<?xml version="1.0" encoding="UTF-8"?><!DOCTYPE article PUBLIC "-//NLM//DTD JATS (Z39.96) Journal Publishing DTD v1.2 20190208//EN" "http://jats.nlm.nih.gov/publishing/1.2/JATS-journalpublishing1.dtd"><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" article-type="research-article" dtd-version="1.2" xml:lang="en">
    <front>
        <journal-meta>
            <journal-id journal-id-type="pmc">F1000Research</journal-id>
            <journal-title-group>
                <journal-title>F1000Research</journal-title>
            </journal-title-group>
            <issn pub-type="epub">2046-1402</issn>
            <publisher>
                <publisher-name>F1000 Research Limited</publisher-name>
                <publisher-loc>London, UK</publisher-loc>
            </publisher>
        </journal-meta>
        <article-meta>
            <article-id pub-id-type="doi">10.12688/f1000research.42125.2</article-id>
            <article-categories>
                <subj-group subj-group-type="heading">
                    <subject>Research Article</subject>
                </subj-group>
                <subj-group>
                    <subject>Articles</subject>
                </subj-group>
            </article-categories>
            <title-group>
                <article-title>Attitudes and habits regarding brain training applications and games among Japanese consumers: a cross-sectional study</article-title>
                <fn-group content-type="pub-status">
                    <fn>
                        <p>[version 2; peer review: 3 not approved]</p>
                    </fn>
                </fn-group>
            </title-group>
            <contrib-group>
                <contrib contrib-type="author" corresp="yes">
                    <name>
                        <surname>Robb</surname>
                        <given-names>Nigel</given-names>
                    </name>
                    <role content-type="http://credit.niso.org/">Conceptualization</role>
                    <role content-type="http://credit.niso.org/">Data Curation</role>
                    <role content-type="http://credit.niso.org/">Formal Analysis</role>
                    <role content-type="http://credit.niso.org/">Funding Acquisition</role>
                    <role content-type="http://credit.niso.org/">Investigation</role>
                    <role content-type="http://credit.niso.org/">Methodology</role>
                    <role content-type="http://credit.niso.org/">Project Administration</role>
                    <role content-type="http://credit.niso.org/">Resources</role>
                    <role content-type="http://credit.niso.org/">Software</role>
                    <role content-type="http://credit.niso.org/">Supervision</role>
                    <role content-type="http://credit.niso.org/">Validation</role>
                    <role content-type="http://credit.niso.org/">Visualization</role>
                    <role content-type="http://credit.niso.org/">Writing &#x2013; Original Draft Preparation</role>
                    <role content-type="http://credit.niso.org/">Writing &#x2013; Review &amp; Editing</role>
                    <uri content-type="orcid">https://orcid.org/0000-0001-7045-0355</uri>
                    <xref ref-type="corresp" rid="c1">a</xref>
                    <xref ref-type="aff" rid="a1">1</xref>
                    <xref ref-type="aff" rid="a2">2</xref>
                </contrib>
                <aff id="a1">
                    <label>1</label>University of Tokyo, Tokyo, Japan</aff>
                <aff id="a2">
                    <label>2</label>Hokkaido University, Sapporo, Japan</aff>
            </contrib-group>
            <author-notes>
                <corresp id="c1">
                    <label>a</label>
                    <email xlink:href="mailto:nigelrobb@imc.hokudai.ac.jp">nigelrobb@imc.hokudai.ac.jp</email>
                </corresp>
                <fn fn-type="conflict">
                    <p>No competing interests were disclosed.</p>
                </fn>
            </author-notes>
            <pub-date pub-type="epub">
                <day>25</day>
                <month>10</month>
                <year>2021</year>
            </pub-date>
            <pub-date pub-type="collection">
                <year>2021</year>
            </pub-date>
            <volume>10</volume>
            <elocation-id>45</elocation-id>
            <history>
                <date date-type="accepted">
                    <day>15</day>
                    <month>10</month>
                    <year>2021</year>
                </date>
            </history>
            <permissions>
                <copyright-statement>Copyright: &#x00a9; 2021 Robb N</copyright-statement>
                <copyright-year>2021</copyright-year>
                <license xlink:href="https://creativecommons.org/licenses/by/4.0/">
                    <license-p>This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
                </license>
            </permissions>
            <self-uri content-type="pdf" xlink:href="https://f1000research.com/articles/10-45/pdf"/>
            <abstract>
                <p>
                    <bold>Background: </bold>While there is now a large amount of research investigating whether brain training applications and games are effective or not, there is less research on the expectations, attitudes, and habits of potential users of brain training programs. Previous research suggests that people generally have positive beliefs about the effectiveness of brain training which are not dependent on their level of experience of brain training. However, this research has primarily focused on western participants.</p>
                <p>
