Author's response to reviews
Title: Factors influencing mode of transport in older adolescents: a qualitative
study
Authors:
Dorien Simons ([email protected])
Peter Clarys ([email protected])
Ilse De Bourdeaudhuij ([email protected])
Bas de Geus ([email protected])
Corneel Vandelanotte ([email protected])
Benedicte Deforche ([email protected])
Version: 2 Date: 1 March 2013
Author's response to reviews: see over
Brussels, 01/03/2013
Dear editor and referees
The authors wish to thank the editorial team and referees for their positive feedback and
possibility to revise the manuscript. We have revised our manuscript according to the
comments. A point-by-point description of the changes is provided below. Elements that have
been added to the article or that have been changed are marked in yellow.
On behalf of all the authors,
Kind regards
Dorien Simons
Editor’s comments
1. For
reporting
qualitative
studies
please
adhere
to
RATS
guidelines.
(http://www.biomedcentral.com/info/ifora/rats )
The authors have read the RATS guidelines and believe that, with the revisions
displayed below, all guidelines have been followed. The elements that have been
added to the article or that have been changed are presented in yellow in the following
table:
RATS
New or changed elements
Study design described and
Focus groups provide the possibility to learn and get a
justified i.e., why was a
broad range of information about topics that are
particular method (e.g.,
poorly understood (travel choices), especially in
interviews) chosen?
particular segments of the population, such as older
1
adolescents
[30].
Interactive
group
discussions
stimulate a process of sharing and comparing, and
different points of view are revealed [31].
study group and setting clearly
Focus group participants were recruited in March
described
2012 from a secondary school in Antwerp (Belgium),
and consisted of 32 volunteers from the two final
years (mean age of 17 ± 1.2 years) in general,
technical, occupational and artistic studies. These are
the four main study disciplines available for
secondary school students in Belgium, in which
general studies prepare for higher education, technical
studies have a more technical and practical approach,
occupational studies are very job specific and artistic
studies combine general education and art practice.
End of data collection justified
Focus groups were held until saturation (a point at
and described
which all questions have been thoroughly explored in
detail and no new concepts or themes emerge in
subsequent interviews) was reached, since a sample
size cannot be pre-determined given the need for a
thorough exploration of an as yet unknown behavior
(transportation mode choice for short distance travel).
Ethics approval cited
The study protocol was approved by the ethics
committee of the university hospital of the Vrije
Universiteit Brussel.
Analytic approach described in
Transcripts of the focus group conversations were
depth and justified
entered into NVivo 9 qualitative software (QRS
International) to analyze the data, based on grounded
theory. Grounded theory is a method of analyzing
qualitative data which is grounded in the data without
preconceived theories and is characterized by
intensively analyzing data, often sentence by
sentence, or phrase by phrase. Codes were developed
by DS throughout the focus groups and during the
2
transcription of the audio recordings according to the
responses and the themes which arose frequently and
were relevant to the aim of the study. DS assigned
segments of the transcripts to the codes (segments
could be assigned to multiple codes). Codes were then
grouped into broader categories. The codes to be used
and the assignment of segments to codes were
validated by two other researchers (JVC, TD). Doubts
or disagreements were discussed until consensus was
reached.
Strengths and limitations
There are several limitations in the present study.
explicitly described and
First, 75% of the participants lived in or at the edge of
discussed
the city. So caution is needed when attempting to
extrapolate the results to rural areas. Second, active
transport was rather high in this group of participants,
making it harder to gather why some older
adolescents do not use active transport for short
distance travelling. Third, results might be different in
other countries since Belgium, and specifically
Flanders, has good geographical and climatological
conditions for cycling and a real ‘cycling mentality’.
Fourth, although the interactive aspect of the focus
groups is a benefit, it might also cause a social
desirability bias.
2. Please update your ethics statement to include the specific name of the ethics
committee that approved your study.
Line 129-130: The specific name of the ethics committee has been included.
The study protocol was approved by the ethics committee of the university hospital of
the Vrije Universiteit Brussel.
3
Reviewer #1:
This a well conducted study following a methodological strategy that fits its purposes.
My only comment is related towards the specific context (Belgian-Antwerp) where the
study was carried-out once the choice of cycling as an active transport is due to
geographic environmental conditions (flat) and this should be acknowledge on either
discussion or conclusion.
Line 340-344: The geographic environmental conditions of the specific context
(Belgium-Antwerp) were already partly acknowledged in the discussion.
