Reviewer’s report
Title: 
Instrument to evaluate the knowledge of patient with cirrhosis on his
disease: construction and validity
Version: 
1 
Date: 
24 Jan 2021
Reviewer's report:
A comma needs to be added between these sentences."...Association of Organ
105 Transplantation (ABTO). In 2018…."
In the Introduction section, the author should also mention whether a score for
the assessment of quality of life of liver cirrhosis is present elsewhere. The
authors have just mentioned that such the score is not present in Brazil. It looks
as if the paper is restricted to Brazil alone. 
The authors should rephrase in such a
way that the final outcome of questionnaire development can be used by other
developing country (having economic background similar to that of Brazil). 
in the abstract, the authors have mentioned about both qualitative as well as
quantitative validation of the questionnaire. 
Whereas is in the figure 
1, only the
qualitative content validity is mentioned. The authors should please clear the
discrepancies. They should modify the figure 1 if required appropriately, to
denote the entire study structure. 
The authors have 
vaguely mentioned that they did review of literature for 2nd
stage. They should mention clearly the search terms, the inclusion and exclusion
criteria, the databases which were searched for and also the period for which the
results were included in the year format. They have just mentioned that the
previous 5 years were looked into. 
The side heading of "qualitative analysis" is mentioned two times and it is
creating confusion. 
Table 1, in the place of decimal point, commas are mentioned by the authors. 
In table 1, "first version treatment" and "second version treatment" heading are
mentioned two times. 
The information about mean CVI and universal CVI of the whole instrument can
be clubbed with table 
2 itself. Mentioning the information separately in table 2 is
not required. 
The authors should mention all the instances of conversion of hard language to
to simpler and more accessible language as suggested by the specialist. Only 
one
example is given in the results section. This will also help the readers to
understand the development process better. 
The authors have mentioned some information as chart 2. Generally information
is provided in manuscript in the form of figure or table. The author should
convert the chart 2 as a figure or as a table, so that it can be included in the
manuscript
This sentence needs to be restructured better to give the complete meaning. "The
creation of an instrument aims to assess the extent of the knowledge that the 266
patient has about the disease, aiming to improve adherence and prognosis."
The author should mention the indication for which Bezerra et al developed
instrument. 
Similar information should be also provided for other studies
mentioned in the discussion section. 
The last paragraph of the discussion section looks very vague, the authors should
reframe it. 
The authors should also add the limitation and strength section to the
manuscript. 
The authors can dedicate some space (in both results and discussion section) to
discuss about the final items which were included in the questionnaire
developed. They have only spoken about the process used for development and
have not mentioned even a single instance about the items which were included
in the final questionnaire. 
I am aware of the fact that they have included the
questionnaire in the supplementary section of the manuscript but still some
mention of the selected items should be present in the manuscript
The conclusion section of the manuscript is very lengthy and have contents
which are not required. Infact some contents are repeated again and again in the
manuscript as a whole. 
I would request to to cut short the conclusion in a crisp
manner. 
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons upon publication of the manuscript. If you have already registered at
Publons, they will notify you of the receipt of this review and update your profile
as per your settings and their policy. If you are not registered with Publons, you
will receive an email from them asking you to register in order for them to be
able to recognize your review on your new profile page. Publons may use the
Review Data to generate derivative metadata for the benefit of Publons and you
as a reviewer, carefully considering the sensitivity of such information. For
example, Publons may verify your record as a reviewer by updating your profile
published on its webservice if you have registered for such service or help
editors to identify candidate reviewers. Please find the details of processing in
Publons’ privacy policy 
https://publons.com/about/terms
Yes
Declaration of competing interests
Please complete a declaration of competing interests, considering the following
questions:
1
. 
Have you in the past five years received reimbursements, fees, funding, or
salary from an organisation that may in any way gain or lose financially
from the publication of this manuscript, either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that may in any way
gain or lose financially from the publication of this manuscript, either now
or in the future?
3
. 
Do you hold or are you currently applying for any patents relating to the
content of the manuscript?
4
. 
Have you received reimbursements, fees, funding, or salary from an
organization that holds or has applied for patents relating to the content of
the manuscript?
5
. 
Do you have any other financial competing interests?
6
. 
Do you have any non-financial competing interests in relation to this
paper?
If you can answer no to all of the above, write 'I declare that I have no competing
interests' below. If your reply is yes to any, please give details below.
I declare that I have no competing interests
Reviewer Publication Consent.
 I agree for my report to be made available
under an Open Access Creative Commons CC-BY License (
http://creativecommons.org/licenses/by/4.0
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the editorial
office before completing the review.
If you wish, you can include your name in your published report. Please note
you must decide whether to include your name at the start of the process and
confirm this decision whenever prompted. If you change your decision later, we
will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please publish my name with my
report.
