PCLM-D-22-00207

Preventing Lyme disease through identification of key beliefs

PLOS Climate

Dear Dr. Valois,

Thank you for submitting your manuscript to PLOS Climate. After careful consideration, we feel that it has merit but does not fully meet PLOS Climate’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please see the comments from three reviewers below. The reviewers have raised overlapping concerns about the motivations and concepts used, and we hope that their comments are useful in revising the manuscript.

Please submit your revised manuscript by May 27 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at climate@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pclm/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

We look forward to receiving your revised manuscript.

Kind regards,

Hanna Landenmark

Staff Editor

PLOS Climate

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Additional Editor Comments (if provided):

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Does this manuscript meet PLOS Climate’s publication criteria? Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe methodologically and ethically rigorous research with conclusions that are appropriately drawn based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Partly

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: No

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3. Have the authors made all data underlying the findings in their manuscript fully available (please refer to the Data Availability Statement at the start of the manuscript PDF file)?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception. The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS Climate does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The authors provide a valuable contribution to the general literature regarding motivations for adopting Lyme disease avoiding behaviors (LDAB) in an area with increasing incidence of this disease. However, there are several changes to the manuscript that are needed to ensure this article can be fully interpreted by the reader.

General Comments

- Line 82: correct from ‘tick-borne vectors’ to ‘tick vectors’

- Line 102: please introduce the text behind the acronym LDAB in the main text prior to first use

- Lines 176 – 178: these results of survey dissemination should be in the results section rather than methods

- Line 180: ‘made up of 25,000 panellists’ is redundant text and can be dropped

- Line 180-181: how many survey invitation waves were executed?

- Line 279: data ‘were’ analyzed

- Line 478: should ‘allow’ be ‘also’?

Major Comments

- Line 178: what were your sampling frame inclusion criteria that dropped the panel from 225,000 to 17,752?

- Line 180: please include the name of the survey firm. Did the survey firm administer the questionnaire and catalog responses, or did they simply share access to their respondent panel? Were there any incentives provided to survey respondents from the firm?

- Please provide a citation to support your designation of an internally consistent scale (i.e., what Cronbach alpha threshold did you use to determine internal consistency?)

- Line 394: identification of specific barriers and facilitating factors – I do not think the authors adequately described what these barriers and facilitating factors are. For example, on control beliefs – which scenarios (combination of an event occurring with its hindrance/facilitation on adoption) were the most significant barriers to LDAB adoption? You touch on some specific question items/factors in the discussion, but the only data presented to the reader are the aggregate scores used in the models and their correlations. It would be helpful to provide additional results information that illustrates these specific question-item associations in the results section rather than introducing these findings in the discussion section, where information is incomplete. Including the full questionnaire so readers can understand how question items contributed to the scores used in analysis will go a long way to addressing this issue. I recommend the authors provide some descriptive statistics on how respondents answered each question item that then contributed to the construct scores.

- Line 418: After several readings, I cannot determine what the ‘third barrier identified’ is referencing.

- Line 427 – 430: Would it be more appropriate to reference the behavioral beliefs score here, rather than attitudes, as – based on my interpretation of the article - the behavioral beliefs score incorporated questions measuring subjective desirability of outcomes from adopting LDAB?

- Line 438: I would argue that posting a map is not sufficient to convey expectations from a municipal government. I would suggest incorporating recommendations for calls to action or similar strategies from municipal government messaging that conveys expectations rather than passive delivery of information.

- I walked away from this paper not better understanding respondents’ attitudes, perceived social norms, and perceived behavioral control regarding LDAB adoption. I understood that the models indicated that control beliefs had a large impact on intention and action on LDAB adoption, as well as beliefs on social norms, but that is still a vague concept. This paper would be much more impactful if the specific constructs measured were better described.

Reviewer #2: This is a very nice study showing both motivating factors and barriers to intention to adopt Lyme Disease prevention behaviors, as well as the self-reported behaviors themselves.

I would like at least a supplement that provided a definition of each of the score variables. Preferably, expand Table 2 to include all of the items for each of the scored categories.

Specific questions:

Table 1: how does this compare to the target population?

201: Why were you dichotomizing these variables? What amount of information did you potentially lose in doing so?

Table 2: Item 10 requires the participant to have a lawn – did you have an NA option, and if so, what proportion responded with NA or failed to respond?

247: Were the behavioral belief scores normally distributed? If not, the average might not be the best summary statistic.

Table 3: It would help with readability if the theoretical ranges were included as a column rather than a footnote

458: I would instead focus on parents of children, as they are often making the decisions for their children

Reviewer #3: In this article, the authors use the Theory of Planned Behaviour to examine what motivates people to take preventive actions against tick bites and Lyme disease. I agree with the authors that this is an important topic that deserves more research attention.