                    <bold>Methods: </bold>In the present study, a questionnaire was used to investigate the attitudes and habits of Japanese consumers towards brain training. The final sample contained responses from 818 people. In addition to descriptive statistics, correlation coefficients were calculated to determine if there were relationships between variables relating to participants' beliefs about brain training and experience of using brain training.</p>
                <p>
                    <bold>Results: </bold>Participants had positive beliefs about the effectiveness of brain training. However, these beliefs were only weakly correlated with their level of experience of using brain training, both in terms of the number programs used (Pearson's r = 0.163) and duration of use (Pearson's r = 0.237). The most widely used brain training program (used by 52.93% of participants) was made by Nintendo for the handheld Nintendo DS games console.</p>
                <p>
                    <bold>Conclusions: </bold>The research presented here supports previous findings which suggest that people's beliefs about the effectiveness of brain training software are not strongly related to their experience of using such software.</p>
            </abstract>
            <kwd-group kwd-group-type="author">
                <kwd>brain training</kwd>
                <kwd>cognitive training</kwd>
                <kwd>cognitive enhancement</kwd>
            </kwd-group>
            <funding-group>
                <award-group id="fund-1" xlink:href="http://dx.doi.org/10.13039/501100000780">
                    <funding-source>European Commission</funding-source>
                    <award-id>PCOFUND-GA-2013-608728</award-id>
                </award-group>
                <award-group id="fund-2" xlink:href="http://dx.doi.org/10.13039/501100001691">
                    <funding-source>Japan Society for the Promotion of Science</funding-source>
                    <award-id>18H05804</award-id>
                </award-group>
                <funding-statement>This work was supported by (1) KAKEN grant no. 18H05804 from the Japan Society for the Promotion of Science and (2) funding from the charity RESPECT and the People Programme (Marie Curie Actions) of the European Union's Seventh Framework Programme (FP7/2007-2013; REA grant agreement no. PCOFUND-GA-2013-608728), both to Nigel Robb.</funding-statement>
            </funding-group>
        </article-meta>
        <notes>
            <sec sec-type="version-changes">
                <label>Revised</label>
                <title>Amendments from Version 1</title>
                <p>Added more theoretical support to justify the use of a Japanese sample. Changed the age groups in Figure 1. Changed the titles of Japanese BT apps/games to either romaji or English (including in updated Figure 3). Reported Phi-coefficient instead of Spearman's Rho (although the actual values remain the same as the two statistics are equivalent in this case). Added analysis of gender differences (and new Figure 4 to illustrate these results). Softened the language throughout the manuscript to highlight that this is a summary study with preliminary results. Added additional limitation due to translation of questionnaire from English to Japanese. Added three new references which are all cited in the text.</p>
            </sec>
        </notes>
    </front>
    <body>
        <sec id="sec1" sec-type="intro">
            <title>Introduction</title>
            <p>Recently, there has been much interest in so-called &#x201c;brain training&#x201d; (BT) applications and games. These programs are typically marketed to consumers as enjoyable, interactive experiences that, if used regularly, are claimed to improve a range of cognitive skills, such as attention, memory, and multitasking ability (
                <xref ref-type="bibr" rid="ref24">Simons 
                    <italic toggle="yes">et al.</italic>, 2016</xref>). The potential benefits of such training, if effective, are numerous. For example, training executive function skills such as working memory and task switching could potentially lead to improved outcomes in education, quality of life, and employment for the general population (
                <xref ref-type="bibr" rid="ref8">Diamond, 2013</xref>). In addition, people with cognitive deficits, such as those with intellectual disabilities or age-related cognitive decline, could also benefit from effective cognitive training software (
                <xref ref-type="bibr" rid="ref20">Robb 
                    <italic toggle="yes">et al.</italic>, 2018</xref>; 
                <xref ref-type="bibr" rid="ref5">Buitenweg 
                    <italic toggle="yes">et al.</italic>, 2012</xref>).</p>
            <p>Research on the effectiveness of various types of cognitive training has found evidence that it can lead to improvements in tasks that bear some resemblance to the training (&#x201c;near transfer&#x201d;), but little or no evidence that these improvements transfer to distantly related tasks (&#x201c;far transfer&#x201d;) or indeed to everyday life (
                <xref ref-type="bibr" rid="ref24">Simons 
                    <italic toggle="yes">et al.</italic>, 2016</xref>; 
                <xref ref-type="bibr" rid="ref23">Sala 
                    <italic toggle="yes">et al.</italic>, 2019</xref>; 
                <xref ref-type="bibr" rid="ref1">Aksayli 
                    <italic toggle="yes">et al.</italic>, 2019</xref>). These findings suggest that theories of transfer that emphasize the importance of overlap between the training and the target skills (e.g., 
                <xref ref-type="bibr" rid="ref11">Gobet, 2016</xref>; 
                <xref ref-type="bibr" rid="ref28">Taatgen, 2013</xref>; 
