate with Safety journal and the reviewers to enhance our manuscript based on the valuable comments and insights provided.

We genuinely value the feedback from the anonymous reviewers and have diligently incorporated the suggested changes into the manuscript. With the careful considerations and revisions made in response to the reviewers' insights, we believe that our article now possesses a more robust foundation and is well-positioned to make a meaningful contribution to Safety.

In the following pages you can find a detailed list of our answers/comments to the reviewers’ questions/comments with an explanation of the corresponding changes in the revised version of the manuscript, which were all highlighted in yellow in the revised version of the manuscript.

 

Reviewer 1

Line 37. The sentence is confusing - consider rephrasing for clarity: Unrealistic optimism was also negatively related to preventive behaviors

We thank the reviewer for this valuable suggestion. We propose the following reformulation: “Adoption of safe behaviors is related to a better perception of the severity of COVID-19. Unrealistic optimism also has a negative impact on preventive behaviors.”

Line 40. Consider editing to "physical contact": physicalizing

Thanks for the improvement suggestion. We replaced the term to physical contact: “With regard to behaviors adopted outside the institution, it was found that students do not avoid physical contact with colleagues and family members.”

Line 41. Rephrase concluding sentence to clearly indicate study main findings a contribution:

The sentence was rephrased.  “These findings contribute to understanding of student behavior during the COVID-19 pandemic, helping the institutions to understand if the strategies applied were or not being effective, denoting the need to reinforce or improve the implemented strategies.”

Line 43. Consider including; COVID-19; preventive behaviour; Unrealistic optimism: Is this an appropriate keyword for the research?

Many thanks for the suggestion. We included “COVID-19”; and removed the keyword “Unrealistic optimism”. In what regards to “preventive behaviour” we decided to replace it by “prevention”.

Line 49. add "cases" in 49. 5,643,062

We added 5,643,062 cases

Line 59. "dematerialized" is a confusing term; consider removing and rephrase "digital distance activities" to e.g. online teaching and learning or technology-mediated academic activities

The sentence was rephrased: “On March 16, 2020, face-to-face teaching was suspended and digital distance activities were privileged.”

Line 60. It is not clear how this paragraph integrates with the prior introduction

Thanks for the observation. We replace the last sentences to the following ones: “However, according to Iorio et al. [4], 10.0% of students shared the computer with another person and 6.2% shared it with more than one person. This practice of sharing computers was contrary to the recommended principles of social distancing. [4,7]. Additionally, it is important to realize that the same authors found that 30.2% of students did not feel comfortable using digital tools and following classes via videoconference.”

Line 67. Reference needed for this claim

The reference was included.

Line 77. Clarify this sentence to align with the title and aim of the study

We suggest the following text – “Concerning the foregoing, the aim of this study is to analyze preventive behavior’s adopted by higher education students during the COVID-19 pandemic and the correlation between those behaviors and risk perception.” Also, the sentence was moved to the end of the introduction (aligned with reviewer 2 suggestion).

Line 81. This section is quite long and represents know information that is not specifically related to the study's aim and could be removed to ensure brevity and clarity

We appreciate your observation and understand its relevance. We tried to summarize and shorten the section.

Line 129. Why is this repeated?

Removed. It was a typing error.

Line 129. What does this refer to in terms of the other individual behavior’s?

Part moved to the end, it will make more sense to frame it at the end of the sentence:

“Given the incidence and mortality of COVID-19, citizens must adopt appropriate preventive measures to minimize and mitigate the spread of the disease, namely physical distancing, wearing a mask, regular hand washing, avoiding touching the eyes, nose or mouth, and coughing or sneezing into the elbow, as well as promoting well-ventilated spaces.”

Line 140. See prior comments about over-inclusion of background information

We tried to summarize and shorten the section.

Line 218. Include references to these studies

Information added: 44.            Roberts, J.A., David, M.E. (2021). Improving Predictions of COVID-19 Preventive Behavior: Development of a Sequential Mediation Model. Journal of Medical Internet Research, 17, 23(3), e23218. https://doi.org/10.2196/23218.

Line 230. & to and

“&” was replaced by “and”.

Line 253. Why are results included in materials and methods?

We consider that the information is about sample characterization. Therefore, we would like to keep it in this section.

Line 254. More information is needed about when the study was done in relation to COVID-19 timelines, the nature of the HEI's and study fields (e.g., what impact would studying towards a healthcare qualification have on students' risk behaviour)

Information about the period when the study was conducted, and the HEI was included. We also included in the study limitations a sentence explaining the possible influence of the students’ background in the obtained results.

Line 259. More information is needed on what is meant by "displacement"

It is meant away from hometown. This was clarified in the manuscript.

Line 264. Add information on questionnaire design (based on what?)

The questionnaire was designed by the research team, considering the background in Environmental Health as well as in Psychology. This information was included in the manuscript.

Line 280. Numbers under 10 to be written in text (e.g., six), numbers 10 and above to be written as numerals. (Apply throughout document)

Many thanks, typing amended.

Line 297. Rephrase for clarity: were these behaviors determined?

We propose the rephrasing: “To this end, behaviors practiced within and outside of the higher education institution were determined.”

Line 313. How long was the questionnaire available? How were students recruited? What was the response rate?

Information explaining that the study was conducted during June 2021 was included. In the end of the questionnaire description there is an explanation about how it was distributed. The response rate was about 10%. This information was now provided.

Line 322. Incomplete sentence

True, many thanks. Rephrased: “Varimax rotation was used to examine the underlying factor structure of the risk perception scales based on Likert scale items.”

Line 349. Include description of the study population demographic characteristics

Demographic information was included in the “Sample” subsection.

Line 393. Highlighted text

Corrected.

Line 487. Highlighted text

Sentence improved.

Line 489. This claim needs substantiation

Sentence changed: “Despite the absence of research to support students' poor hand hygiene and equipment use, it may be associated with the characteristics described above, as well as the absence or scarcity of disinfectant gel in places of access, and the short time young people spend in schools.”

Line 510. Clarify "physical education"

Corrected.

Line 526. Results regarding study programme and seniority have not been presented or discussed

Data was only analyzed in relation to the degree level, i.e., master vs bachelor. The study programme was not questioned to the students due to ethical limitations. In what regards to the seniority, this information was not included since no relevant statistical differences were found.