The popularity of cycling could be explained by the fact that this study was conducted
in Flanders, Belgium. Because of geographical and climatological advantages (flat
landscape, many urban areas, short distances, not too warm…), Flanders has a real
‘cycling mentality’ with 34.7% of the households owning 3 or more bicycles and
26.2% of the population cycling at least once a week for transportation [42].
Based on the reviewers’ comment, the geographic environmental conditions of the
specific context (Belgium-Antwerp) have been added as a limitation.
Line 421-423: Third, results might be different in other countries since Belgium, and
specifically Flanders, has good geographical and climatological conditions for
cycling and a real ‘cycling mentality’.
4
Reviewer #2
Major Compulsory Revisions (which the author must respond to before a decision on
publication can be reached)
Data Analysis
1. Line 155 – the authors’ state that “Grounded theory is characterized by intensively
analyzing data, often sentence by sentence, or phrase by phrase” this is not a sufficient
description. Grounded theory is a method of analyzing qualitative data which is
grounded in the data without preconceived theories. Please expand to make it clear
exactly how the data were analyzed according to grounded theory.
Line 162-172: We expanded the description of grounded theory and the analysis.
Transcripts of the focus group conversations were entered into NVivo 9 qualitative
software (QRS International) to analyze the data, based on grounded theory.
Grounded theory is a method of analyzing qualitative data that is grounded in the
data without preconceived theories and is characterized by intensively analyzing
data, often sentence by sentence, or phrase by phrase. Codes were developed by DS
throughout the focus groups and during the transcription of the audio recordings
according to the responses and the themes which arose frequently and were relevant
to the aim of the study. DS assigned segments of the transcripts to the codes (segments
could be assigned to multiple codes). Codes were then grouped into broader
categories. The codes to be used and the assignment of segments to codes were
validated by two other researchers (JVC, TD). Doubts or disagreements were
discussed until consensus was reached.
5
2. Line 156 – the authors’ state that “Through constant comparisons, the analysis
derived categories and subcategories from the data.” The method of constant
comparison is a process of inductively classifying emergent themes by comparing data
coded as a theme to previous data coded at that same theme. Can the authors please
expand on what they mean by constant comparison and 'content analysis' which
appears on Line 170?
Line 162-172: As previously suggested, we expanded the explanation of the data analysis.
Therefore, the sentence “through constant comparisons, the analysis derived categories
and subcategories from the data” has been replaced (the new paragraph is displayed at the
previous question).
Line 185: With ‘content analysis’ we mean the analysis of the qualitative data, retrieved
from the focus groups. This is a commonly used term in qualitative data analysis.
•Minor Essential Revisions (such as missing labels on figures, or the wrong use of a
term, which the author can be trusted to correct)
Background
3.Adolescence
Firstly the authors should define the term adolescence. Secondly, the authors state that
a ‘steep decline in activity levels occurs in adolescence’, can the authors give more detail
as to when this decline begins? At the moment the case for focusing on older adolescents
is not as strong as it could be. Why is it that the focus should be on the end of the
adolescent period rather than at the beginning where the decline has just begun or even
in late childhood to prevent the decline in the first place? This could be strengthened by
6
emphasising the increased independence adolescents have at this age (e.g. move and
expand paragraph 2, line 83 to paragraph 1).
Adolescence, older adolescents and young adolescents have been defined more
clearly by adding age range.
Line 70-72: Since a steep decline in activity levels and in active transport occurs in
adolescence (12-18 years) [1, 9, 10], it could be important to focus on active
transport to increase the daily physical activity in older adolescents (17-18 years)
[11].
Line 83-84: To date, most research investigating correlates of active transport in
adolescents has only focused on young adolescents (12-16 years).
The decline in activity levels and in active transport occurs during adolescence,
starting from the age of 12. The focus is on the end of the adolescent period because
we want to use active transport to increase overall activity levels. Only older
adolescents have multiple transportation options such as a moped or a car.
Furthermore, physical activity tracks stronger from late adolescence to adulthood than
from early adolescence to adulthood. Lastly, there is indeed an increased
independence in older adolescents. We have moved parts of paragraph 2 to paragraph
1 to emphasize these reasons more.
Line 70-78 (paragraph 1): Since a steep decline in activity levels and in active
transport occurs in adolescence (12-18 years) [1, 9, 10], it could be important to
focus on active transport to increase the daily physical activity in older adolescents
(17-18 years) [11]. Especially since Belgian adolescents are allowed to drive a
moped from the age of 16 and a car from the age of 18. Older adolescents also
7
become more independent, they perceive less parental control and more peer pressure
[12] and they are allowed to purchase and consume alcohol from the age of 16.