                <xref ref-type="bibr" rid="ref16">Oei and Patterson, 2014</xref>) may provide the best account of the mechanisms by which cognitive training is effective. Therefore, a detailed theoretical understanding of the overlap between the training and the desired outcome may be an important factor in the design of effective, tailored cognitive training programs in the future (see 
                <xref ref-type="bibr" rid="ref25">Smid 
                    <italic toggle="yes">et al.</italic>, 2020</xref>, for this and other recommendations).</p>
            <p>As part of a more comprehensive science of cognitive training, it is also important to investigate the attitudes and habits of the people who will potentially use the training. Individual differences in personality, motivation, expectations etc., are likely to play a role in determining a user&#x2019;s engagement with a training program (
                <xref ref-type="bibr" rid="ref25">Smid 
                    <italic toggle="yes">et al.</italic>, 2020</xref>). Regular engagement is obviously an important factor in any kind of training; however, attrition is a commonly reported problem in trials of cognitive training software (
                <xref ref-type="bibr" rid="ref7">Corbett 
                    <italic toggle="yes">et al.</italic>, 2015</xref>; 
                <xref ref-type="bibr" rid="ref21">Robb 
                    <italic toggle="yes">et al.</italic>, 2019</xref>), and at least one commercial BT program (
                <ext-link ext-link-type="uri" xlink:href="https://www.cogmed.com/working-memory/method">Cogmed</ext-link>) assigns users a coach to ensure that they regularly engage with the software. Understanding how and why people use cognitive training programs may therefore be an important additional factor in determining their effectiveness.</p>
            <p>Previous research has found that participants typically have positive beliefs about the effectiveness of BT. 
                <xref ref-type="bibr" rid="ref29">Torous 
                    <italic toggle="yes">et al.</italic> (2016)</xref> found positive beliefs about the effectiveness of BT mobile applications in young American consumers, both in participants who had used BT programs and those who had not. Other research found similar results in parents of children with intellectual disabilities (who may benefit from cognitive training): parents believed that BT could benefit their children and expressed positive attitudes towards supporting such training. Again, these attitudes were not related to how much experience the parents had with BT apps or games (
                <xref ref-type="bibr" rid="ref20">Robb 
                    <italic toggle="yes">et al.</italic>, 2018</xref>). It has also been shown that people&#x2019;s expectations about the effectiveness of BT can be influenced by the information they receive about such programs. 
                <xref ref-type="bibr" rid="ref18">Rabipour &amp; Davidson (2015)</xref> and 
                <xref ref-type="bibr" rid="ref19">Rabipour 
                    <italic toggle="yes">et al.</italic> (2018)</xref> found that participants&#x2019; expectations about the effectiveness of BT at baseline could be subsequently raised or lowered by presenting them with positive or negative messages about BT. Finally, 
                <xref ref-type="bibr" rid="ref15">Ng 
                    <italic toggle="yes">et al.</italic> (2020)</xref> found that frequency of engagement was only weakly correlated with perceived cognitive benefit for a range of activities, including BT. While this research reveals important information about the attitudes, habits, and expectations of a range of potential consumers of BT, it is primarily focused on Western users. It is widely recognized that much research involving human subjects may be biased towards certain demographics (
                <xref ref-type="bibr" rid="ref12">Henrich 
                    <italic toggle="yes">et al.</italic>, 2010</xref>). In the case of understanding attitudes and habits regarding BT, the largest previous study was conducted in the United States (
                <xref ref-type="bibr" rid="ref29">Torous 
                    <italic toggle="yes">et al.</italic>, 2016</xref>). To fully understand the attitudes of BT users, it is vital that a global perspective is considered.</p>
            <p>Japan represents a large group of potential consumers of cognitive training who may have different habits or attitudes than, for example, those in the US. Previous research has found differences between users from Japan and the US in terms of how they access and use mobile apps (
                <xref ref-type="bibr" rid="ref31">Lim 
                    <italic toggle="yes">et al.</italic>, 2014</xref>). Japan also has a developed BT market, with popular BT games having been released in the country for several years (
                <xref ref-type="bibr" rid="ref10">Fuyuno, 2007</xref>; 
                <xref ref-type="bibr" rid="ref6">Chancellor &amp; Chatterjee, 2011</xref>). Taken together, these points suggest the possibility that attitudes and habits regarding BT may differ between users in Japan and other countries. Therefore, the main purpose of this paper is to provide preliminary data on the habits and attitudes of Japanese people regarding BT apps and games, thus expanding our knowledge of how and why such programs are used around the world and laying the groundwork for future research in this area.</p>
        </sec>
        <sec id="sec2" sec-type="methods">
            <title>Methods</title>
            <sec id="sec3">
                <title>Questionnaire</title>
                <p>To facilitate a direct comparison between Japanese consumers and their American counterparts, this cross-sectional study used a Japanese translation of the questionnaire used by 
                    <xref ref-type="bibr" rid="ref29">Torous 