Line 535. Is difficulties the appropriate word? Or rather "adopt behaviours"

Sentence changed: “This study revealed that students struggle to maintain physical distance both inside and outside the higher education institution.”

Line 546. Or three? Please ensure consistency

Sorry for the typing error, corrected to “Three higher education institutions”.

Line 547. Needs elaboration in the results section

The sentence was improved “Furthermore, the limited sample size resulted from a lower than expected research enrollment.” Additionally, information about response ratio was included in methodology section.

Line 550. Yet the study was done in HEIs, not schools

Corrected to higher education institutions.

Line 550. Reference this claim

The last sentence was removed.

 

 

 

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Covid-19 has taught us that epidemics of a global scale are always around the corner and that personal behavior is an essential element in dealing with the spreading of diseases. In this context the manuscript subject is very interesting.

There is a lot of research on the subject preventive behaviors and the factors related to them, and this research aimed to expand the current knowledge, by exploring the relationships between higher education students' risk-perceptions and their preventive activities. However, the manuscript is not ready for publication and requires many revisions in all sections and subsections.

Comments for author File: Comments.pdf

Comments on the Quality of English Language

The language should be checked, revised and corrected, by a professional English-speaking language editor. 

Author Response

Dear Reviewer,

Thank you for the opportunity to review our manuscript entitled “Factors influencing the behavior of higher education students in response to COVID-19”. We are pleased to collaborate with Safety journal and the reviewers to enhance our manuscript based on the valuable comments and insights provided.

We genuinely value the feedback from the anonymous reviewers and have diligently incorporated the suggested changes into the manuscript. With the careful considerations and revisions made in response to the reviewers' insights, we believe that our article now possesses a more robust foundation and is well-positioned to make a meaningful contribution to Safety.

In the following pages you can find a detailed list of our answers/comments to the reviewers’ questions/comments with an explanation of the corresponding changes in the revised version of the manuscript, which were all highlighted in yellow in the revised version of the manuscript.

 

Reviewer 2

Row 2. According to the title, the study explored "factors" "influencing" "the behavior" of higher education students. The two factor that are actually presented are "risk perception" (unrealistic optimism is a subset of risk perception) and the studied behaviors were "in-school and out-of-school safe behaviors" (line 36), and the study tested correlations, not influence. Manuscript title should be more specific.

Thank you very much for the suggestions. Unfortunately, this point was not clear in our original article. The title was replaced to the following one: “Preventive behaviors among higher education students in response to the COVID-19: The role of risk perception”.

Row 41 – 42. It is not clear how the results "are helping to design control programs and measures". The last sentence of the abstract is irrelevant to an abstract

The sentence was changed, aligned with comments of reviewer 1: “These findings contribute to understanding of student behavior during the COVID-19 pandemic, helping the institutions to understand if the strategies applied were or not being effective, denoting the need to reinforce or improve the implemented strategies”

However, we must highlight that the results of the present study may allow the confirmation of the behaviors adopted by students inside and outside the institutions. This contribute to understand if the strategies applied by the different institutions were or not being effective, denoting the need to reinforce or improve the implemented strategies.

Row 46-59. The first part of the introduction provides a chronological description of the onset of COVID and the suspension of face-to-face teaching.

Yes, we consider the international background to be relevant and then the respective national background.

Row 61-64. I fail to understand how the percentage of students that shared computers or felt uncomfortable with remote learning digital are relevant to the manuscript.

Thank you very much for the observation. The data presented refer to the study by Ioro et al. For our study, we think it becomes relevant, due to the fact that it was also observed the need to share tools (computers, internet access) for distance learning process. This situation has been reported to cause several "mental health problems", as described in the following sentence. We hope we were able to clarify.

Row 64-66. "These issues have been…" What issues? The authors should clarify what "issues" have been associated with mental health problems, and why is this relevant to the manuscript.

Thank you for notice that. All this section was reviewed.

Row 77-79. 1. Authors should use precise wording: "preventive behaviors" instead of "behaviors"; " influencing factors" is wrong; "namely their perception of risk" is bad English" | 2. The aim of the study should be better placed at the end of the introduction section.

1. Thank you for the suggestion. We propose the following text: “Concerning the foregoing, the aim of this study is to analyze preventive behavior’s adopted by higher education students during the COVID-19 pandemic and the correlation between those behaviors and risk perception.”
2. The above-mentioned sentence was moved to the end of the introduction.

Row 81-108. Most of this SARS-CoV-2 related data is not relevant to the study. Information in the introduction section should be directly related to the studied factors/variables.

We appreciate your observation. Part of the information was removed.

Row 109-132. This information is related to the study, however, the authors should and focus on COVID outbreaks/waves, infection pathways, health outcomes, risk groups and preventive measures. Sub-section title should be improved.

The full sub-section was reviewed.

Row 154-160. The authors states that "students tend to neglect…" with no specific reference, and continues to discuss "young people" providing references to adults aged 18-60+ [28], 16-55+ people [29], medical students [30], and secondary school students aged 14-18 years [31]. The study tested "higher education students". The references should relate to the studied population. It is not clear if tending to neglect preventive behaviors specifically characterizes students (or people).

Thank you for notice that. The following references were included:

22. Tsegaw, M., Mulat, B., & Shitu, K. (2020). Risk perception and preventive behaviours of COVID-19 among university students, Gondar, Ethiopia: a cross-sectional study. BMJ Open, 12, e057404. https://doi.org/10.1136/ bmjopen-2021-057404
23. Duygulu, S., Kuruca-Ozdemir, E., Erdat, Y., Kocoglu-Tanyer, D. (2022). University Students' Risk Perception, Protective Measures, and General Health During the COVID-19 Pandemic in Turkey. Disaster Medicine and Public Health Pre-paredness, 22(17), e267. https://doi.org/10.1017/dmp.2022.216.Additionally, “students” was replaced to “university students”.

Row 161-162. The authors should begin discussing risk perception by clarifying that it is based on evaluating both probability of the risk and the possible severity of its outcomes.

According to the prior knowledge that the research team has on the topic of risk perception, there are numerous theories amongst the highlighted (Risk compensation / Risk homeostasis theory, Protection motivation theory, situated rationality theory, social action a social control theory, among others) with different explanatory models. Nevertheless, we suggest the addition of the paragraph: “Risk perception is a term used to refer to the knowledge and experience associated with it, including the potential consequences contingent on a situation or a mix of circumstances [27].”