Furthermore, as physical activity tracks stronger from late adolescence to adulthood
than from early adolescence to adulthood [13, 14], increasing walking or cycling for
transport in older adolescents may be particularly important because this transport
choice may persist into adulthood.
4.Literature
Can the authors’ review any qualitative studies in the background. The Lorenc et al.
[43] systematic review referenced in the discussion could be referred to in the
Background for example.
We agree and have now referred to this systematic review of Lorenc et al. in the
background section as well.
Line 91-95: But even within the distance of eight kilometers, approximately 40% of
adolescents use passive transport to go to school, as shown in a Belgian and a UK
study. [21, 24]. A review of qualitative studies on the views of children, young people
and parents about walking and cycling [25] also described a culture of car use. They
found that young people perceive active transport as less safe, pleasant and
convenient than car travel.
[25] Lorenc T, Brunton G, Oliver S, Oliver K, Oakley A: Attitudes to walking and cycling
among children, young people and parents: a systematic review. J Epidemiol Community
Health 2008, 62(10):852-857.
8
5.Context
Were the focus group participants legally allowed to purchase and consume alcohol?
Can this information be included in the Background as a potential social influence on
travel behaviours? Was this factor found to be influential in travel choices in the focus
groups?
Yes, the older adolescents were legally allowed to purchase and consume alcohol, in
Belgium this is allowed from the age of 16. Nevertheless, this factor was not
mentioned during the focus groups to be influential in the adolescents’ travel choices.
Line 73-75: we included the information about the purchase and consumption of
alcohol in the Background section.
Older adolescents also become more independent, they perceive less parental control
and more peer pressure [12] and they are allowed to purchase and consume alcohol
from the age of 16.
6.Methods
Line 108 – Can the authors please clarify what it is about focus groups that mean
information about topics that are poorly understood can be produced and provide
references to support this statement? I.e. how is this different from other qualitative
methods or even quantitative studies? Can the researchers provide an explanation for
why focus groups are appropriate with this sample? Did the authors consider the
composition of the focus groups, e.g. friendship groups, single sex? The latter
considerations will conceivably impact on the data collected.
Line 112-115: The segment about focus groups has been clarified and a reference has
been added to support the explanation.
9
Focus groups provide the possibility to learn and get a broad range of information
about topics that are poorly understood (travel choices), especially in particular
segments of the population, such as older adolescents [30]. Interactive group
discussions stimulate a process of sharing and comparing, and different points of
view are revealed [31].
[30] Clifton KJ, Handy SL: Qualitative methods in travel behaviour research. Transport
Survey Quality and Innovation 2003:283-302.
[31] Morgan DL: The Focus Group Guidebook: Focus Group Kit 1, vol. 1. California: Sage
Publications; 1998.
Other qualitative methods lack the interactive aspect of focus groups and it would not
be possible to obtain such in depth and rich information using quantitative methods
[31]. Furthermore, we did consider the composition of the focus groups, as we divided
the students by study discipline. We chose this approach in order to find differences in
influencing factors according to SES. However, we did not find any differences
according to SES.
Line 143: In total, five focus groups were held (divided by study discipline), with a
range of five to eight participants per group.
7. Line 100 – can the authors provide a reference for habit being a strong correlate of
transport mode choice.
Line 104: We provided a reference for habit being a strong correlate of transport
mode choice.
Since habit is a strong correlate of transport mode choice [26], it is important to
promote active transport before the use of motorized transport modes for travelling
short distances becomes a habit.
10
[26] Gardner B: Modelling motivation and habit in stable travel mode contexts.
Transport Res F-Traf 2009, 12(1):68-76.
8.Line 117- Why did the researchers recruit that school in particular? Is it similar in
terms of pupil demographics to other schools in the area?
The researchers recruited that school in particular because it is located in the city of
Antwerp and Antwerp has a single condensed urbanized built-up area with plenty of
destinations for short distance transportation. Furthermore, it is a large secondary
school with general, technical, occupational and artistic studies and it is indeed similar
in terms of pupil demographics to other schools in Antwerp.
9.Line 118- Can the authors expand on the meaning of “general, technical, occupational
and artistic studies” for an audience unfamiliar with the Belgian school system?
Line 120-125:
Focus group participants were recruited in March 2012 from a secondary school in
Antwerp (Belgium), and consisted of 32 volunteers from the two final years (mean age
of 17 ± 1.2 years) in general, technical, occupational and artistic studies. These are
the four main study disciplines available for secondary school students in Belgium, in
which general studies prepare for higher education, technical studies have a more
technical and practical approach, occupational studies are very job specific and
artistic studies combine general education and art practice.