                        <italic toggle="yes">et al.</italic> (2016)</xref> with minor adaptations. Before translation, the original questionnaire was adapted in two ways. Firstly, while 
                    <xref ref-type="bibr" rid="ref29">Torous 
                        <italic toggle="yes">et al.</italic>&#x2019;s (2016)</xref> questionnaire specifically focused on using smartphone apps, the present study also included questions (and adapted the wording of questions) to refer to games consoles. This was because it was expected that Japanese-produced BT programs would be popular among Japanese people, and 
                    <ext-link ext-link-type="uri" xlink:href="https://www.nintendo.co.jp/ds/andj/">some such software</ext-link> is only available on games consoles. Secondly, when asking participants which cognitive training programs they had used, the list of options was updated to reflect apps and games available in Japan.</p>
                <p>This questionnaire was then translated into Japanese by two professional translators, who both independently produced separate translations. Professional translators were contracted through 
                    <ext-link ext-link-type="uri" xlink:href="https://gengo.com/">Gengo</ext-link>, a web-based human translation platform. A native Japanese speaker familiar with the research project merged these translations; differences in the two translations were resolved through discussion between this person and the author of the paper. This resulted in a final Japanese version of the questionnaire. Before being used, this version was translated back into English by a third professional translator, and this version was compared with 
                    <xref ref-type="bibr" rid="ref29">Torous 
                        <italic toggle="yes">et al.</italic>&#x2019;s (2016)</xref> original questionnaire. There were some minor differences in the wording of the original questionnaire and the back-translation. For example, &#x201c;duration&#x201d; (original) became &#x201c;period of time&#x201d; (back-translation); the phrase &#x201c;For the purpose of this survey, we will call these &#x2018;brain training apps/games&#x2019;&#x201d; (original) became &#x201c;In this survey, we will refer to these as &#x2018;brain training apps/games&#x2019;&#x201d; (back-translation); and the question &#x201c;Do you own a smartphone?&#x201d; (original) became &#x201c;Do you have a smartphone?&#x201d; (back-translation). It was judged that none of these minor differences would affect the meaning of any of the questions. The questionnaire can be viewed in full in both English and Japanese as extended data on the Open Science Framework (
                    <xref ref-type="bibr" rid="ref22">Robb, 2021</xref>).</p>
            </sec>
            <sec id="sec4">
                <title>Participants and procedure</title>
                <p>Participants were recruited using 
                    <ext-link ext-link-type="uri" xlink:href="https://crowdworks.jp/">CrowdWorks</ext-link>, a Japanese crowdsourcing website. All registered CrowdWorks users were deemed eligible to participate; there were no additional inclusion or exclusion criteria. Crowdsourcing websites have been shown to be viable methods for recruiting participants for questionnaire research (
                    <xref ref-type="bibr" rid="ref2">Behrend 
                        <italic toggle="yes">et al.</italic>, 2011</xref>; 
                    <xref ref-type="bibr" rid="ref17">Peer 
                        <italic toggle="yes">et al.</italic>, 2017</xref>). Previously, 
                    <xref ref-type="bibr" rid="ref30">Majima 
                        <italic toggle="yes">et al.</italic>, (2017)</xref> compared participants recruited via CrowdWorks with Japanese student samples and found that there were relatively small differences in some personality traits, and that the CrowdWorks participants were (as would be expected) more diverse in terms of age and employment history. The translated questionnaire was uploaded to CrowdWorks and responses collected during December 2017. At the start of the questionnaire, the purpose of the research was explained, and participants were informed that they were not obliged to take part, that their responses would be used for research purposes, and that by continuing with the questionnaire they would indicating their consent to participate. No identifying information about the participants was collected. All participants were paid 30 JPY (approximately 0.27 USD in December 2017) to complete the questionnaire, whether their response was used in the final analyses or not. The research was conducted according to the recommendations of the Human Research Ethics Committee (Sciences) at University College Dublin, where the lead author of the paper was employed at the time of the research. The protocol was deemed to be exempt from full ethical review as the data were collected anonymously, the participants were not from a vulnerable group, and they were not placed at any risk during the research.</p>
            </sec>
            <sec id="sec5">
                <title>Sample size</title>
                <p>Assuming that the number of people aged 16 and over in Japan is approximately 110,000,000 (
                    <xref ref-type="bibr" rid="ref26">Statistics Bureau of Japan, n.d.</xref>), and that 50% have used BT (based on results from 
                    <xref ref-type="bibr" rid="ref29">Torous 
                        <italic toggle="yes">et al.</italic>, 2016</xref>), with a margin of error of 5% and a confidence level of 99%, the ideal sample size was calculated to be 664. Given that previous research has highlighted concerns with unreliable responses and high attrition rates in crowdsourced samples (
                    <xref ref-type="bibr" rid="ref14">Keith 