Row 178. Higher education students can belong to risk groups. The authors probably meant that they don’t form a specific, unified risk group. Need correction.

Totally correct, sentence changed to: Although, commonly, higher education students do not belong to any risk group…

Row 179. The term "high-priority group" is not clear.

We refer to the high incidence and transmission rates of COVID-19 amongst higher education students.

Row 182-184. The mentioned reasons for not being vaccinated are not related to ither risk perception or optimism. What is their relevance here?

This information refers only to the study conducted by Graupensperger et. al. From the authors' perspective, it serves as a framework for the theme, more specifically with regard to the perception, more or less informed, regarding risk, and the respective behaviors, particularly with regard to vaccination.

Row 185-187. This sub-section closing sentence is irrelevant here. It should be replaced with a sentence that connects the content of the sub-section to the HBM.

Sentence changed.

Row 193. The word "model" is redundant after the term HBM.

Correction made (HBM model).

Row 194. The word "dental" should be replaced with "dental care" or "dental hygiene".

Correction made (dental hygiene)

Row 218. The word "model" is redundant after the term HBM.

Correction made (HBM model).

218-219. This sentence is opening a description for the next paragraphs. As such it should mention the common relationships between risk perceptions and preventive behaviors according to the HBM.

A sentence was included to better link the information.

 

Row 222-223. "…students seek information from scientific sources [48]" – the location of this sentence here is not clear.

Thank you for notice that. The sentence was removed.

Row 223-225 The word "also" at this location, implies that the sentence refers to students, however, the article in reference [48] refers to adolescents. The study is about higher education students. Authors are advised to provide consistent data.

Thank you for notice that. This section was reorganized.

 

Row 227-229. The description is inaccurate. The study referenced as [49] found that participants with less information followed the guidelines for prevention better, but vaccinations were more acceptable with people with more/better information.

Many thanks for the suggestion. Effectively, the description proposed imposes a significant improvement on the description, which is why we suggest the following change: It was also found that the benefits should outweigh the perceived barriers. In this study, the main barrier was identified as a lack of knowledge about the disease and preventive measures [49]. Participants with less information followed guidelines more closely, whereas vaccination was more acceptable among individuals with more information [49].

 

Row 239-252. There are many studies regarding unrealistic optimism (UO). Since the authors regard UO as an important factor in the study, they should elaborate and expand this sub-section, including reference to the back-path, as studies have shown that optimism is strengthened by personal prevention activities.

Thank you for notice that. The full sub-section was updated.

 

Row 240. It is recommended to add a reference to Clarke, V. A., Lovegrove, H., Williams, A., & Machperson, M. (2000). Unrealistic optimism and the health belief model. Journal of behavioral medicine, 23, 367-376, in order to connect UO to its location in the HBM and its significance. This could also provide a better flow, connecting to the previous sub-section.

Many thanks. Reference added

Clarke, V. A., Lovegrove, H., Williams, A., & Machperson, M. (2000). Unrealistic optimism and the health belief model. Journal of behavioral medicine, 23, 367-376. https://doi.org/10.1023/a:1005500917875

Row 240. The mathematics of assessing UO belongs to the Tools subsection in the Method section. What is required here is a better description of optimistic bias as a general term (with better references) and better definition of the term UO vs. optimistic bias, as UO is an extreme form of optimistic bias.

Thank you for notice that. The full sub-section was updated. Information related to the determination of UO was moved to methods section.

 

Row 253. Materials and Methods – "method" is enough.

Correction made.

 

Row 258. About 86% of the participants were female students. Is this the normal distribution in Portuguese higher education? If not – it should be mentioned in the discussion as a limitation.

Excellent observation. Although the ratio of women in higher education in Portugal is around 55%, in the area of health and social protection, this figure is around 75% (information available at https://www.pordata.pt/pesquisa/alunos+do+sexo+feminino+matriculados+no+ensino+superior%3a+total+e+por+area+de+educacao+e+formacao).

 

Row 274-288. Did the authors use a common, verified measuring tool or did they create a new one? If they used a known tool, they should reference it. If a new tool was used the authors should include a better description of the tool's creation, initial testing and manuscript should.

Thank you for notice that. The questionnaire was developed by the research team. This information was included in methodology section.

Procedures for its validation are described in Data analysis section. We used Exploratory Factor Analysis and then, Alpha de Cronbach was determined. A sentence was also included to explain the pre-teste.

 

Row 281-283. "6 items were developed" – any tool "development" process should be detailed.

Additional explanations were included.

 

Row 288. The authors used a 5-item tool to measure the perception that individuals had of the barriers to adopting preventive measures, with "Wearing a mask is expensive" as an item example. The quoted item refers to an instrumental barrier. Was there a division between instrumental barriers and cognitive/emotional barriers?

Despite this item appears instrumental, was associated with a false perception of cost. What was mandatory was the use of surgical masks, which were very cheap in Portugal at the time, to promote their use. Even if the students did not have them, they were often provided.

 

Row 289-294. A 2-Item, 7-point Likert "scale" was used to measure unrealistic optimism. This variable is considered by the authors as important for the study results and conclusion. The authors should expand the description of the tool, adding information about its origin/creation, testing, and verification. The authors should explain how this is used as a scale, yet It is not in the reliability table (Table 1, p. 9).

Information about the development of the items was included. Reliability was not determined, since Cronbach's Alpha can only be computed for scales with a minimum of three items.

 

Row 295. "… behaviors adopted by students about COVID-19…” – "about" is wrong wording.

Correction performed: behaviors adopted by students on COVID-19.

 

Row 350. This subsection belongs to the Method section, not the Results.

Thank you for the observation. Section replaced at Method section.

 

Row 835. 1. This subsection belongs to the Method section, not the Results. 2. The data for every scale should be part of the description of tool, and the table could be excluded from the manuscript. 3. The unrealistic optimism measure is missing.

We believe that this reviewer is refereeing to Table 1 (line 364). We understand he/she point of view. However, since we developed a new tool that was also validated in our study, we decided that this information is part of our results.

As previous noticed, it is not possible to determine Cronbach's Alpha when you only have two items.

 

Row 364. Tables headings/titles should provide a good description of the content. Table 1 title is relevant to only one table column. If Authors decide to keep the table they should change its title.