My main criticism relates to the theoretical focus of this article. The authors focus specifically on the Theory of Planned Behaviour, claiming it will be an ‘an excellent tool’, but it is not specified why the authors chose specifically this theory (and not others theories within the health psychology domain) to understand preventive behaviours. It is also not examined whether this approach is indeed more effective than previous attempts to study preventive behaviours, which have focused on perceived risk, knowledge, and barriers. The authors mention that the TPB focuses on ‘key or primary beliefs’, but it’s not explained why the authors consider the components of TPB as key beliefs. This study is also not the first to use the Theory of Planned Behaviour to understand preventive behaviours for Lyme disease (Daltroy et al., 2007; de Vries & van Dillen, 2002; Omodior et al., 2015). Overall, I think this paper needs a stronger overall argument to support the novelty and theoretical relevance of the results presented in this paper.

I also have some methodological criticisms regarding how the theory of planned behaviour was examined here. First, there is a mismatch in the level of specificity used to examine intentions and behaviour. While the behaviour measurement is very specific, the intention measurement is far more general. In general, it is proposed that all constructs within the Theory of Planned Behaviour should be measured at the same level of specificity (Ajzen, 1991). Second, the authors use current levels of intentions to predict past behaviours. I recommend the authors read the article by Weinstein et al. (1998) why this is not desirable, and should be avoided with cross-sectional data. The items for social norms and normative beliefs also seem very similar, it is not clear how they are conceptually different.

Lastly, the authors report results from different SEM analysis, where a few of the reported models demonstrate a perfect fit with CFI = 1; TLI = 1; RMSEA = 0. The authors interpret this as an excellent fit of the model, but a perfect model fit is in fact not informative at all. I suspect the authors allow everything to correlate with each other, which leads to a perfect fit of the model. Importantly, this should not be interpreted as support for the model: the authors have simply recreated the data-matrix (i.e., the correlation table). The authors should not report this section as separate SEM analyses with perfect fit, a better approach would be to report a simple correlation table. Please consult with a statistician on how to conduct and interpret SEM analyses. In general, it is not clear to me why the authors analyse how the individual belief items are related to attitudes/perceived social norms/perceived behavioural control in this section, since in the methods section it is stated that these items are averaged into an index.

Minor point

In the introduction, the authors use the abbreviation LDAB, but this is not defined (only in the abstract). I would suggest defining this term upon first use in the main text.

References

Ajzen, I. (1991). The Theory of Planned Behaviour. Organizational Behaviour and Human Decision Processes, 50, 179-211.

Daltroy, L. H., Phillips, C., Lew, R., Wright, E., Shadick, N. A., & Liang, M. H. (2007). A Controlled Trial of a Novel Primary

Prevention Program for Lyme Disease and Other Tick-Borne Illnesses. Health Education & Behaviour, 34(3), 531-542.

de Vries, H., & van Dillen, S. (2002). Prevention of Lyme disease in Dutch children: analysis of determinants of tick inspection by parents. Prev Med, 35(2), 160-165. https://doi.org/10.1006/pmed.2002.1055

Omodior, O., Pennington-Gray, L., & Donohoe, H. (2015). Efficacy of the Theory of Planned Behaviour in Predicting the Intention to Engage in Tick-Borne Disease Personal Protective Behaviour Amongst Visitors to a Recreation Center. Journal of Park and Recreation Administration, 33(2), 38-53.

Weinstein, N. D., Rothman, A. J., & Nicolich, M. (1998). Use of correlational data to examine the effects of risk perceptions on precautionary behavior. Psychology & Health, 13(3), 479-501. https://doi.org/10.1080/08870449808407305

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Reviewer #1: No

Reviewer #2: Yes: Rebecca Smith

Reviewer #3: No

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PCLM-D-22-00207R1

Preventing Lyme disease through identification of key beliefs

PLOS Climate

Dear Dr. Valois,

Thank you for submitting your manuscript to PLOS Climate. After careful consideration, we feel that it has merit but does not fully meet PLOS Climate’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Specifically, two of the three previous reviewers still have some concerns. Please see their comments below.

Please submit your revised manuscript by Aug 28 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at climate@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pclm/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

We look forward to receiving your revised manuscript.

Kind regards,

Jianhong Zhou

Staff Editor

PLOS Climate

Journal Requirements:

Additional Editor Comments (if provided):

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: (No Response)

Reviewer #2: All comments have been addressed

Reviewer #3: (No Response)

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2. Does this manuscript meet PLOS Climate’s publication criteria? Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe methodologically and ethically rigorous research with conclusions that are appropriately drawn based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Partly

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available (please refer to the Data Availability Statement at the start of the manuscript PDF file)?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception. The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS Climate does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Overall, this revision is much improved from the original version. The addition of Table 3, the survey questionnaire supplement, and revision for clarifying text have addressed the majority of review comments, and I thank the authors for their efforts. I only have a few minor comments for consideration:

- Throughout, please confirm Lyme disease is written as such (rather than Lyme Disease)

- This is a little nit-picky, but on L52-53, Ixodes scapularis is a vector of the causative agent of Lyme disease, Borrelia burgdorferi, not of Lyme disease itself

- Line 75 – there are several causative agents within the Borrelia burgdorferi sensu lato complex. Please correct to make bacteria plural and reference that this is a complex rather than one bacterial species.