                        <italic toggle="yes">et al.</italic>, 2017</xref>), 1000 responses were collected.</p>
            </sec>
            <sec id="sec6">
                <title>Statistical analysis</title>
                <p>After collection, the data were inspected, and potentially unreliable responses were removed. Unreliable responses included those with inconsistent answers to similar questions, or the wrong answer to the simple sum of nine plus four (included to check that participants were diligently reading and responding to the questions). There were no missing data in the final dataset used for analysis.</p>
                <p>Descriptive statistics were used to investigate smartphone and games console ownership of participants; usage of health and fitness apps; concerns about BT; BT apps/games used by participants; and participants' beliefs about the effectiveness of BT. Phi-coefficients were calculated to determine if there were associations between participants' beliefs about whether BT could lead to cognitive/emotional improvements (specifically in thinking ability, attention, memory, and mood), whether they had used BT, and if they thought BT apps/games had negative side effects. Following 
                    <xref ref-type="bibr" rid="ref29">Torous 
                        <italic toggle="yes">et al.</italic> (2016)</xref> a score was calculated for each participant measuring how positively they felt about BT. The difference in this score between participants who had used BT and those who had not was investigated using a Mann-Whitney U-test. Pearson correlation coefficients were calculated between this score, the number of BT apps/games participants had used, and the longest period of time participants had used BT. Finally, gender differences were also investigated. These analyses were performed using 
                    <ext-link ext-link-type="uri" xlink:href="https://jasp-stats.org/">JASP</ext-link> version 0.11.1 and version 0.14.1.</p>
            </sec>
        </sec>
        <sec id="sec7" sec-type="results">
            <title>Results</title>
            <p>A total of 1000 responses were received. Of these, one response was excluded as the age in years was entered as 336, while six responses were removed as they provided an incorrect answer to the sum of nine and four. A further 175 participants&#x2019; responses were removed as they gave inconsistent answers about their history of using BT apps or games. There were four kinds of inconsistency. Firstly, 13 participants answered &#x201c;yes&#x201d; to item 8 (&#x201c;Have you ever used an app or game that claims to increase memory, concentration, attentiveness, or other cognitive abilities? In this survey, we will refer to these as &#x2018;brain training apps/games.&#x2019;&#x201d;) but answered &#x201c;I have never used one&#x201d; to item 16 (&#x201c;What is the longest period of time you have used a brain training app/game? If you have never used one, please select &#x2018;I have never used one.&#x2019;&#x201d;). Secondly, 11 participants answered &#x201c;yes&#x201d; to item 8 but did not enter any brain training apps or games that they had used when asked to do so in item 15. Thirdly, 111 participants answered &#x201c;no&#x201d; to item 8, but indicated they had used BT apps or games in item 16 (i.e., they entered a period of time they had used apps or games). Fourthly, 152 participants answered &#x201c;no&#x201d; to item 8, but entered apps or games they had used when asked to do so in item 15. Note that some participants' responses were inconsistent in more than one of these ways. With these responses removed, the final sample used for analyses contained responses from 818 participants (524 female, 294 male; mean age 36.1 years; standard deviation 9.5 years). The underlying data can be accessed on the Open Science Framework (
                <xref ref-type="bibr" rid="ref22">Robb, 2021</xref>).</p>
            <p>
                <xref ref-type="fig" rid="f1">Figure 1</xref> shows the devices and kind of apps owned by participants, divided into seven age categories. In all age groups, at least 70% of participants owned a smartphone, with the highest rate of smartphone ownership (94.12%) in participants aged 30 years and under. Games console ownership was approximately 40% in the 20-29 years, 30-39 years, and 40-49 years categories. </p>
            <fig id="f1" orientation="portrait" position="float">
                <label>Figure 1. </label>
                <caption>
                    <title>Percentage of participants with a smartphone and/or games console, and health/fitness apps, divided into seven age categories.</title>
                </caption>
                <graphic orientation="portrait" position="float" xlink:href="https://f1000research-files.f1000.com/manuscripts/77695/bb558586-3f04-4acd-95e7-c162da9ca71d_figure1.gif"/>
            </fig>
            <p>The most common concerns participants had about BT apps and games were the cost of the product, the time required to use them, and a lack of certainty regarding their effectiveness. Most participants did not express concerns about the safety of their health data or whether the apps or games have medical recommendation (
                <xref ref-type="fig" rid="f2">Figure 2</xref>).</p>
            <fig id="f2" orientation="portrait" position="float">
                <label>Figure 2. </label>
                <caption>
                    <title>Participants&#x2019; concerns about brain training apps and games.</title>
                </caption>
                <graphic orientation="portrait" position="float" xlink:href="https://f1000research-files.f1000.com/manuscripts/77695/bb558586-3f04-4acd-95e7-c162da9ca71d_figure2.gif"/>
            </fig>