Title changed: Table 1. Mean, Standard deviation and Cronbach's alpha coefficient.

 

Row 366-368. Unnecessary for high Cronbach's alpha values.

Thank for your appreciation. However, we consider that is also important to notice that the other Cronbach's alpha values are good or excellent, as this emphasizes the overall reliability of our scales.

 

 Row 369-373. The decision to use the less-reliable perception of barriers tool should be discussed in the Method section.

As previous noticed, we consider the validation of the tool part of our results. According, this information should remain in results section.

 

Row 374. Sub-section title should be more precise, as almost ALL study variables are "related to COVID-19". This sub-section actually describes COVID-related demographic results.

Thank you for notice that. We replace the sub-section title for the following one: “Variables related to COVID-19 infection and risk groups”

 

Row 375-380. This is a redundant description. It is fully described in lines 339-342, above.

Description removed: At the beginning of the study, some variables were identified that could influence the behavior adopted by students in the face of COVID-19 namely the fact that they were or had already been infected with COVID-19, whether they knew anyone who had already been infected with COVID-19, whether anyone they knew had severe symptoms, whether they were vaccinated, whether they belonged to a risk group or whether they lived with someone who belonged to a risk group.

 

Row 381. 1. Table 2 title should be more precise. 2. Providing both "yes" and "no" statistics for every item is redundant.

Thanks for the suggestion. yes and no lines removed, leaving only the absolute and relative frequency for affirmative answers. The title was also improved.

 

Row 383-388. This is the correct way to present the COVID related demographic results that are already presented in table 2. All of the "results" information on this subject are described in these 8 lines.

Row 389. This is a good sub-section heading, describing ist content.

Many thanks for the observations.

 

Row 392. 1. Table 3 title should be improved, for example: "Higher education students' preventive behaviors inside the education institute". 2. Table column heading should include "Percentage" (%).

1. Title improved to: Higher education students' preventive behaviors inside the education institute
2. Item Percentage added

 

Row 395-413. 1. The authors consider "sometimes" as negative or low. While "never" and "rarely" are definingly low, "sometimes" is actually "in the middle". 2. An example for better wording: "The majority of the students (93.6%) always and often disinfects their hands on every school entry, however only 73.6% do it every time they enter the classroom, and 25% of the students never or rarely disinfect their equipment.

Thank you for the suggestion. The text was improved.

 

Row 414-419. Demographic based analysis is not described in the Method section. Please add it.

The part regarding the collection of these variables can be found in the instrument description, section A. The part regarding data processing can be found in the section Data Processing.

 

Row 420-422. It is not clear how the data was analyzed. It is not clear how one T value (2.885) relates to multiple "behaviors". Were all other differences insignificant? Did the authors analyze differences based on participants belonging to risk groups and/or vaccinated?

Text from the method section: “A descriptive analysis of the variables was carried out, applying measures of central tendency and dispersion, namely the mean, standard deviation, minimum and maximum, as well as determining the relative frequency. This was followed by the Student's t-test for independent samples, which is part of the group of hypothesis tests to verify the differences in behaviors adopted inside and outside of the higher education institution, and in relation to gender, level of education, whether or not they were displaced from the household, whether or not they were infected with COVID-19, whether they knew someone who had severe symptoms, whether they belong to or live with someone in the risk group and whether someone they knew was or is diagnosed with COVID-19”

Only the analysis for which significant differences were found were described in the text.

 

Row 427. Table 5 title should be improved. The table does not show "most used sources" (the most used sources are summarized in lines 429-430). The table displays the percentage of students using every source of COVID-related information.

Excellent observation, less precise title attribution, so we propose “Sources of information used by students”.

 

Row 436. 1. Table 6 title reads: "Descriptive statistics of the dimensions" – what dimensions? Bad title wording. 2. All of the information in Table 6 was already displayed in table 1.

Row 440. " …which means that students have a good perception of risk". I fail to understand the conclusion. This could not be implied by the mean and SD alone. Also, assuming normal distribution, expecting a mean value of three (3.00) for 5- item, 6-item, and 8-item scales is statistically wrong.

Row 441-443. "… a negative average… revealing that ... are not motivated to protect themselves" – This is an assumption of the authors. there is no scientific way to conclude this from the information in table 6 (or from any other result).

We agree that the text had become repetitive, so Table 6 and the full subsection were removed.

 

Row 447. Table 7 title does not relate to the study variables.

Title was improved.

 

Row 447. Why Spearman correlation test? Likert based tools produce continuous scales. The authors assumption that 3 should have been the mean of the scales (row 440) probably relied on normal distributions of the scales. In this case Pearson correlation should have been used.

To determine the dimension score, we considered the following equation: Σitems/total items. In that way, we can obtain a continuum scale between 0 and 5 (e.g. 3.2, 3.3….). According, Spearman correlation can be applied. Even so, the Spearman coefficient is the best option if we are studying ordinal data.

 

Row 453-454. In other words – students' protective behaviors are related with personal perceptions and not with the location.

Row 451-459. Authors should use better descriptions for correlation results, like: "students with higher perception of XXX, use protective behaviors inside school more frequently than students with lower perception.", and avoid assumptions and/or conclusions.

Row 459. Replace "understanding" with "perception". Understanding was not measured. In the Results section authors should present only results, not assumptions.

Subsection was improved.

 

Row. 458-485 Suggest to replace with: "Correlation results imply that students with a greater awareness of the consequences of the disease and the benefits of prevention use preventive behaviors more frequently".

Thank you for the suggestion. It was considered in the text.

 

Row 463-465. The only example of an item on the barriers scale referred to the high cost of masks. The finding that instrumental difficulties in acquiring or using a preventive method are related to reduced usage of that method seems pointless.

The sentence was improved to clarify the meaning.

Row 471. People who believe they are at a higher risk of getting sick have more barriers for using preventive measures? This should probably be discussed in the Discussion section.

The sentence was improved to clarify its meaning.

 

Row 472. "…significant negative effect" – Correlation testing does not test effects.

Thank you for notice that. The sentence was improved to clarify its meaning.

 

Row 479-480. The low correlation values of unrealistic optimism should be discussed in the Discussion section

Thank you for emphasizing this.