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Reviewer’s report
Title: 
Instrument to evaluate the knowledge of patient with cirrhosis on his
disease: construction and validity
Version: 
1 
Date: 
24 Jan 2021
Reviewer's report:
A comma needs to be added between these sentences."...Association of Organ
105 Transplantation (ABTO). In 2018…."
In the Introduction section, the author should also mention whether a score for
the assessment of quality of life of liver cirrhosis is present elsewhere. The
authors have just mentioned that such the score is not present in Brazil. It looks
as if the paper is restricted to Brazil alone. 
The authors should rephrase in such a
way that the final outcome of questionnaire development can be used by other
developing country (having economic background similar to that of Brazil). 
in the abstract, the authors have mentioned about both qualitative as well as
quantitative validation of the questionnaire. 
Whereas is in the figure 
1, only the
qualitative content validity is mentioned. The authors should please clear the
discrepancies. They should modify the figure 1 if required appropriately, to
denote the entire study structure. 
The authors have 
vaguely mentioned that they did review of literature for 2nd
stage. They should mention clearly the search terms, the inclusion and exclusion
criteria, the databases which were searched for and also the period for which the
results were included in the year format. They have just mentioned that the
previous 5 years were looked into. 
The side heading of "qualitative analysis" is mentioned two times and it is
creating confusion. 
Table 1, in the place of decimal point, commas are mentioned by the authors. 
In table 1, "first version treatment" and "second version treatment" heading are
mentioned two times. 
The information about mean CVI and universal CVI of the whole instrument can
be clubbed with table 
2 itself. Mentioning the information separately in table 2 is
not required. 
The authors should mention all the instances of conversion of hard language to
to simpler and more accessible language as suggested by the specialist. Only 
one
example is given in the results section. This will also help the readers to
understand the development process better. 
The authors have mentioned some information as chart 2. Generally information
is provided in manuscript in the form of figure or table. The author should
convert the chart 2 as a figure or as a table, so that it can be included in the
manuscript
This sentence needs to be restructured better to give the complete meaning. "The
creation of an instrument aims to assess the extent of the knowledge that the 266
patient has about the disease, aiming to improve adherence and prognosis."
The author should mention the indication for which Bezerra et al developed
instrument. 
Similar information should be also provided for other studies
mentioned in the discussion section. 
The last paragraph of the discussion section looks very vague, the authors should
reframe it. 
The authors should also add the limitation and strength section to the
manuscript. 
The authors can dedicate some space (in both results and discussion section) to
discuss about the final items which were included in the questionnaire
developed. They have only spoken about the process used for development and
have not mentioned even a single instance about the items which were included
in the final questionnaire. 
I am aware of the fact that they have included the
questionnaire in the supplementary section of the manuscript but still some
mention of the selected items should be present in the manuscript
The conclusion section of the manuscript is very lengthy and have contents
which are not required. Infact some contents are repeated again and again in the
manuscript as a whole. 
I would request to to cut short the conclusion in a crisp
manner. 
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons upon publication of the manuscript. If you have already registered at
Publons, they will notify you of the receipt of this review and update your profile
as per your settings and their policy. If you are not registered with Publons, you
will receive an email from them asking you to register in order for them to be
able to recognize your review on your new profile page. Publons may use the
Review Data to generate derivative metadata for the benefit of Publons and you
as a reviewer, carefully considering the sensitivity of such information. For
example, Publons may verify your record as a reviewer by updating your profile
published on its webservice if you have registered for such service or help
editors to identify candidate reviewers. Please find the details of processing in
Publons’ privacy policy 
https://publons.com/about/terms
Yes
Declaration of competing interests
Please complete a declaration of competing interests, considering the following
questions:
1
. 
Have you in the past five years received reimbursements, fees, funding, or
salary from an organisation that may in any way gain or lose financially
from the publication of this manuscript, either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that may in any way
gain or lose financially from the publication of this manuscript, either now
or in the future?
3
. 
Do you hold or are you currently applying for any patents relating to the
content of the manuscript?
4
. 
Have you received reimbursements, fees, funding, or salary from an
organization that holds or has applied for patents relating to the content of
the manuscript?
5
. 
Do you have any other financial competing interests?
6
. 
Do you have any non-financial competing interests in relation to this
paper?
If you can answer no to all of the above, write 'I declare that I have no competing
interests' below. If your reply is yes to any, please give details below.
I declare that I have no competing interests
Reviewer Publication Consent.
 I agree for my report to be made available
under an Open Access Creative Commons CC-BY License (
http://creativecommons.org/licenses/by/4.0
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the editorial
office before completing the review.
If you wish, you can include your name in your published report. Please note
you must decide whether to include your name at the start of the process and
confirm this decision whenever prompted. If you change your decision later, we
will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please publish my name with my
report.