            <p>The most-used training programs were produced by Nintendo and released on the Nintendo DS handheld games console. Over half the participants reported having used 
                <italic toggle="yes"/>
                <italic toggle="yes">Nou wo kitaeru otona no DS training</italic> (released in the US as 
                <italic toggle="yes">Brain Age: Train Your Brain in Minutes a Day!</italic> and in Europe as 
                <italic toggle="yes">Dr. Kawashima&#x2019;s Brain Training: How Old Is Your Brain?</italic>) and just under a quarter of participants reported using the follow-up game (
                <italic toggle="yes">Motto nou wo kitaeru otona no DS training</italic>; US: 
                <italic toggle="yes">Brain Age 2: More Training in Minutes a Day!</italic> Europe: 
                <italic toggle="yes">More Brain Training from Dr. Kawashima: How Old Is Your Brain?</italic>). Of the remaining programs, all but one were used by fewer than 10% of participants. Only 19 participants (2.32%) reported having used 
                <italic toggle="yes">Lumosity</italic> (
                <xref ref-type="fig" rid="f3">Figure 3</xref>).</p>
            <fig id="f3" orientation="portrait" position="float">
                <label>Figure 3. </label>
                <caption>
                    <title>Brain training apps and games used by participants.</title>
                </caption>
                <graphic orientation="portrait" position="float" xlink:href="https://f1000research-files.f1000.com/manuscripts/77695/bb558586-3f04-4acd-95e7-c162da9ca71d_figure3.gif"/>
            </fig>
            <p>Participants indicated positive perceptions of BT apps and games, believing that they could improve thinking ability (79.58%), attention (66.26%), memory (78.61%), and mood (73.35%). Phi-coefficients were calculated for all combinations of the binary variables (i.e., yes/no questions) regarding participants&#x2019; views about whether BT could improve thinking ability, attention, memory, and mood, as well as the binary variables regarding whether they had used BT, and if they thought BT had negative side effects. There were weak to moderate positive correlations between (1) thinking ability and attention (&#x03d5; = 0.376, p &lt; 0.001), (2) thinking ability and memory (&#x03d5; = 0.453, p &lt; 0.001), and (3) attention and memory (&#x03d5; = 0.378, p &lt; 0.001) (
                <xref ref-type="table" rid="T1">Table 1</xref>) (see 
                <xref ref-type="bibr" rid="ref45">Akoglu, 2018</xref>, and 
                <xref ref-type="bibr" rid="ref32">Schober 
                    <italic toggle="yes">et al.</italic>, 2018</xref>, for discussion of interpretation of strength of correlations).</p>
            <table-wrap id="T1" orientation="portrait" position="float">
                <label>Table 1. </label>
                <caption>
                    <title>Phi-coefficients for associations between participants&#x2019; beliefs about whether brain training can improve four mental factors, whether they had used brain training, and whether they thought brain training has negative side effects.</title>
                    <p>All variables are dichotomous yes/no items. Chi-square tests showed that all associations were positive except for that between &#x201c;Has used brain training apps/games&#x201d; and &#x201c;Apps/games have negative side effects&#x201d;. Significant at p = 0.01 level marked with *.</p>
                </caption>
                <table content-type="article-table" frame="hsides">
                    <thead>
                        <tr>
                            <th colspan="1" rowspan="1"/>
                            <th align="center" colspan="1" rowspan="1" valign="bottom">Improve thinking ability</th>
                            <th align="center" colspan="1" rowspan="1" valign="bottom">Improve attention</th>
                            <th align="center" colspan="1" rowspan="1" valign="bottom">Improve memory</th>
                            <th align="center" colspan="1" rowspan="1" valign="bottom">Improve mood</th>
                            <th align="center" colspan="1" rowspan="1" valign="bottom">Has used brain training apps/games</th>
                            <th align="center" colspan="1" rowspan="1" valign="bottom">Apps/games have negative side effects</th>
                        </tr>
                    </thead>
                    <tbody>
                        <tr>
                            <td align="left" colspan="1" rowspan="1" valign="top">
                                <bold>Improve thinking ability</bold>
                            </td>
                            <td align="left" colspan="1" rowspan="1" valign="top">-</td>
                            <td align="left" colspan="1" rowspan="1" valign="top">-</td>
                            <td align="left" colspan="1" rowspan="1" valign="top">-</td>
                            <td align="left" colspan="1" rowspan="1" valign="top">-</td>
                            <td align="left" colspan="1" rowspan="1" valign="top">-</td>
                            <td align="left" colspan="1" rowspan="1" valign="top">-</td>
                        </tr>
                        <tr>
                            <td align="left" colspan="1" rowspan="1" valign="top">
                                <bold>Improve attention</bold>
                            </td>
                            <td align="char" char="." colspan="1" rowspan="1" valign="top">0.376*</td>
                            <td align="left" colspan="1" rowspan="1" valign="top">-</td>
                            <td align="left" colspan="1" rowspan="1" valign="top">-</td>
                            <td align="left" colspan="1" rowspan="1" valign="top">-</td>
                            <td align="left" colspan="1" rowspan="1" valign="top">-</td>