 

Row 482-484 1. Authors should replace "behaviors" with "preventive behaviors". 2. Table 3 shows that only 12.6% of the students never or rarely maintained physical distance and 56.1% did it always or often, and 31.3% did it sometimes. The authors used a 5-item Likert scale, where items 1 and 2 are "low", items 4+5 are "high", and item 3 (sometimes) is "neutral". It is not clear why they choose to consider the "neutral" item as a part of the "low" side of the results.

1.  
2. This information was corrected along the manuscript. Thank you for notice that.

 

Row 501-502. 1. "other studies" – only one reference was provided, please add another reference. 2. "…students were more likely to turn to physical media for information [55]" – the referenced pre-published manuscript actually describes web-sites, social media and family as the most used sources.

Information was corrected.

 

Row 503. If a big part or all the students in this study were students in "health institutions", this could bias results and should be discussed as a limitation.

Great observation, limitations subsection was improved. The next sentence was included “Also, as the target sample of the study are students in higher education in the health area may represent a bias since they will be somehow more informed.”

 

Row 508-509. The findings support the understanding that students in higher education rely more on formal information, coming from formal media. Although " sharing information about COVID-19 in the most varied media so that knowledge reaches the entire population" is always a good recommendation, yet, it is not clear how the findings lead to it.

The authors consider it pertinent to reinforce the importance of sharing information, as a way of reaching the general population. Therefore, we consider that this information should remain in discussion section.

 

Row 511. "…students have underestimated preventive behaviors in relation to barriers" – the meaning of this sentence wording is not clear.

Rephrased: “Despite extensive education regarding the high transmissibility of COVID-19, students have underestimated preventive behaviors in relation to physical barriers, in line with a study by Mukhtar [61]”

 

Row 512. Reference [61] should be marked [57].

Corrected

 

Row 517. "Understanding of the consequences" – according to the manuscript the tool measured "perceived severity", using items line "COVID-19 is a serious disease". The authors should use "awareness" or "perceptions" instead of "understanding".

The sentence was corrected.

Row 520. UO "influences" – no influence was measured in the study. when authors suggest an explanation or an assumption, the wording should be accordingly' using "could", "maybe", "we suggest", etc.

This statement concerns Park's study. et al.

 

Row 520-522. The only testing for the "role" of UO was a correlation test, with significant, yet very low coefficient sizes. This should be mentioned and discussed.

Additional explanations were included.

 

Row 523-525. 1. Correlation does not suggest causality. 2. The study identified that Portuguese students with a stronger sense of risk of infection and a stronger perception of the negative consequences of infection tend to use more measures to avoid infection, than students with lower perceptions of risk and severity. 3. In addition to supporting previous studies, the authors should also discuss the meaning of the findings and maybe suggest ways of using the findings.

Thank you for the suggestions. Texts was improved and ways of using findings were included.

 

Row 528-530. "Students who have not yet been diagnosed… tend to adopt more preventive behaviors". The authors should only discuss results that were presented in the Results section.

Additional discussion was included.

 

Row 535-538. 1. "This study showed that several students…" – The language is not clear. It would be better to use percentage. 2. Repeating results that were already discussed with no conclusions. 3. Using causality wording like influence is wrong here.

1. Putting the statement as a percentage can become ambiguous, since the behaviors considered are varied (maintain physical distancing, but also Avoid attending parties, Avoid physical contact with friends or family), so if you agree, we would like to keep the sentence, with the possible change: This study revealed that students struggle to adopt preventive behaviors both inside and outside the higher education institution.
2. The text was revised.

Row 539-540. I am not sure that this sentence is correct. The tested barriers were probably instrumental and measuring unrealistic optimism is not very convincing.

The sentence was removed because it made the text repetitive.

Row. 541-544. This is not a conclusion

The authors consider this sentence relevant, this it ties together the study's contributions, practical implications, and future research directions, reinforcing the significance of the research and its broader impact.

Row 549-551. Did the authors consider future strengthening the formal information tools, or organizational removal of instrumental barriers (like free masks)?

Additional information was included.

Row 722. Reference [55] is not full.

Corrected.

 

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

Thank you very much for the possibility to read and review your article entitled “Factors influencing the behavior of higher education students in response to COVID-19”. This article tackles an interesting health problem, and results are useful and add something to our knowledge. However, some aspects of the manuscript require improvement to clarify some points and make the presentation of the results both clearer and closer to the data and analyses.

Main comments

I have two main comments that will be detailed in the detailed comments section:

1.      Some parts of the method sections are very imprecise, so the reader cannot fully understand what was done. A rewriting of this section is required.

2.      The sample if very unrepresentative of the population under study, and/or this population is much more limited than what is indicated in the manuscript. In both cases, this is a major limitation of this research, greatly limiting the generalizability of results. This must be clearly stated and discussed in the manuscript. 

Detailed comments

Abstract: There is no mention of the HBM model, even if a significant part of the article makes use of this model.

Line 47: “over the last two years”: you should replace it with precise years (e.g. “in 2020-2021”), because your formulation is relative to the present time (that is now 2024).

Lines 81-102: This is a very precise and detailed account of the emergence of COVID-19, but this can be found in many other documents. I have no problem with that, but the Editor could have another point of view.

Lines 128-129: “namely physical distancing (also called physical distancing)”: I don’t understand why you repeat “physical distancing” twice.

Line 149: “The state of emergency lasted until April 2021.”: Already written on lines 147-148.

Lines 150-151: Could you provide more details about the vaccination campaign and the vaccination rate, especially among young adults?

Lines 173-177: The discrepancies found between studies are likely to be influenced by different socio-cultural contexts and differences in methodology. You should expand the comparison of these divergent findings to take these factors into account.

Lines 178-180: Again, the findings of ref [37] are in contradiction with the end of the previous paragraph, so you should better explain why.

Lines 255-261: Even if it can be deduced from lines 313-315, you should mention that your sample is a convenience sample. Moreover, it would be interesting to know the repartition of students between the three institutions and between BA and MA students. I also noticed that you mention only once (line 503) that these three institutions are in the field of health. Given that such students can have a different perspective on health questions than other students, it should be commented. Moreover, it clearly decreases the generalizability of your results. The age range is quite unusual for students, with a maximum of 59. Is there a specific reason for that, or is 59 an isolated value? I believe that if 59 can be considered as an extreme value, then this observation should be dropped from the sample, or at least it should be examined in detail for substantive and systematic differences with the other respondents. Another important point is the total absence of mention of missing data. If there is really no missing data at all for the 620 observations, then it should be stated. Otherwise, you should indicate the number of missing data on each variable, as well as the treatment you applied to each of them (imputation, deletion, …). In case of deletion, the numbers of data really used should appear on each Table. Finally, there is a very high overrepresentation of females in the sample. It should be clearly stated in the limitation section of the article. Moreover, the impact on the generalizability of results should be discussed in detail.