10.Line 132- Can the researchers provide a clearer definition of what saturation means
and outline how this was reached?
Line 139-143: We provided a clearer definition of “saturation”.
11
Focus groups were held until saturation (a point at which all questions have been
thoroughly explored in detail and no new concepts or themes emerge in subsequent
interviews) was reached, since a sample size cannot be pre-determined given the need
for a thorough exploration of an as yet unknown behavior (transportation mode
choice for short distance travel).
The method of saturation is commonly used in qualitative research. It is not
predetermined how many focus groups are needed, because of a diminishing return
for each additional group. When no new elements emerge, saturation is reached and
no new focus groups have to be conducted.
11.Line 157- Can the authors outline what each of the three researchers did in the
analysis?
Line 166-172: We outlined what each of the three researchers did. The following
paragraph has been added:
Codes were developed by DS throughout the focus groups and during the
transcription of the audio recordings according to the responses and the themes
which arose frequently and were relevant to the aim of the study. DS assigned
segments of the transcripts to the codes (segments could be assigned to multiple
codes). Codes were then grouped into broader categories. The codes to be used and
the assignment of segments to codes were validated by two other researchers (JVC,
TD). Doubts or disagreements were discussed until consensus was reached.
12.Line 153- Could the authors state the language in which the interviews were
conducted?
Line 144: We added the language in which the focus groups were conducted.
12
All focus groups were conducted in Dutch and lasted approximately 50 minutes.
13.Line 159- For the reasons stated earlier I think this article would benefit from the
authors reconsidering the quantification of people who talk about certain factors.
Based on the qualitative research review guidelines (RATS), semi-quantification of
the data should be used when it is appropriate. We believe that it is appropriate to use
percentages as a type of semi-quantification in this article.
14.Line 117- Can the authors add in the month and years that the data were collected?
Line 120: We added the month and year of the data collection.
Focus group participants were recruited in March 2012 from a secondary school in
Antwerp (Belgium), and consisted of 32 volunteers from the two final years (mean age
of 17 ± 1.2 years) in general, technical, occupational and artistic studies.
Results
15. The quantitative questionnaire data could be incorporated more effectively into the
results. For instance, are there any patterns in the qualitative data relating to these
different questionnaire responses?
We cannot investigate this because we did not conduct separate focus groups in
different target groups such as cyclists versus non-cyclists. As this was an exploratory
qualitative study, the questionnaire was only used to retrieve basic information on
demographics and transport habits to get a general view on the subjects who
participated in the focus groups. It was not our intention to use these quantitative data
for anything more than descriptive statistics. Moreover, as indicated by Krueger
13
(1989), this information can only be used to help understand comments and opinions
shared within the focus groups.
Krueger R.A.: Analyzing and Reporting Focus Group Results: Focus Group Kit 6, vol. 1.
California: Sage Publications; 1998.
16.Line 249 – replace ‘nearby’ with ‘near to’
Line 264: “nearby” has been replaced with “near to”.
17.Line 251 – replace ‘every’ with ‘any’
Line 266: “every” has been replaced with “any”.
18.Line 261 – make the ‘b’ in bicycles italic
Line 275: the ‘b’ in bicycles has been made italic.
19.Line 266 – this is confusing – how did the authors determine that the weather was
‘rather’ important from the fact that a lot of people discussed this factor? This is an
example of where quantifying qualitative work can be confusing.
Line 280: The authors agree that the word ‘rather’ might be confusing. Therefore, this
word has been removed. Furthermore, it was said by the adolescents that the weather
was an important factor, it was not determined by the authors.
The weather is an important factor in choosing a transportation mode, according to a
lot of adolescents.
20.Line 297 – replace ‘feeling of unsafety’ to ‘feeling of being unsafe’
Line 310: “feelings of unsafety” has been replaced with “feelings of being unsafe”.
21.Line 313 – this line appears incomplete.
14
In order to reduce the length of the results and the discussion of this manuscript, we
deleted the paragraph that contained this line.
Discussion
22.Can the authors address the following instances where the results and discussion are
not coherent:
-The authors report that safety did not influence the choice of transport mode in older
adolescents in the discussion. However in the results the participants are referred to as
talking about bikes being stolen in a way which appears to suggest it is an important
factor.