                            <td align="left" colspan="1" rowspan="1" valign="top">-</td>
                        </tr>
                        <tr>
                            <td align="left" colspan="1" rowspan="1" valign="top">
                                <bold>Improve memory</bold>
                            </td>
                            <td align="char" char="." colspan="1" rowspan="1" valign="top">0.453*</td>
                            <td align="char" char="." colspan="1" rowspan="1" valign="top">0.378*</td>
                            <td align="left" colspan="1" rowspan="1" valign="top">-</td>
                            <td align="left" colspan="1" rowspan="1" valign="top">-</td>
                            <td align="left" colspan="1" rowspan="1" valign="top">-</td>
                            <td align="left" colspan="1" rowspan="1" valign="top">-</td>
                        </tr>
                        <tr>
                            <td align="left" colspan="1" rowspan="1" valign="top">
                                <bold>Improve mood</bold>
                            </td>
                            <td align="char" char="." colspan="1" rowspan="1" valign="top">0.120*</td>
                            <td align="char" char="." colspan="1" rowspan="1" valign="top">0.143*</td>
                            <td align="char" char="." colspan="1" rowspan="1" valign="top">0.036</td>
                            <td align="left" colspan="1" rowspan="1" valign="top">-</td>
                            <td align="left" colspan="1" rowspan="1" valign="top">-</td>
                            <td align="left" colspan="1" rowspan="1" valign="top">-</td>
                        </tr>
                        <tr>
                            <td align="left" colspan="1" rowspan="1" valign="top">
                                <bold>Has used brain training apps/games</bold>
                            </td>
                            <td align="char" char="." colspan="1" rowspan="1" valign="top">0.08</td>
                            <td align="char" char="." colspan="1" rowspan="1" valign="top">0.096*</td>
                            <td align="char" char="." colspan="1" rowspan="1" valign="top">0.139*</td>
                            <td align="left" colspan="1" rowspan="1" valign="top">0.081</td>
                            <td align="left" colspan="1" rowspan="1" valign="top">-</td>
                            <td align="left" colspan="1" rowspan="1" valign="top">-</td>
                        </tr>
                        <tr>
                            <td align="left" colspan="1" rowspan="1" valign="top">
                                <bold>Apps/games have negative side effects</bold>
                            </td>
                            <td align="char" char="." colspan="1" rowspan="1" valign="top">0.085</td>
                            <td align="char" char="." colspan="1" rowspan="1" valign="top">0.017</td>
                            <td align="char" char="." colspan="1" rowspan="1" valign="top">0.086</td>
                            <td align="left" colspan="1" rowspan="1" valign="top">0.008</td>
                            <td align="left" colspan="1" rowspan="1" valign="top">-0.055 (negative association)</td>
                            <td align="left" colspan="1" rowspan="1" valign="top">-</td>
                        </tr>
                    </tbody>
                </table>
            </table-wrap>
            <p>Following 
                <xref ref-type="bibr" rid="ref29">Torous 
                    <italic toggle="yes">et al.</italic> (2016)</xref>, a score was calculated for each participant measuring how positively they felt about BT. Participants were given one point for each positive answer to the four questions about whether they thought BT improved thinking ability, attention, memory, and mood, and one point for a negative answer to the question about whether they thought BT apps and games have negative side effects. The maximum score of five indicated a participant thought BT improved all four factors and had no side effects, while the minimum score of zero indicated a participant thought BT did not improve any of the four factors and had negative side effects. This score was significantly higher among respondents who indicated that they had used BT apps or games (Mann-Whitney U test, U = 37757, p &lt; 0.001); the rank biserial correlation was -0.213, indicating a weak effect size. This score showed negligible or weak correlations (Pearson correlation) with both the total number of apps/games a participant had used (Pearson&#x2019;s r = 0.163, p &lt; 0.001) and the duration they had used BT apps/games (Pearson&#x2019;s r = 0.237, p &lt; 0.001) (
                <xref ref-type="table" rid="T2">Table 2</xref>).</p>
            <table-wrap id="T2" orientation="portrait" position="float">
                <label>Table 2. </label>
                <caption>
                    <title>Pearson correlations between participants&#x2019; positive beliefs about brain training, the total number of brain training apps or games they had used, and the maximum duration they had used brain training apps or games.</title>
                    <p>Significant at p = 0.01 level marked with *.</p>
                </caption>
                <table content-type="article-table" frame="hsides">
                    <thead>
                        <tr>
                            <th colspan="1" rowspan="1"/>
                            <th align="center" colspan="1" rowspan="1" valign="bottom">Score (positive beliefs about brain training)</th>
                            <th align="center" colspan="1" rowspan="1" valign="bottom">Total number of apps/games used</th>
