Editors

Health and Place

Dear Dr Ana Donnelly and Dr Natalie Pafitis

Assessing adolescent diet and physical activity behaviour, knowledge and awareness in low- and
middle-income countries: A systematised review of quantitative epidemiological tools
(Submission ID eb40c9e0-fea7-43fe-a8bb-e3b38b9cdb35)

Thank you for consideration of our manuscript ‘Assessing adolescent diet and physical activity
behaviour, knowledge and awareness in low- and middle-income countries: A systematised review of
quantitative epidemiological tools’ for publication in BMC Public Health. Our manuscript has been
edited in direct response to the reviewers’ comments and a revised manuscript is re-submitted.
Detailed descriptions of the changes that have been made in the manuscript are attached below for
ease of reference.

All authors have agreed to this revised submission and the manuscript is not currently under
submission in any other journal.

The authors have no conflict of interest to declare.

Yours sincerely,

Trish Muzenda

Reponses to Reviewer comments

Reviewer 1

1. By presenting a more extended purpose and synthesis (e.g., with information on constructs,
validation, and administration of available instruments), I consider that you have conducted a scoping
review. Thus, I strongly recommend reading the text by Munn et al. (BMC Medical Research
Methodology. 2018;18:143 https://doi.org/10.1186/s12874-018-0611-x) and adjusting the
terminology accordingly.

Thank you for the comment and the suggested reading. This study sought to identify and synthesise
research studies that have used quantitative epidemiological tools used for assessing adolescent diet
and physical activity in low- and middle-income country settings. The overarching idea was to
provide a repository of validated epidemiological tools that have already been utilised in LMICs,
thereby providing researchers in similar contexts with a rigorously synthesised resource on tools that
are contextually relevant.

Given this rationale, we utilised the systematized literature review approach (Grant and Booth 2009;
https://onlinelibrary.wiley.com/doi/10.1111/j.1471-1842.2009.00848.x )The systematised review
approach was selected because it combined two elements to achieve our objective. Firstly, it adopts a
systematic search of research articles in academic databases (similar to the systematic review
method). Secondly, it follows the narrative approach of the traditional literature review method to
highlight the main findings and discuss the limitations and make recommendations for future research
practice.

2. In regard of systematic searches, I point out two weaknesses: I) the search period ended in
December 2019, more than a year and a half ago (it is suggested that literature reviews be submitted
no later than eight months after the searches ended) and II) the use of only three electronic databases,
excluding, for example, Medline and more specific Latin America/Caribbean databases, such as
Scielo and Lilacs, which cover potential journals (with many articles written in English, including)
not indexed in the larger databases.

Thank you for the comments and highlighting these weaknesses. In line with your comments, the
systematic search has now been updated up to January 2022. We have included details on the updated
search in the manuscript as follows:

“The systematized search was subsequently updated in January 2022. A total of 573 (Scopus – 106,
EbscoHost – 215, Web of Science – 252) studies were identified. Retrieved studies underwent title,
abstract and full text screening, of which 26 studies met the inclusion criteria. The reference lists of
included studies were thereafter examined to identify additional relevant studies. This process yielded
a further 39 articles.”

Following a consultation with a librarian at the University of Cambridge, we selected and utilised
three expansive academic databases – Scopus, Web of Science, and EbscoHost. The rationale for this
selection is as follows:

• Scopus - Scopus is a bigger database that houses all Medline content. As such we did not
apply the search in Medline as this would have been a duplication of the search.
• EbscoHost – The database hosts a number of databases. We specifically selected the
following: Academic Search Premier, Africa-Wide Information, CINAHL, ERIC,
PsycARTICLES, PsycINFO, PsycTESTS. Additionally, SciELO journals are indexed in
EbscoHost (https://blog.scielo.org/en/2016/04/13/scielo-in-the-major-discovery-
services/#.Ye_x9ljP23I).
• Web of Science – This database is expansive, and SciELO journals are also indexed.

While there are varying sentiments on the exact optimal number of databases that should be used
when searching for academic literature, there is some agreement (see references a-d below) that
systematic literature searches should be conducted using at least three academic databases, including
larger databases such as Web of Science
a. https://libguides.kcl.ac.uk/systematicreview/searchdb
b. https://guides.lib.uiowa.edu/systematicreviews/database
c. https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-017-0644-y
d. https://utas.libguides.com/SystematicReviews/Databases).

Accordingly, we believe that our literature review meets these criteria.

3. Even with a broader description of the results, I missed the presentation of short, informative tables,
allowing a more direct look at the review results. I should point out that a review is not just a
summary of the individual articles included: it should present the reader with a synthesis, with its own
results, built from the available evidence. This is also a point that left a lot to be desired, considering
all the work that went into the study of the instruments.

The purpose of the review was to synthesise existing evidence on instruments used to measure diet
and physical activity in low and middle-income settings. We did not aim to synthesise findings on
patterns of diet and physical activity behaviour. Therefore, while a synthesis of the findings on diet
and PA behaviour from identified manuscripts would undoubtedly be of interest, this is beyond the
scope of this paper.

We have clarified this including the following text in the study limitations section:
“As the aim of this review was to synthesise existing evidence on validated instruments used to
measure diet and physical activity in the context of adolescents in low and middle-income settings, a
synthesis of findings on patterns of diet and physical activity behaviour from papers identified was
beyond the scope of this paper and not included.”

Reviewer 2

1. The search for evidence was carried out between August and December 2019, that is over a year.
An updated search should be carried, to add to the body of existing evidence.

Thank you for the comments. We have updated the literature search to January 2022 and included the
following text:

“The systematized search was subsequently updated in January 2022. A total of 573 (Scopus – 106,
EbscoHost – 215, Web of Science – 252) studies were identified. Retrieved studies underwent title,
abstract and full text screening, of which 26 studies met the inclusion criteria.

2. Also, the references of texts included needs to be manually searched, in case there is any paper that
was not picked using the electronic data bases.

Thank you for highlighting this. We have examined the reference lists of included articles and
included the following information in the text for clarification:

“The reference lists of included studies were thereafter examined to identify additional relevant
studies. This process yielded a further 39 articles.”

3. Kindly add justification as to why the search of evidence was limited to only three databases.

Thank you for the comments. We have addressed the issues raised here under Reviewer 1 point
number 2.