Line 358-360: This issue might be explained by the fact that, in Belgium, people do
not necessarily feel unsafe when a bicycle gets stolen. It is more a ‘security’ issue
than a ‘safety’ issue. Nevertheless, we did make a more careful statement about
overall safety in the discussion.
Safety, which is regularly stated to be a barrier of active transport in previous
research in children and young adults, was less important for older adolescents’
choice of transport in the present study.
Line 367-370: However, bicycle theft was already mentioned in the discussion.
On the other hand, concerns about bicycle theft were a barrier for cycling in this
study. As suggested by the adolescents themselves, more bicycle storage and safe
bicycle parking would be required in promoting active transport.
15
The authors suggest that peer pressure to look good may result in adolescents not
cycling to avoid sweating however in the results this was highlighted as a less important
influence –“few adolescents mentioned they do not like to arrive sweaty and red-faced”.
The authors confirm that only few adolescents in the study mentioned they do not like
to arrive sweaty and red-faced. Because this was indeed not a very important factor
influencing transport mode choice in the adolescents and because it was suggested to
reduce the length of the discussion, the authors deleted this segment of the discussion.
Line 339: This part has been deleted.
However, in this study it became clear that social influence can also be negatively
associated with cycling. Because of peer pressure to always look good, adolescents
might avoid cycling, as they do not want to arrive at a destination sweaty and redfaced.
The cost of driving a motorcycle is presented in the discussion (line 412) but is not
included in the results (at least not under the heading ‘financial aspect’).
Line 406-408: The authors agree with the comment, as the financial aspect was only
mentioned by the adolescents in relation to moped use and not to motorcycle use. This
aspect has therefore been removed from the discussion.
Driving a motorcycle did not seem to be something adolescents of the present study
want to do in the near future. The costs and the possible safety issues are a barrier to
this transportation mode.
23.Line 316 – rethink the use of the term ‘correlate’ as this is more commonly used in
quantitative studies.
16
Line 319: The term ‘correlates’ has been replaced with ‘influencing factors’.
24. Line 352- be careful here and elsewhere not to over generalise the findings.
“Rain, snow or ice make most older adolescents switch to motorized and public
transportation” – the participants may suggest this but with qualitative research we
cannot make such a strong statement about the actual behaviour of these and other
adolescents.
Line 351: We agree with the observation, but because another reviewer suggested to
reduce the length of the results and discussion, we deleted this sentence.
Most older adolescents in this study mentioned switching to motorized and public
transportation in case of rain, snow or ice.
25. Line 410 – can the authors expand on the term ‘emotionally charged preference’ or
perhaps consider replacing this with something clearer – such as ‘strong preference’?
Line 405: “emotionally charged preference” has been replaced with “strong
preference”.
26. Line 429 – replace ‘than’ with ‘then’
Line 290: “than” has been replaced with “then”.
27. Line 445-446 – the phrase “to go whenever they want to wherever they want” is
usually written the other way round “to go wherever they want whenever they want”
this is quite informal language so perhaps there is a better way to phrase this?
Line 432: We rephrased the sentence as follows:
17
It is a fast transportation mode, it offers a lot of freedom to go to many places at all
times and they can easily cycle together with friends.
28.Line 166 and Table 2– could the authors add information about car driving amongst
the sample. This is mentioned later in the results section but as a quantitative finding it
would be useful to state this earlier.
Line 183:We added information about car driving amongst the sample.
No adolescents in this study had a car driver license.
29.Limitations
Please also include limitations of qualitative research in general and focus groups in
particular (e.g. subject to researchers interpretation of what the sample were willing to
say at one point in time, social desirability bias etc) and the limitation of conducting this
research in Flanders where there is a ‘cycling mentality’.
Line 418-426: We included some more limitations.
There are several limitations in the present study. First, 75% of the participants lived
in or at the edge of the city. So caution is needed when attempting to extrapolate the
results to rural areas. Second, active transport was rather high in this group of
participants, making it harder to gather why some older adolescents do not use active
transport for short distance travelling. Third, results might be different in other
countries since Belgium, and specifically Flanders, has good geographical and
climatological conditions for cycling and a real ‘cycling mentality’. Fourth, although
the interactive aspect of the focus groups is a benefit, it might also cause a social
desirability bias.
18
•Discretionary Revisions (which are recommendations for improvement but which the
author can choose to ignore)
30. Line 175 - Can the author consider a clearer term than ‘ecology’ (e.g.
environmentally friendly)?
Line 190: We appreciate the suggestion, we looked for an alternative term, but did not
find any better option. Therefore we decided to keep the term “ecology”.