Section 2.2: The complete questionnaire should be provided in Appendix.

Lines 274-288: What are the psychometric qualities of this tool (in general and in the case of your own study)? Is it a validated tool or did you create some questions for this specific research?

Lines 295-303: Same questions as for the previous paragraph.

Lines 322-323: “Varimax rotation” is not a statistical analysis tool, but a way of improving the presentation and interpretability of factor analysis. You should begin this section by explaining the descriptive analyses performed on your data, and then you could speak about factor analysis. A statistician could help you on this point.

Lines 336-342: The number of t-tests is not clear. You may know that performing many successive t-tests is not always appropriate because it inflates the total error, hence the risk of accepting the wrong hypothesis in some of these tests. This is why specific post-hoc testing procedures were developed in the case of ANOVA. So, could you explain in detail why you were using t-tests, how many of them, and the influence on the total error of your computations?

Line 343: You certainly have good reason to use Spearman’s correlation instead of Pearson’s one, but can you justify this choice?

Results: Begin by presenting the data through descriptive analyses before presenting the factor analysis.

Section 3.1: You should explain that factor analysis was performed only to check that four latent dimensions are identifiable. Then, the different scales were built on the basis of Cronbach alpha only (cf Section 3.2).

Line 354: Are really ALL communities higher than 0.4? Since the four-factor model accounts for only 54.7% of the total information, it is not straightforward. Could you provide (in appendix) the complete results of the factor analysis?

Line 355: Similarly to my last comment, I would be interested in seeing the complete results regarding loadings. The sentence “All items exhibited adequate loadings” is very unclear: Does it mean that absolutely ALL loadings are >0.4, or that at least one loading per variable is >0.4? This makes a huge difference for interpretation.

Lines 369-371: Another possible explanation is that, in the specific context in which you obtained your data, some of the variables may have been interpreted differently (what is not the same as being not understood).

Lines 383-388: The expression “vast majority" used on line 383 refers grammatically to the whole paragraph, but some figures (52.9% and 61.1%) clearly don’t represent the “vast majority” of respondents, but only the majority of them. It must be made clearer by partially rewriting this paragraph.

Tables 3 and 4: I don’t understand the label of some variables when compared to the answer’s scale. For instance, “Disinfect your hands EVERY TIME you enter the school” calls for only two possible answers: yes or no. To be consistent with the answers, the question should be something like “How often do you disinfect your hands when you enter the school”. If the questions were really asked as you indicate, then you certainly have a number of imprecise answers (and it can explain missing data if any). Please, correct and or explain (possibly in the limitation section) such incoherence. Similarly, the use of “always” in some labels calls for the same comment.

Lines 414-419: Did you try to identify specific profiles of respondents? For instance, you could perform a PCA on your data, including socio-demographic variables. It could be much more informative, and complete the figures provided in Tables 3-5.

Lines 493-494: If wearing a mask is mandatory, then it is difficult not to wear it, because everyone can see you are not wearing it.

Line 503: This is the only time you precise that your data comes from health institutions. You should discuss the results in function of this important information.

Line 546: You write “two” higher education institutions, but you indicated three everywhere else.

Author Response

Dear Reviewer,

Thank you for the opportunity to review our manuscript entitled “Factors influencing the behavior of higher education students in response to COVID-19”. We are pleased to collaborate with Safety journal and the reviewers to enhance our manuscript based on the valuable comments and insights provided.

We genuinely value the feedback from the anonymous reviewers and have diligently incorporated the suggested changes into the manuscript. With the careful considerations and revisions made in response to the reviewers' insights, we believe that our article now possesses a more robust foundation and is well-positioned to make a meaningful contribution to Safety.

In the following pages you can find a detailed list of our answers/comments to the reviewers’ questions/comments with an explanation of the corresponding changes in the revised version of the manuscript, which were all highlighted in yellow in the revised version of the manuscript.

Reviewer 3

Abstract: There is no mention of the HBM model, even if a significant part of the article makes use of this model.

A mention to HBM in abstract was included.

Line 47: “over the last two years”: you should replace it with precise years (e.g. “in 2020-2021”), because your formulation is relative to the present time (that is now 2024).

Thank you for the opportunity to improve our article. Paragraph rephrased: The COVID-19 pandemic (CO=Corona, VI=Virus, D=Disease) has dramatically affected societies and the economy over the last years.

Lines 81-102: This is a very precise and detailed account of the emergence of COVID-19, but this can be found in many other documents. I have no problem with that, but the Editor could have another point of view.

Information was removed from the manuscript.

Lines 128-129: “namely physical distancing (also called physical distancing)”: I don’t understand why you repeat “physical distancing” twice.

Removed, typing error.

Line 149: “The state of emergency lasted until April 2021.”: Already written on lines 147-148.

Duplicated information, sentence removed.

Lines 150-151: Could you provide more details about the vaccination campaign and the vaccination rate, especially among young adults?

In Portugal the vaccinate rate was incredibly high. More that 90% of the population was fully vaccinated in 2022, and 95% of citizens have received at least one dose of the vaccine. We did not consider the specification by group of subjects relevant, because high adherence to vaccination in the country.

Lines 173-177: The discrepancies found between studies are likely to be influenced by different socio-cultural contexts and differences in methodology. You should expand the comparison of these divergent findings to take these factors into account.

Thank you for the suggestion. The following explanation was included: “Different contextual realities may explain these findings, as they involve different infectious agents and were conducted in different countries. Additionally, some of the countries studied during COVID-19 had previously been affected by H1N1, which could have influenced the results of the subsequent studies.”

 

Lines 178-180: Again, the findings of ref [37] are in contradiction with the end of the previous paragraph, so you should better explain why.

Sentence was already reviewed according to the recommendation from reviewer 2.

Lines 255-261: Even if it can be deduced from lines 313-315, you should mention that your sample is a convenience sample.

Information included.