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Please review this paper.
user
Reviewer’s report
Title: 
Instrument to evaluate the knowledge of patient with cirrhosis on his
disease: construction and validity
Version: 
1 
Date: 
24 Jan 2021
Reviewer's report:
A comma needs to be added between these sentences."...Association of Organ
105 Transplantation (ABTO). In 2018…."
In the Introduction section, the author should also mention whether a score for
the assessment of quality of life of liver cirrhosis is present elsewhere. The
authors have just mentioned that such the score is not present in Brazil. It looks
as if the paper is restricted to Brazil alone. 
The authors should rephrase in such a
way that the final outcome of questionnaire development can be used by other
developing country (having economic background similar to that of Brazil). 
in the abstract, the authors have mentioned about both qualitative as well as
quantitative validation of the questionnaire. 
Whereas is in the figure 
1, only the
qualitative content validity is mentioned. The authors should please clear the
discrepancies. They should modify the figure 1 if required appropriately, to
denote the entire study structure. 
The authors have 
vaguely mentioned that they did review of literature for 2nd
stage. They should mention clearly the search terms, the inclusion and exclusion
criteria, the databases which were searched for and also the period for which the
results were included in the year format. They have just mentioned that the
previous 5 years were looked into. 
The side heading of "qualitative analysis" is mentioned two times and it is
creating confusion. 
Table 1, in the place of decimal point, commas are mentioned by the authors. 
In table 1, "first version treatment" and "second version treatment" heading are
mentioned two times. 
The information about mean CVI and universal CVI of the whole instrument can
be clubbed with table 
2 itself. Mentioning the information separately in table 2 is
not required. 
The authors should mention all the instances of conversion of hard language to
to simpler and more accessible language as suggested by the specialist. Only 
one
example is given in the results section. This will also help the readers to
understand the development process better. 
The authors have mentioned some information as chart 2. Generally information
is provided in manuscript in the form of figure or table. The author should
convert the chart 2 as a figure or as a table, so that it can be included in the
manuscript
This sentence needs to be restructured better to give the complete meaning. "The
creation of an instrument aims to assess the extent of the knowledge that the 266
patient has about the disease, aiming to improve adherence and prognosis."
The author should mention the indication for which Bezerra et al developed
instrument. 
Similar information should be also provided for other studies
mentioned in the discussion section. 
The last paragraph of the discussion section looks very vague, the authors should
reframe it. 
The authors should also add the limitation and strength section to the
manuscript. 
The authors can dedicate some space (in both results and discussion section) to
discuss about the final items which were included in the questionnaire
developed. They have only spoken about the process used for development and
have not mentioned even a single instance about the items which were included
in the final questionnaire. 
I am aware of the fact that they have included the
questionnaire in the supplementary section of the manuscript but still some
mention of the selected items should be present in the manuscript
The conclusion section of the manuscript is very lengthy and have contents
which are not required. Infact some contents are repeated again and again in the
manuscript as a whole. 
I would request to to cut short the conclusion in a crisp
manner. 
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons upon publication of the manuscript. If you have already registered at
Publons, they will notify you of the receipt of this review and update your profile
as per your settings and their policy. If you are not registered with Publons, you
will receive an email from them asking you to register in order for them to be
able to recognize your review on your new profile page. Publons may use the
Review Data to generate derivative metadata for the benefit of Publons and you
as a reviewer, carefully considering the sensitivity of such information. For
example, Publons may verify your record as a reviewer by updating your profile
published on its webservice if you have registered for such service or help
editors to identify candidate reviewers. Please find the details of processing in
Publons’ privacy policy 
https://publons.com/about/terms
Yes
Declaration of competing interests
Please complete a declaration of competing interests, considering the following
questions:
1
. 
Have you in the past five years received reimbursements, fees, funding, or
salary from an organisation that may in any way gain or lose financially
from the publication of this manuscript, either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that may in any way
gain or lose financially from the publication of this manuscript, either now
or in the future?
3
. 
Do you hold or are you currently applying for any patents relating to the
content of the manuscript?
4
. 
Have you received reimbursements, fees, funding, or salary from an
organization that holds or has applied for patents relating to the content of
the manuscript?
5
. 
Do you have any other financial competing interests?
6
. 
Do you have any non-financial competing interests in relation to this
paper?
If you can answer no to all of the above, write 'I declare that I have no competing
interests' below. If your reply is yes to any, please give details below.
I declare that I have no competing interests
Reviewer Publication Consent.
 I agree for my report to be made available
under an Open Access Creative Commons CC-BY License (
http://creativecommons.org/licenses/by/4.0
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the editorial
office before completing the review.
If you wish, you can include your name in your published report. Please note
you must decide whether to include your name at the start of the process and
confirm this decision whenever prompted. If you change your decision later, we
will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please publish my name with my
report.
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
assistant