31. Line 186 – does the author mean ‘feels dependent on it’ rather than feels dependent
of it’?
Line 194: “feels dependent of it” has been replaced with “feels dependent on it”.
32. Line 200 – can the authors consider a clearer term than ‘subscription’ (e.g. bus
pass?)
Line 217: We understand the suggestion, but as we want to address all types of public
transport subscriptions, and not only a bus subscription, we did not replace the term.
33. Line 233 - can the authors consider a clearer term than ‘random’ and remove the
word ‘for’
Line 249: We removed the word ‘random’ and ‘for’.
A lot of participants stated that, to go to short distance destinations, they usually
choose the fastest transportation mode.
Reviewer #3
19
This manuscript addresses an important public health issue, i.e. the factors associated
with the choice of transportation mode among Belgian old adolescents. The stronger
value of the study is the use of qualitative data. However, the manuscript would need a
deep and meticulous work to be clearly understood. There are several major issues and
minor issues that should be addressed by the authors to improve the manuscript. See
the comments below.
Major Compulsory Revisions:
1. It is strongly recommended to reduce the results and discussion. There are too many
information, the same information is repeated sometimes and it is difficult to follow the
article. I would suggest discuss only the most relevant factors that have influenced the
mode of transportation. Results and discussion are in some cases very similar.
The following parts have been deleted to avoid repetition and to reduce the results and
discussion.
Line 227-228: Few participants did mention that they like the relaxing effect of
walking and cycling.
Line 273-274: Cycling to school is not a problem, according to some adolescents,
because there they have a good and safe bicycle parking.
Line 293-294: Although few others thought that the city was doing a good job in the
reconstruction of some roads and the construction of cycling paths, it can still be
better.
Line 317-325:
Promotion
20
The participants were also asked how they would promote active transport in their
own age group. Some adolescents mentioned more access to facilities such as bicycle
storage and shared bicycles, and more and better cycling paths. Some discussed
rewards and compensations such as free bicycle lights or a bicycle allowance. Few of
them suggested encouraging cycling in a group and also few of them thought there is
no need to promote active transport in their age group, because most of them already
use active transport. Almost all of them said the best way to reach their peers is
through social networks such a Facebook. Television, school and billboards were
also mentioned as possible media to reach older adolescents.
Line 330: Cyclists can use shortcuts and one-way streets in two directions, they have
no traffic jams and they can cycle as fast as they want.
Line 339: However, in this study it became clear that social influence can also be
negatively associated with cycling. Because of peer pressure to always look good,
adolescents might avoid cycling, as they do not want to arrive at a destination sweaty
and red-faced.
Line 351-352: Most older adolescents in this study mentioned switching to motorized
and public transportation in case of rain, snow or ice.
Line 373: Such as autonomy (walkers are not dependent on something or someone)
and the social aspect.
Line 381-384: From the age of 18, adolescents can get a driver license and since cars
offer more possibilities and benefits than mopeds, adolescents find it worth waiting
and saving money for
21
Line 387-388: Having a transit stop close to home or having a subscription were
facilitators of public transport.
Line 400: It is possible for them to get their driver’s license at school.
Line 417-427: It is difficult to point out the most important factor for older
adolescents in choosing between transport modes. It seems to be the result of a
combination of factors. For instance, when older adolescents have a bicycle that is
not broken or stolen, the weather is good and they have friends to accompany them,
they will most likely choose to cycle to the destination. When the weather is bad,
adolescents tend to choose passive transportation, although the social influence of
friends can persuade them to still cycle to the destination. When it is snowy or icy,
there is an even bigger chance that passive transportation will be used because then
there is a safety issue involved. Adolescents who choose not to cycle, tend to use
public transportation when the public transportation stop is nearby their home or
when they have a subscription. Otherwise they might ask somebody to give them a
ride. If they do not have a subscription, the use of public transportation depends on
their financial situation.
Some less relevant elements, such as the peer pressure to always look good, the
advantages of walking and the facilitators of public transport, have been removed
from the discussion.
2. There must be consistency in the terms used and chose only 1 term per each concept.
For example, authors use active transport, active transportation or active commuting
for referring the same issue. Or bicycle and cycle. Or transportation mode and
transport mode and mode of transportation…etc.
22
Line 86: the term “active commuting” has only been used ones and refers to the travel
from home to school. Therefore, we did not replace this term.
“Active transportation” has been replaced with “active transport” throughout the
manuscript.
“Transportation mode”, “mode of transport” and “mode of transportation” have been
replaced with “transport mode” throughout the manuscript.
