Social Representations of “Tinnitus” and “Health” among Individuals with Tinnitus Seeking Online Psychological Interventions

Round 1

Reviewer 1 Report

This is a novel approach to analyse the social representations of ‘tinnitus’ and ‘health’ among a specific subgroup of tinnitus  patients, those who are seeking online psychological interventions AND choose to participate in a ICBT clinical trial. 

The selected approach is overall very interesting, and the paper is being read very pleasantly. Nevertheless, the rationale behind the selection of SRT and researchers' objective are not clearly stated. I recommend that the authors elaborate on their background thinking for choosing it for the case of tinnitus. As a reader, I also find the interpretation and practical implications of the findings generic  or not based on the actual findings (I will give some examples later). Without a clear objective, and since conclusions differ between abstract and draft, it is difficult to understand what is the clear message of this study. I would suggest that the authors stick to the highlights of their results, elaborate on them in the discussion and drive the reader to a safe conclusion. Finally, throughout the manuscript, they should also clarify that these results reflect a particular sample and not tinnitus patients in general.

Major revision:

Abstract: It is not obvious that ENT's, audiologists or other tinnitus-related clinicians and scientists are aware of SRT. Please provide some information about SRT for the reader that is not aware of it as a scientific method.

The conclusion is phrased in a very generic way and there is a logic leap between it and the results provided in the abstract. Why tinnitus management should focus on what the authors suggest? for which patients? I suggest that the conclusions are changed and explain in a phrase what was found in this particular study and not what authors suggest for the future.

Introduction:

Throught the Introduction, it is not clear why SRT was chosen. I would elaborate on the rationale of choosing SRT and provide examples where similar approach has been used for other conditions and how this helped (i.e. chronic pain? depression? other condition). 

Methods: Why did authors choose 5 words/phrases? Is there previous evidence suggesting that this is the average number of words used? Is it part of SRT methods? Lines 115-120 are not clearly phrased: what is "this" in line 119?

Results: Sample seems very heterogenous, which makes the reader think that any non-cluster analysis may be too generic and of limited utility. It should be stated how the authors address this limitation.

Discussion: - What lines 161-162 mean? Is there a syntaxt or content issue?

- When reading the discussion, one can spot the highlights or conclusions of the study: Patients tend to describe their tinnitus when searching online. that individuals in the current study sample have more positive outlook about their general health. Connotations were mixed for health, negative for tinnitus. Individuals with tinnitus in this study didn’t have much commonality regarding how they think about their health and about their tinnitus

- In lines 275-7, there is not sufficient explanation of why this argument is true. Which evidence lead to this conclusion?

- Practice implications: This whole section is quite generic, talking about SRT's theoretical results in general, but with no actual practical implications: How did this study which is based on SRT helped us in better understanding tinnitus? I would suggest to explain which specific results may be useful in clinical practice and future research, and link them to the abstract conclusions. 

Minor revisions:

lines 285 and 287: references are missing

line 291: "don't" may be considered colloquial. Better to replace with "do not".

Author Response

Comment: This is a novel approach to analyse the social representations of ‘tinnitus’ and ‘health’ among a specific subgroup of tinnitus  patients, those who are seeking online psychological interventions AND choose to participate in a ICBT clinical trial. 

 

The selected approach is overall very interesting, and the paper is being read very pleasantly. Nevertheless, the rationale behind the selection of SRT and researchers' objective are not clearly stated. I recommend that the authors elaborate on their background thinking for choosing it for the case of tinnitus. As a reader, I also find the interpretation and practical implications of the findings generic or not based on the actual findings (I will give some examples later). Without a clear objective, and since conclusions differ between abstract and draft, it is difficult to understand what is the clear message of this study. I would suggest that the authors stick to the highlights of their results, elaborate on them in the discussion and drive the reader to a safe conclusion. Finally, throughout the manuscript, they should also clarify that these results reflect a particular sample and not tinnitus patients in general.

 

Response: Thank you for your very helpful comments. We have revised the manuscript to include rationale for using the SRT as well as clarified the key message throughout the manuscript.

 

Comment: Major revision: Abstract: It is not obvious that ENT's, audiologists or other tinnitus-related clinicians and scientists are aware of SRT. Please provide some information about SRT for the reader that is not aware of it as a scientific method.