- Line 83 – verb tense agreement, please update to read ‘strategies’

- Line 453 – both factors are described as external by the authors, but ‘comprehending the measures and behaviors recommended’ seems like it would be at least partially internal, as it relates to a person’s individual level of mental processing and understanding.

- Table 3. In the section on perceived behavioral control, it looks like your third 6-point scale item “you think it will be too demanding” is reverse worded compared to the other items in that section. For the previous items, a higher response option is associated with a positive attitude (very easy, will develop an understanding), while in the last item the higher response option is associated with a negative attitude (will be too demanding to adopt LDAB). Thus, having a lower mean value for this question item has a different interpretation when compared to the other question items. Did you account for this in analysis?

Reviewer #2: All my concerns have been addressed.

Reviewer #3: I appreciate the extensive revisions the authors have made to the paper, and their reflections on the theoretical questions posed by the authors. I however do have some remaining concerns that I would like to see addressed.

First, I appreciate that the authors now reflect more on the theoretical relevance and innovation of the current paper. Specifically, the authors write that:

‘The current research, however, derives its novelty and theoretical relevance from its consideration of key beliefs underlying constructs of the TPB, which represents a gap in the literature on LDAB.’

However, I still find it a bit unclear why It is so important to focus on these precursory beliefs. The authors themselves write:

‘[since] these beliefs underlie the formation of attitudes, perceived social norms, and perceived behavioral control. Learning more about them could thus assist in identifying the factors that guide people’s decision to adopt or not adopt LDABs.’

And

‘This belief-based analysis can then guide the design of behavioral hange interventions targeting adoption of LDAB in the population’

However, previous intervention studies using the TPB usually directly focus on attitudes, perceived social norms, and perceived behavioural control, and do not consider the underlying beliefs (e.g., Fife-Shaw et al., 2007). I am therefore wondering what the added value is, both theoretically as well as practically, of examining these precursory beliefs. Also in the results section, it is not convincingly demonstrated what the added value of the precursory beliefs is.

Second, I noticed that the mean scores for the attitude item are extremely high. It seems to me that this is the case because the items are leading respondents to agree with them (for example, who would really say that conducting a tick-check is ‘dangerous’ or ‘unhealthy’?). The attitude measure does not really offer the opportunity for respondents to indicate a negative opinion (e.g., that it is too time consuming or uncomfortable to implement the actions). I am therefore worried about the validity of these items. I feel that this also applies to some of the other items in this questionnaire. The way that items are phrased makes it difficult to disagree with them (for example, who would really disagree with the item ‘People important to you will appreciate your adoption of measures and behaviors that can protect you from Lyme disease during the next tick season’). It can also lead to socially desirable responses.

Lastly, the authors report that the TPB model accounted for 94.4% of variance of people’s intentions to adopt LDAB. This seems extremely high to me. For example, previous estimates suggest that the TPB constructs usually predict between 30% to 50% of the variance of intentions (Fife-Schaw et al., 2007). Can the authors reflect more on why the results from this study seem to diverge from previous applications of the TPB model?

References

Fife-Schaw, C., Sheeran, P. and Norman, P. (2007), Simulating behaviour change interventions based on the theory of planned behaviour: Impacts on intention and action. British Journal of Social Psychology, 46: 43-68.

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Reviewer #1: No

Reviewer #2: Yes: Rebecca Smith

Reviewer #3: No

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[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Preventing Lyme disease through identification of key beliefs

PCLM-D-22-00207R2

Dear Mr. Valois,

We are pleased to inform you that your manuscript 'Preventing Lyme disease through identification of key beliefs' has been provisionally accepted for publication in PLOS Climate.

Before your manuscript can be formally accepted you will need to complete some formatting changes, which you will receive in a follow-up email from a member of our team. 

Please note that your manuscript will not be scheduled for publication until you have made the required changes, so a swift response is appreciated.

IMPORTANT: The editorial review process is now complete. PLOS will only permit corrections to spelling, formatting or significant scientific errors from this point onwards. Requests for major changes, or any which affect the scientific understanding of your work, will cause delays to the publication date of your manuscript.

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Thank you again for supporting Open Access publishing; we are looking forward to publishing your work in PLOS Climate.

Best regards,

Jamie Males

Executive Editor

PLOS Climate

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Reviewer Comments (if any, and for reference):

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

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2. Does this manuscript meet PLOS Climate’s publication criteria? Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe methodologically and ethically rigorous research with conclusions that are appropriately drawn based on the data presented.

Reviewer #1: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available (please refer to the Data Availability Statement at the start of the manuscript PDF file)?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception. The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS Climate does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: (No Response)

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

Do you want your identity to be public for this peer review? If you choose “no”, your identity will remain anonymous but your review may still be made public.

For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

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