“public transportation” has been replaced with “public transport” throughout the
manuscript.
“cycle” has been used throughout the document as verb (to cycle), whereas “bicycle”
has been used throughout the document as noun (a bicycle). “Bike” has been replaced
with “bicycle” throughout the document.
3. It is suggest a deep review of the grammar by an English native expert of the overall
article. There are many colloquial expressions and incorrect constructed sentences.
Following the suggestion, an English native expert reviewed the overall article.
4. The introduction is confusing.
- The 1st paragraph references studies about transportation to school (1-4 and 6-8),
however, they are included as references for overall active transportation, which is not
true. Authors must specify always in the article when the active commuting is on the
way to school or when the active commuting is on the way to other destinations
(example in page 5, line 86).
Line 66-69: A reference on overall active transport ([1] Chillon P, Gottrand F, Ortega FB,
Gonzalez-Gross M, Ruiz JR, Ward DS, De Bourdeaudhuij I, Moreno LA, Martinez-Gomez D,
23
Castillo MJ et al: Active Commuting and Physical Activity in Adolescents From Europe:
Results From the HELENA Study. Pediatr Exerc Sci 2011, 23(2):207-217) has been added so
that both studies on transportation to school and overall transport are used to get a
broad view of the health benefits of active transportation.
Active transport (i.e. walking, cycling,…) is a type of physical activity that offers
health benefits, such as higher levels of daily physical activity [1], lower odds of
being overweight or obese [2, 3], an overall reduction in cardiovascular risk [4],
higher levels of cardiovascular fitness [5, 6] and a better cognitive performance [7].
An increase in active transport might also reduce traffic congestion and CO2
emissions [8].
According to the US Census Bureau, commuting refers to a worker’s travel from
home to work or a student’s travel from home to school. Based on that definition,
active commuting is always on the way to school and never on the way to other
destinations. The term ‘active transport’ has been used to indicate the travel mode to
various destinations.
- Moreover, the information provided in the introduction must belong to other studies
and have references; the second paragraph in page 6 (from lines 95 to 104) has only 2
references at the end.
We agree that the introduction should refer to previous studies, but in this part of the
article it is also necessary to point out which information is lacking in literature. The
first sentences of this paragraph refer to gaps in current knowledge and are therefore
not referenced.
But on line 99-108, a reference has been added.
24
Not only knowledge about correlates of active transport is important, it is also
necessary to be aware of the barriers and facilitators of other modes of
transportation. Knowing why older adolescents choose to drive a moped or ask their
parents for a ride might help in explaining participation in active transport. There is
no information on which factors push older adolescents into the use of mopeds for
travelling short distances once they reach the age they are allowed to drive these
motorized vehicles. Since habit is a strong correlate of transport mode choice [26], it
is important to promote active transport before the use of motorized transport modes
for travelling short distances becomes a habit. Furthermore, public transport might
be a good alternative for active transport, as the additional minutes of walking before
and after use of public transport may help to increase activity levels and reduce
health risks [27, 28].
- Regarding the last sentence of this paragraph, it is suggest including reference
indicating that public transportation is an active transportation.
We believe that public transportation is indeed more ‘active’ than car travel (as shown
by two references) and could therefore be a good alternative for active transport
(when active transport is not possible), but we do not think public transportation is an
active transportation.
Furthermore, public transport might be a good alternative for active transport, as the
additional minutes of walking before and after use of public transport may help to
increase activity levels and reduce health risks [27, 28].
- The third paragraph (lines 105 to 110) must be deeply reviewed and this information
should be included in the method.
25
The information from the third paragraph has been adjusted and a reference has been
added. We understand the recommendation to include this part in the method, but
decided that it is also important background information. Readers should be able to
get some background information about qualitative research and focus groups, before
they start reading the method.
Line 109-115: To date, not much is known about the factors influencing transport
choice for short distance travel to various destinations in older adolescents. There is
a need for qualitative studies to explore this research area, as qualitative research
methods offer a broad and in-depth insight into the individuals’ experiences and
perceptions [29]. Focus groups provide the possibility to learn and get a broad range
of information about topics that are poorly understood (travel choices), especially in
particular segments of the population, such as older adolescents [30]. Interactive
group discussions stimulate a process of sharing and comparing, and different points
of view are revealed [31].