 

Response: We have provided some background information about SRT in the abstract as suggested.

 

Comment: The conclusion is phrased in a very generic way and there is a logic leap between it and the results provided in the abstract. Why tinnitus management should focus on what the authors suggest? for which patients? I suggest that the conclusions are changed and explain in a phrase what was found in this particular study and not what authors suggest for the future.

 

Response: We have revised the conclusion section in the abstract to be more precise.

 

Comment: Introduction: Throughout the Introduction, it is not clear why SRT was chosen. I would elaborate on the rationale of choosing SRT and provide examples where similar approach has been used for other conditions and how this helped (i.e. chronic pain? depression? other condition). 

 

Response: We have provided a rationale for using SRT in this study as well as cited relevant literature on SRT in other health areas.

 

Comment: Methods: Why did authors choose 5 words/phrases? Is there previous evidence suggesting that this is the average number of words used? Is it part of SRT methods?

 

Response: The use of 5 word/phrase is a standard methodology used in SRT studies. We have clarified this in the revised manuscript.

 

Comment: Lines 115-120 are not clearly phrased: what is "this" in line 119?

 

Response: We have revised the text in these sections as suggested.

 

Comment: Results: Sample seems very heterogenous, which makes the reader think that any non-cluster analysis may be too generic and of limited utility. It should be stated how the authors address this limitation.

 

Response: We agree with your comment. We have highlighted this in the method section as well as added this as a study limitation.

 

Comment: Discussion: - What lines 161-162 mean? Is there a syntaxt or content issue?

 

Response: We have revised this sentence as suggested.

 

Comment: When reading the discussion, one can spot the highlights or conclusions of the study: Patients tend to describe their tinnitus when searching online. that individuals in the current study sample have more positive outlook about their general health. Connotations were mixed for health, negative for tinnitus. Individuals with tinnitus in this study didn’t have much commonality regarding how they think about their health and about their tinnitus

 

Response: We agree with your comment. However, due to lack of any previous studies in this area, we have tried to discuss the current study results with other relevant tinnitus literature.

 

Comment: In lines 275-7, there is not sufficient explanation of why this argument is true. Which evidence lead to this conclusion?

 

Response: WE have provided further clarification to this text.

 

Comment: Practice implications: This whole section is quite generic, talking about SRT's theoretical results in general, but with no actual practical implications: How did this study which is based on SRT helped us in better understanding tinnitus? I would suggest to explain which specific results may be useful in clinical practice and future research, and link them to the abstract conclusions. 

 

Response: We have added more specific practice implications in the revised manuscript.

 

Comment: Minor revisions: lines 285 and 287: references are missing

 

Response: Text in these lines is from the current manuscript. So, we have not added any external reference.

 

Comment: line 291: "don't" may be considered colloquial. Better to replace with "do not".

 

Response: We have made the suggested change.

 

Reviewer 2 Report

The article is interesting even although the results require to be more clear. I suggest to better clarify the figures and the tables. Moreover, the the reference and the discussion could be improved focusing on psychological distress, cognitive dysfunction an qualiy of life of patients

Author Response

Comment: The article is interesting even although the results require to be more clear. I suggest to better clarify the figures and the tables. Moreover, the the reference and the discussion could be improved focusing on psychological distress, cognitive dysfunction an quality of life of patients.

 

Response: Thank you for your helpful feedback. We have revised the manuscript based on your and other reviewer comments.

Round 2

Reviewer 1 Report

Minor changes:

for matters of consistency, throughout the manuscript when referring to "tinnitus" and "health" as terms, ensure that you use "" (i.e. line 30 or p12, lines 285-287)

Similarly for categories i.e. p13, line 303 annoying should be in italics

line 320 replace "have" with "has"

Author Response

Comment: For matters of consistency, throughout the manuscript when referring to "tinnitus" and "health" as terms, ensure that you use "" (i.e. line 30 or p12, lines 285-287)

 

Response: Thank you for your very helpful comments. We have made the suggested change.

Comment: Similarly for categories i.e. p13, line 303 annoying should be in italics

 Response: Thank you for your very helpful comments. We have made the suggested change.

 Comment: line 320 replace "have" with "has"

Response: Thank you for your very helpful comments. We have made the suggested change.