Review for 10.1186/s12876-025-03623-6 (2025)

Title: Structural Equation Modeling of the Impact of Disease Activity on Inflammatory Bowel
Disease Control: The Mediating Roles of Self- Efficacy and Self-Management Behaviors
Version: 1 Date: 24 Dec 2024
Reviewer:  Mohammad Reza Hatamnejad
Reviewer's report:
Thank you for the opportunity to provide a peer review for this article on " Structural Equation
Modeling of the Impact of Disease Activity on Inflammatory Bowel Disease Control: The
Mediating Roles of Self-Efficacy and Self-Management Behaviors." In the context of IBD,
this cross-sectional investigation aimed to evaluate the effect of disease activity on control,
either directly or indirectly, through self-management and self-efficacy behaviors. They utilized
Structural equation modeling and path analysis. They showed three significant axes: 1) negative
direct association of activity and control, 2) disease activity - (Negative association) - self-
efficacy - (positive association) - disease control, 3) disease activity - (Negative association) -
self-efficacy - (positive association) - self-management - (positive association) - disease control;
Last axis, the chain-mediated path of self-efficacy and self-management behavior between IBD
activity and IBD-control, showed a borderline significant trend. Also, the authors failed to
demonstrate whether disease activity through self-management can affect disease control. They
justified this discrepancy by mentioning variations in assessment tools or subjective reporting
biases. There is robust statistical analysis, and the author perfectly explained the result and how
factors such as medication rather than biological or financial stress can influence disease control.
Also, they properly provided 1) future research perspective, specifically in self-management, 2)
practical suggestions to enhance self-efficacy, and 3) study limitations.
Here are some comments that may help authors to boost the paper's quality:
1. Some papers show the effect of disease activity/severity on control or patient outcomes,
especially using the common sense model (Hayes B, Moller S, Wilding H, Burgell R,
Apputhurai P, Knowles SR. Application of the common sense model in inflammatory
bowel disease: A systematic review. J Psychosom Res. 2020 Dec;139:110283. Doi: 10.1016/
j.jpsychores.2020.110283. Epub 2020 Oct 26. PMID: 33161175). Recently, a thesis was
published explaining how activity through self-efficacy can affect disease control (Kantidakis,
Jim (2016). The psychological mediators in the relationship between disease activity,
psychological distress, and quality of life in inflammatory bowel disease. Swinburne. Thesis.
https://doi.org/10.25916/sut.26295121.v1); Authors should explain the novelty of current papers
and its differentiation from other investigations.
2. The manuscript needs language editing. For instant:
a. In line 63, "To better understand disease control and its influencing factors in IBD patients,
this study employed the Common Sense Model of Self-Regulation (CSM) [13] as its theoretical
foundation." The authors first need to introduce the study to understand what " this study" refers
to.
b. In line 200, it is not recommended that the sentence start with the number “246 cases (80.39%)
admitted that there was financial pressure.” However, if this is not avoidable, they can bring it
in written format.
c. In line 223, the author mentioned that “symptom management scored slightly higher than co-
management.” However, in the table, there is Common disease management. Could the authors
clarify if these terms are synonymous or distinct?
d. In the abstract and method sub-section, Structural equation modeling was defined two times
and abbreviated as (SEM).
3. Why did the authors not hypothesize about the effect of self-management on self-efficacy?
Better self-management leads to more efficient chronic disease management self-efficacy.
(Magharei et al. PMID: 30643831). Pathway of activity-# self-management-> self-efficacy->
control can be measured too.
4. Did the authors qualitatively measure the perceived economic stress by splitting the
answers into high pressure, some pressure, and free pressure? Why didn’t they use
a previously established questionnaire (https://doi.org/10.1023/A:1023080826557, https://
doi.org/10.1037/0893-3200.19.2.246 to measure the economic stress?
5. Citation for “diagnostic criteria for inflammatory bowel disease established by the Chinese
Medical Association Gastroenterological Diseases” is needed.
6. It's relatively common for some inflammatory bowel disease (IBD) patients to exhibit
overlapping features of ulcerative colitis (UC) and Crohn's disease (CD) without fitting neatly
into either category. Why did the authors decide to exclude these patients and not group IBD
patients into three groups containing UC, CD, and unclassified IBD?
7. For questionnaires, HBI and SCCAI authors should cite a cross-culturally adapted
Chinese version; otherwise, the authors should have evaluated the questionnaires' transcultural
adaptation.
8. Do authors for any questionnaires, including IBD-Control-8 and SEMCD6, conduct a test/
retest reliability?
9. In Table 1, for education and marital status, there are some errors in rounding the numbers,
e.g., the summation of the percentages of married, unmarried, and divorced more than 100.