5. There is, under my knowledge, one study focused in older adolescents (since the
sample was adolescents from 12 to 18) and in the overall commuting (see the reference:
Chillón P, Ortega FB, Ruiz JR, de Bourdeaudhuij I, Martínez-Gómez D, VicenteRodríguez G, Widhalm K, Molnar D, Gottrand F, González-Gross M, Ward DS,
Moreno LA, Castillo MJ, Sjöström M on behalf of the HELENA study group. Active
commuting and physical activity in adolescents from Europe: Results from the
HELENA study. Pediatric Exercise Science, 2011, 23(2):207-217.). So, there are some
unreal statements in the introduction. It is suggested rewriting the introduction and
include this study in the discussion.
26
The study of Chillon et al. (2011) has been added both to the introduction and to the
discussion.
Line 66-67: Active transport (i.e. walking, cycling,…) is a type of physical activity
that offers health benefits, such as higher levels of daily physical activity [1]…
Line 70: Since a steep decline in activity levels and in active transport occurs in
adolescence [1, 9, 10],…
Line 376-377: Although in a study on active commuting and physical activity in
adolescents in ten European countries commuting by bicycle was reported less
frequently than walking [1].
[1] Chillon P, Gottrand F, Ortega FB, Gonzalez-Gross M, Ruiz JR, Ward DS, De Bourdeaudhuij
I, Moreno LA, Martinez-Gomez D, Castillo MJ et al: Active Commuting and Physical Activity
in Adolescents From Europe: Results From the HELENA Study. Pediatr Exerc Sci 2011,
23(2):207-217.
Minor Essential Revisions:
1. Title. It is suggested to rewrite the title in a more direct way. I do not think is
necessary to include “short distances”.
We rewrote the title in a more direct way:
Title: Factors influencing mode of transport in older adolescents: a qualitative study
2. Methods.
- Sampling. The name of the University hospital must be included. The justification of
choose Antwerp regarding the distance is not clear; aren´t there other cities with short
distances?
27
Line 129-130: The name of the university hospital has been included.
The study protocol was approved by the ethical committee of the university hospital of
the Vrije Universiteit Brussel.
There are other cities with many short distance destinations, Antwerp is indeed just
one such city, but we do not expect results to have been different if the study would
have been conducted in another city.
- Research protocol and measures (line 132). The single question about PA was valid in
older adults (reference 30), and not for older adolescents. This must be solved.
The reference has been replaced with another reference concerning the validity of a
single physical activity question. Since we did not found any references for a single
question in older adolescents, the reference is in adults, which is closer related to
older adolescents than older adults.
Line 137: Such single questions have shown to have a good validity in studies where
physical activity is not the primary focus and more detailed measures are not feasible
[33].
[33] Schechtman KB, Barzilai B, Rost K, Fisher EB, Jr.: Measuring physical activity with a
single question. Am J Public Health 1991, 81(6):771-773.
3. Results.
- It is suggested including percentages of the number of participants supporting every
opinion for every variable (i.e. Instead of writing “A lot of participants…” write the
exact percentage…).
28
The authors appreciate the suggestion, and admit that there will always be a
discussion about whether or not to use numbers to report the results of a qualitative
study. But they believe that the system suggested by Sandelowski finds a good
balance between qualitative data and quantitative counts.
Line162: As suggested by Sandelowski and previously used by Van Cauwenberg et
al., the qualitative data are reinforced by quantitative counts of the participants
discussing certain factors influencing their choice of transportation. Thus, when a
factor was discussed by less than 25%, we called it “few”, for between 25% and 50%,
we called it “some”, for between 50% and 75%, we called it “a lot of” and for more
than 75% of the participants, we called it “almost all” in the results’ description.
- Table 2, “transportation and physical activity behavior”. It is suggested separating the
group of variables for a better understanding. For example, the first 4 variables of
%cycling/walking to school, %car passenger to school, %moped to school and %public
transport to school should be separated from the next variables group of variables (i.e.
there will be 3 groups separated by two horizontal lines).
Table 2: The groups of variables have been separated.
Demographics
Age (years) (M ± SD)
17 ± 1.2
% male
65.6
% general study
43.8
% technical/occupational/artistic study
56.3
% living in/at the edge of the city
75.0
% driver license moped
12.5
Transportation and physical activity behavior
% cycling/walking to school
59.4
% car passenger to school
3.1
% moped to school
9.4
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% public transport to school
28.1
% mostly walking/cycling to other destinations
81.3
% mostly car/moped to other destinations
3.1
% mostly public transport to other destinations
15.6
% walking/cycling as favorite transport mode
78.1
% car/moped as favorite transport mode
9.4
% public transport as favorite transport mode
12.5
% moderately physically active
37.5
30