Moreover, it would be interesting to know the repartition of students between the three institutions and between BA and MA students.

Information about the distribution of students between BA and MA programs was included. However, regarding the distribution by school, it is not possible to describe this because the questionnaire was administered online across three schools, without distinguishing between them.

I also noticed that you mention only once (line 503) that these three institutions are in the field of health. Given that such students can have a different perspective on health questions than other students, it should be commented. Moreover, it clearly decreases the generalizability of your results

Information was included in study’s limitations.

The age range is quite unusual for students, with a maximum of 59. Is there a specific reason for that, or is 59 an isolated value? I believe that if 59 can be considered as an extreme value, then this observation should be dropped from the sample, or at least it should be examined in detail for substantive and systematic differences with the other respondents.

In our context, master's students are often older than bachelor's students, with several being over 40 years old. However, we did not find a significant impact of age on our results.

 

Another important point is the total absence of mention of missing data. If there is really no missing data at all for the 620 observations, then it should be stated. Otherwise, you should indicate the number of missing data on each variable, as well as the treatment you applied to each of them (imputation, deletion, …). In case of deletion, the numbers of data really used should appear on each Table.

All questions in the online questionnaire were mandatory, so there were no missing values to address.

 Finally, there is a very high overrepresentation of females in the sample. It should be clearly stated in the limitation section of the article. Moreover, the impact on the generalizability of results should be discussed in detail.

Information was included in study’s limitations.

Section 2.2: The complete questionnaire should be provided in Appendix.

Questionnaire was included in appendix.

 

Lines 274-288: What are the psychometric qualities of this tool (in general and in the case of your own study)? Is it a validated tool or did you create some questions for this specific research?

The items were developed to this study. Additional explanations were included. The validity of the construct was analyzed through the exploratory factor analysis and the Cronbach Alpha’s.

Lines 295-303: Same questions as for the previous paragraph.

Additional information was included.

Lines 322-323: “Varimax rotation” is not a statistical analysis tool, but a way of improving the presentation and interpretability of factor analysis. You should begin this section by explaining the descriptive analyses performed on your data, and then you could speak about factor analysis. A statistician could help you on this point.

The translation of the information was not conducted the best way. The sentence was rephrased.

Lines 336-342: The number of t-tests is not clear. You may know that performing many successive t-tests is not always appropriate because it inflates the total error, hence the risk of accepting the wrong hypothesis in some of these tests. This is why specific post-hoc testing procedures were developed in the case of ANOVA. So, could you explain in detail why you were using t-tests, how many of them, and the influence on the total error of your computations?

T-test was applied for two independent variables: differences in behaviors adopted inside and outside of the higher education institution; relation to gender (male vs female); level of education (master vs BSc); whether or not they were displaced from the household (Yes/NO); whether or not they were infected  with COVID-19 (Yes/NO); whether they knew someone who had severe symptoms (YES/NO); whether they  belong to or live with someone in the risk group (YES/NO); whether someone they knew was or is diagnosed with COVID-19 (YES/NO). According, ANOVA is not applied in this case.

 

Line 343: You certainly have good reason to use Spearman’s correlation instead of Pearson’s one, but can you justify this choice?

We used T-test based on the Central Limit Theorem. However, this theorem  should not be applied in correlations. As the data do not follow a normal distribution, Spearman’s test is the correct one.

Results: Begin by presenting the data through descriptive analyses before presenting the factor analysis.

Data processing is described according it was treated. First, EFA was conducted. Only after that, descriptive analysis was conducted. The opposite does not make sense, since some items could be removed during EFA.

Section 3.1: You should explain that factor analysis was performed only to check that four latent dimensions are identifiable. Then, the different scales were built on the basis of Cronbach alpha only (cf Section 3.2).

Information included.

Line 354: Are really ALL communities higher than 0.4? Since the four-factor model accounts for only 54.7% of the total information, it is not straightforward. Could you provide (in appendix) the complete results of the factor analysis?

Line 355: Similarly to my last comment, I would be interested in seeing the complete results regarding loadings. The sentence “All items exhibited adequate loadings” is very unclear: Does it mean that absolutely ALL loadings are >0.4, or that at least one loading per variable is >0.4? This makes a huge difference for interpretation.

Lines 369-371: Another possible explanation is that, in the specific context in which you obtained your data, some of the variables may have been interpreted differently (what is not the same as being not understood).

The communities' values are higher than 0.4. The final component matrix and loadings is described below. We do not have an explanation to justify the total variance obtained. However, the explained variance between 50-60% is acceptable (Hair et al. 1995).

Hair, J., R. & Anderson, et al. (1995). Multivariate data analysis. New Jersey, Prentice-Hall Inc.

 

Lines 383-388: The expression “vast majority" used on line 383 refers grammatically to the whole paragraph, but some figures (52.9% and 61.1%) clearly don’t represent the “vast majority” of respondents, but only the majority of them. It must be made clearer by partially rewriting this paragraph.

Corrected.

Tables 3 and 4: I don’t understand the label of some variables when compared to the answer’s scale. For instance, “Disinfect your hands EVERY TIME you enter the school” calls for only two possible answers: yes or no. To be consistent with the answers, the question should be something like “How often do you disinfect your hands when you enter the school”. If the questions were really asked as you indicate, then you certainly have a number of imprecise answers (and it can explain missing data if any). Please, correct and or explain (possibly in the limitation section) such incoherence. Similarly, the use of “always” in some labels calls for the same comment.

This note was included in the table: Note: Question – “Indicate how often you engage in the described behaviors according to the following scale”

Additional information about the questionnaire was included in appendix.

Lines 414-419: Did you try to identify specific profiles of respondents? For instance, you could perform a PCA on your data, including socio-demographic variables. It could be much more informative, and complete the figures provided in Tables 3-5.

This analysis was not considered.

Lines 493-494: If wearing a mask is mandatory, then it is difficult not to wear it, because everyone can see you are not wearing it.

Outside was not mandatory.

Line 503: This is the only time you precise that your data comes from health institutions. You should discuss the results in function of this important information.

Additional information about the sample was included in methods section.

Line 546: You write “two” higher education institutions, but you indicated three everywhere else.

