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: 26 Dec 2024
Reviewer:  Peeyush Kumar
Reviewer's report:
This study is a commendable effort by the authors to investigate the impact of disease activity
on inflammatory bowel disease control using Structural Equation Modeling. It focuses on
evaluating and managing interventions that target disease activity, self-efficacy, and self-
management behaviors.
However, if the authors could address a few queries, it would enhance the quality of the paper.
• The sample is geographically limited to Chongqing, potentially restricting the applicability
of findings to other populations, authors can state this limitation and propose studies in varied
settings to enhance generalizability.
• If possible add more diagrams to illustrate complex relationships and key results, particularly
for the structural equation model.
• The paper identifies self-efficacy as an important factor but doesn’t suggest how to improve it
in practice. It would be better to add measures such as patient education programs or counseling.
• The study relies heavily on self-reported data, which can be biased. Suggest acknowledging
this limitation more clearly and proposing ways to reduce bias in future studies.
• The study captures self-efficacy, self-management behaviours, and disease control at a single
point in time. For instance, self-efficacy is measured through a snapshot questionnaire, but no
follow-up data shows whether it improves or declines over time. A longitudinal design could
track changes in self-efficacy and disease control after an intervention, such as a structured self-
management program. Authors can add this in limitations.
• Self-management behaviors are aggregated into broad categories like “medication
management” and “dietary management.” However, detailed behaviors within these categories,
such as specific adherence patterns (timing, dosage) or diet types (low FODMAP, anti-
inflammatory diets), are not examined.  It would be better to Collect data on specific self-
management practices to identify which ones most influence disease control, such as daily
tracking of food triggers or adherence to exercise routines. This is also a short coming in study
which can be specified in limitations and if possible addressed upon.
• The study combines Crohn’s disease (CD) and ulcerative colitis (UC) into one IBD category but
does not analyze how self-efficacy or disease activity might differ between the two. For instance,
patients with CD might face more fistulas, which could impact self-management behaviors
differently than UC. Conduct subgroup analyses to see if the pathways from disease activity to
disease control vary between CD and UC.
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: 26 Dec 2024
Reviewer:  Peeyush Kumar
Reviewer's report:
This study is a commendable effort by the authors to investigate the impact of disease activity
on inflammatory bowel disease control using Structural Equation Modeling. It focuses on
evaluating and managing interventions that target disease activity, self-efficacy, and self-
management behaviors.
However, if the authors could address a few queries, it would enhance the quality of the paper.
• The sample is geographically limited to Chongqing, potentially restricting the applicability
of findings to other populations, authors can state this limitation and propose studies in varied
settings to enhance generalizability.
• If possible add more diagrams to illustrate complex relationships and key results, particularly
for the structural equation model.
• The paper identifies self-efficacy as an important factor but doesn’t suggest how to improve it
in practice. It would be better to add measures such as patient education programs or counseling.
• The study relies heavily on self-reported data, which can be biased. Suggest acknowledging
this limitation more clearly and proposing ways to reduce bias in future studies.
• The study captures self-efficacy, self-management behaviours, and disease control at a single
point in time. For instance, self-efficacy is measured through a snapshot questionnaire, but no
follow-up data shows whether it improves or declines over time. A longitudinal design could
track changes in self-efficacy and disease control after an intervention, such as a structured self-
management program. Authors can add this in limitations.
• Self-management behaviors are aggregated into broad categories like “medication
management” and “dietary management.” However, detailed behaviors within these categories,
such as specific adherence patterns (timing, dosage) or diet types (low FODMAP, anti-
inflammatory diets), are not examined.  It would be better to Collect data on specific self-
management practices to identify which ones most influence disease control, such as daily
tracking of food triggers or adherence to exercise routines. This is also a short coming in study
which can be specified in limitations and if possible addressed upon.
• The study combines Crohn’s disease (CD) and ulcerative colitis (UC) into one IBD category but
does not analyze how self-efficacy or disease activity might differ between the two. For instance,
patients with CD might face more fistulas, which could impact self-management behaviors
differently than UC. Conduct subgroup analyses to see if the pathways from disease activity to
disease control vary between CD and UC.
Please review this paper.
user
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: 26 Dec 2024
Reviewer:  Peeyush Kumar
Reviewer's report:
This study is a commendable effort by the authors to investigate the impact of disease activity
on inflammatory bowel disease control using Structural Equation Modeling. It focuses on
evaluating and managing interventions that target disease activity, self-efficacy, and self-
management behaviors.
However, if the authors could address a few queries, it would enhance the quality of the paper.
• The sample is geographically limited to Chongqing, potentially restricting the applicability
of findings to other populations, authors can state this limitation and propose studies in varied
settings to enhance generalizability.
• If possible add more diagrams to illustrate complex relationships and key results, particularly
for the structural equation model.
• The paper identifies self-efficacy as an important factor but doesn’t suggest how to improve it
in practice. It would be better to add measures such as patient education programs or counseling.
• The study relies heavily on self-reported data, which can be biased. Suggest acknowledging
this limitation more clearly and proposing ways to reduce bias in future studies.
• The study captures self-efficacy, self-management behaviours, and disease control at a single
point in time. For instance, self-efficacy is measured through a snapshot questionnaire, but no
follow-up data shows whether it improves or declines over time. A longitudinal design could
track changes in self-efficacy and disease control after an intervention, such as a structured self-
management program. Authors can add this in limitations.
• Self-management behaviors are aggregated into broad categories like “medication
management” and “dietary management.” However, detailed behaviors within these categories,
such as specific adherence patterns (timing, dosage) or diet types (low FODMAP, anti-
inflammatory diets), are not examined.  It would be better to Collect data on specific self-
management practices to identify which ones most influence disease control, such as daily
tracking of food triggers or adherence to exercise routines. This is also a short coming in study
which can be specified in limitations and if possible addressed upon.
• The study combines Crohn’s disease (CD) and ulcerative colitis (UC) into one IBD category but
does not analyze how self-efficacy or disease activity might differ between the two. For instance,
patients with CD might face more fistulas, which could impact self-management behaviors
differently than UC. Conduct subgroup analyses to see if the pathways from disease activity to
disease control vary between CD and UC.
assistant