Response: Knowledge, attitude, practice, self‐ efficacy and barriers to exclusive breastfeeding practices among women in a middle eastern country: A prospective cohort study

(1) The first concern relates to sampling and representativeness. Although participants were drawn from all 11 governorates of Oman, the study employed a convenience sampling strategy and collected data online. Such an approach is vulnerable to selection bias, favoring literate, urban, and internet-connected women. This design limits the representativeness of the sample and undermines the claim that the findings are generalizable to the wider Omani population, particularly to women of lower socioeconomic or educational backgrounds who may face the greatest barriers to exclusive breastfeeding (EBF). Response Thank you for your response. Though convenient sampling is not a probability sampling technique, the investigators ensured the selection of representative samples. In the Omani context, all pregnancies are registered and the deliveries are conducted in the healthcare facility. Our study included participants of low, moderate and high economic status. In particular, majority (86.8%) of our study participants belongs to moderate economic status. Only 6.5 belongs to low economic status. However, they had access to internet facility. According to a United Nations ESCWA report, the estimated poverty (low-economic) headcount rate for Omani nationals is 10.1% only. Our sample represented 6.5 of participants of low economic status. (2) The second issue involves inconsistency in statistical analysis and reporting. In the results, the authors state that “the overall breastfeeding barriers were statistically significant (odds ratio [OR] = 0.688; F = 44.287; P < 0.001) with R2 = 0.621 (adjusted R2 = 0.0607).” This combination of odds ratios, F-statistics, and R2 values is contradictory, as ORs derive from logistic regression while F-statistics and R2 are parameters of linear regression. Such mixed reporting makes it unclear which model was actually used and how the relationships between predictors and barriers were quantified. Consequently, the reliability and interpretation of the reported associations are uncertain. Response The adjusted R2 = 0.607. It is a typo error. The predictors of barriers to breastfeeding were analyzed using linear regression analysis by enter method. (3) The third problem concerns weak explanatory power and over-interpretation of results. Despite the model explaining only about 6% of the variance in barriers to exclusive breastfeeding (adjusted R2 = 0.0607), the authors describe these variables as significant “predictors” and discuss them as determinants of EBF practices. Statistical significance alone does not imply strong or meaningful associations, and the small effect size suggests that unmeasured factors likely explain most of the variation. Presenting such weak predictors as determinants risks overstating the study's practical implications for policy or intervention design. Response The adjusted R2 = 0.607. It is a typo error. The percentage is 60% not 6%. In the results, it has been reported that the major barriers to exclusive breastfeeding practices as more than 60% except policies and practices by health services and healthcare providers (53.3%). These issues, while not diminishing the importance of the topic, indicate the need for greater methodological transparency and analytic precision in future breastfeeding research. Employing probability-based sampling, clearly distinguishing statistical models, and interpreting results in proportion to their explanatory power would enhance both the rigor and policy relevance of this valuable line of work. Girija Kalayil Madhavanprabhakaran: Conceived the idea, conducted the study and wrote the original version of the manuscript. Judie Arulappan: Conceived the idea, wrote the methodology, and original version of the manuscript. Frincy Francis: Conducted the study, reviewed and edited the manuscript. Basma Al Yazeedi: Reviewed and edited the manuscript. Tamima Al-Dughaishi: Supervised the study, Reviewed and edited the manuscript. Suwaina Khalfan Al Mandhari: Conducted the study, Reviewed and edited the manuscript. Siham Saif Saleh Al Jabri: Conducted the study, Reviewed and edited the manuscript. Hanan Soud Al Mawali: Conducted the study, Reviewed and edited the manuscript. The authors confirm there are no conflicts of interest. The data will be made available upon request from the authors.