Sorry for the typing error, corrected to Three higher education institutions

 

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

Thank you for attending to the suggestions and comments in your revised manuscript

Comments for author File: Comments.pdf

Comments on the Quality of English Language

The language editing is included in the revised manuscript

Author Response

Dear Reviewer,

Thank you for attending to the suggestions and comments in your revised manuscript. The language editing is included in the revised manuscript

We appreciate all the collaboration and care in reviewing our work. With your contributions, it has become considerably better. The article has been revised in terms of language, and your suggestions have been taken into consideration.

Best regards,

All authors

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Thank you for your major effort to follow the notes and correct the manuscript. The revised manuscript is a much better than the original one.

Comments on the Quality of English Language

Although already better than the original, the manuscript language could be further improved by a native English speaking language editor. 

Author Response

Dear Reviewer,

Thank you for your major effort to follow the notes and correct the manuscript. The revised manuscript is a much better than the original one.

Although already better than the original, the manuscript language could be further improved by a native English speaking language editor.

We appreciate all the collaboration and care in reviewing our work. With your contributions, it has become considerably better. The article has been revised in terms of language.

 

Best regards,

All authors

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

This new version considers most of my comments. There are now only a few details to improve before publication.

In your answer to my previous comments, you indicated that there was no missing data, because the answer to all questions was mandatory. OK, but it should be mentioned in the manuscript. In fact, it is known that having all questions mandatory tends to diminish the number of respondents we can obtain from a survey. Similarly, the quite old age of some respondents should be commented on in the manuscript.

In another answer, you wrote “Data processing is described according it was treated. First, EFA was conducted. Only after that, descriptive analysis was conducted. The opposite does not make sense, since some items could be removed during EFA.” I strongly disagree with this point, even if I don’t ask you to completely change this part of the manuscript. The role of descriptive analysis is also to identify specificities in the data, to detect erroneous data, etc. So, it must be performed before any more substantive analysis.

Table 2: You should specify that figures represent the number or percentage of positive answers to each question.

Table 3: I’m sorry, but even with the added note at the bottom of the table, there is still an important problem of wording and/or logic when “always” is mentioned in an item. If we take the last line “Always use their own school materials”, the question calls only for a yes/no answer. You cannot at the same time ask for “Indicate how often you engage […]”. Given your answer to my comments on the previous version of the article and the changes made in the article, my guess is that a wording error was present in your original questionnaire. It happens, but you should acknowledge that in the limitation section, since answers can have been influenced by the way each person individually understood what you were really asking for.

Table 4: Same comment as for Table 3 (regarding the ”Always wear a mask outside” item).

Lines 735-737: If the number of women in health schools is really much higher than the number of men, then the sample is maybe not so biased as a health school sample. On the other hand, the sample is very biased if we consider it as a general sample of students and if you want to generalize your results. You must improve the manuscript on both of these aspects.

Comments on the Quality of English Language

English should be improved. For instance, on line 469, “dimension” instead of “dimention”. On lines 361-362: “The sample is a convenience sample” instead of “The sample was obtained by sample convenience”. The sentence on lines 734-735 “Also, as the target sample of the study are students in higher education in 734 the health area may represent a bias since they will be somehow more informed.” should be rewritten. Etc.

Author Response

Dear Reviewer,

 

In your answer to my previous comments, you indicated that there was no missing data, because the answer to all questions was mandatory. OK, but it should be mentioned in the manuscript. In fact, it is known that having all questions mandatory tends to diminish the number of respondents we can obtain from a survey. Similarly, the quite old age of some respondents should be commented on in the manuscript.

Thank you for the recommendation. It was included in the Methods section a sentence indicating that all the questions were mandatory.

Additionally, the following sentence was included also in Methods section “In our reality, many Master's students are already working. Additionally, students over the age of 23 have the option to enroll in undergraduate courses, which results in the institution having students of more advanced ages.”

In another answer, you wrote “Data processing is described according it was treated. First, EFA was conducted. Only after that, descriptive analysis was conducted. The opposite does not make sense, since some items could be removed during EFA.” I strongly disagree with this point, even if I don’t ask you to completely change this part of the manuscript. The role of descriptive analysis is also to identify specificities in the data, to detect erroneous data, etc. So, it must be performed before any more substantive analysis.

It is a valid point of view. However, this is a practice we regularly adopt in data analysis and description. Several other research papers adopt a similar approach.

Table 2: You should specify that figures represent the number or percentage of positive answers to each question.

Information included in Table 2.

Table 3: I’m sorry, but even with the added note at the bottom of the table, there is still an important problem of wording and/or logic when “always” is mentioned in an item. If we take the last line “Always use their own school materials”, the question calls only for a yes/no answer. You cannot at the same time ask for “Indicate how often you engage […]”. Given your answer to my comments on the previous version of the article and the changes made in the article, my guess is that a wording error was present in your original questionnaire. It happens, but you should acknowledge that in the limitation section, since answers can have been influenced by the way each person individually understood what you were really asking for.

Table 4: Same comment as for Table 3 (regarding the ”Always wear a mask outside” item).

Thank you for clarifying this issue. We added the following sentences: “Some items included in the original questionnaire, particularly those related to behavior, were redundant. This was because respondents were asked to evaluate how frequently they adopted certain behaviors, while the items themselves included the word 'always' in the phrasing. Although we do not believe this issue significantly affected the responses, it is important to note that greater care should be taken with such situations in future surveys.”

Lines 735-737: If the number of women in health schools is really much higher than the number of men, then the sample is maybe not so biased as a health school sample. On the other hand, the sample is very biased if we consider it as a general sample of students and if you want to generalize your results. You must improve the manuscript on both of these aspects.

Thank you. The sentences were improved.

 

English should be improved. For instance, on line 469, “dimension” instead of “dimention”. On lines 361-362: “The sample is a convenience sample” instead of “The sample was obtained by sample convenience”. The sentence on lines 734-735 “Also, as the target sample of the study are students in higher education in 734 the health area may represent a bias since they will be somehow more informed.” should be rewritten. Etc.

The article has been revised in terms of language, and your suggestions have been taken into consideration.

 

 

Best regards,

All authors

 

 

Author Response File: Author Response.pdf

Round 3

Reviewer 1 Report

Comments and Suggestions for Authors

Thank you for the revisions made in this version. 

Comments on the Quality of English Language

Only minor language editing is required, possibly due to the multiple revisions and track changes that lead to grammar errors

Reviewer 3 Report

Comments and Suggestions for Authors

The authors answered to all of my comments.