                            <th align="center" colspan="1" rowspan="1" valign="bottom">Duration used apps/games</th>
                        </tr>
                    </thead>
                    <tbody>
                        <tr>
                            <td align="center" colspan="1" rowspan="1" valign="top">
                                <bold>Score (positive beliefs about brain training)</bold>
                            </td>
                            <td align="center" colspan="1" rowspan="1" valign="top">
                                <italic toggle="yes">-</italic>
                            </td>
                            <td align="center" colspan="1" rowspan="1" valign="top">
                                <italic toggle="yes">-</italic>
                            </td>
                            <td align="center" colspan="1" rowspan="1" valign="top">
                                <italic toggle="yes">-</italic>
                            </td>
                        </tr>
                        <tr>
                            <td align="center" colspan="1" rowspan="1" valign="top">
                                <bold>Total number of apps/games used</bold>
                            </td>
                            <td align="center" colspan="1" rowspan="1" valign="top">0.163*</td>
                            <td align="center" colspan="1" rowspan="1" valign="top">-</td>
                            <td align="center" colspan="1" rowspan="1" valign="top">-</td>
                        </tr>
                        <tr>
                            <td align="center" colspan="1" rowspan="1" valign="top">
                                <bold>Duration used apps/games</bold>
                            </td>
                            <td align="center" colspan="1" rowspan="1" valign="top">0.237*</td>
                            <td align="center" colspan="1" rowspan="1" valign="top">0.479*</td>
                            <td align="center" colspan="1" rowspan="1" valign="top">-</td>
                        </tr>
                    </tbody>
                </table>
            </table-wrap>
            <p>Finally, gender differences were also examined, as suggested by reviewer 1. There were significant differences between males and females in terms of smartphone ownership (females more likely to own), games console ownership (males more likely to own) and the belief that BT apps/games have negative side effects (females more likely to think so). Phi-coefficients showed that these associations were all weak or negligible (&#x03d5; ranged from 0.097 to 0.12). These results are shown in 
                <xref ref-type="fig" rid="f4">Figure 4</xref>.</p>
            <fig id="f4" orientation="portrait" position="float">
                <label>Figure 4. </label>
                <caption>
                    <title>Gender differences in smartphone ownership, games console ownership, and beliefs that BT apps/games have negative side effects.</title>
                </caption>
                <graphic orientation="portrait" position="float" xlink:href="https://f1000research-files.f1000.com/manuscripts/77695/bb558586-3f04-4acd-95e7-c162da9ca71d_figure4.gif"/>
            </fig>
        </sec>
        <sec id="sec8" sec-type="discussion">
            <title>Discussion</title>
            <p>The results of the present study suggest that a high rate of Japanese consumers may have positive perceptions of the potential benefits of BT apps and games, comparable to or (in the case of positive effects on mood) higher than the rate in US consumers (
                <xref ref-type="bibr" rid="ref29">Torous 
                    <italic toggle="yes">et al.</italic>, 2016</xref>). While there were correlations between positive perceptions about the effects of BT on specific cognitive factors (thinking ability and attention, thinking ability and memory, and attention and memory), these were weaker than those found in US consumers (
                <xref ref-type="bibr" rid="ref29">Torous 
                    <italic toggle="yes">et al.</italic>, 2016</xref>). Similarly to 
                <xref ref-type="bibr" rid="ref29">Torous 
                    <italic toggle="yes">et al.</italic>&#x2019;s (2016)</xref> findings in US consumers, most participants in the present study did not indicate concerns about clinical recommendations, privacy of health data, or negative side effects, when considering BT games. Rather, the cost of apps/games, the time involved, and uncertainty about their effectiveness were the main concerns in the present sample. While this study only presents preliminary findings, it is interesting to note the similarities with the US participants in the previous study. Previously, it was shown that there were only minor demographic differences (in terms of gender and level of education) in beliefs about benefits of BT (
                <xref ref-type="bibr" rid="ref15">Ng 
                    <italic toggle="yes">et al.</italic>, 2020</xref>). It may be that there are similarly minor differences between people from different socio-cultural backgrounds, although further research to investigation this specific hypothesis would be required. </p>
            <p> Lumosity, which was used by 70% of US consumers in the previous study by 
                <xref ref-type="bibr" rid="ref29">Torous 
                    <italic toggle="yes">et al.</italic> (2016)</xref> was only used by 2.3% of the Japanese participants. This large difference in the number of participants using 
                <italic toggle="yes">Lumosity</italic> may be partly explained by the fact that the app was only released in Japanese in 
                <ext-link ext-link-type="uri" xlink:href="https://blog.btrax.com/lumosity-japan/">December 2014</ext-link>. In the Japanese paticipants surveyed here, the most popular brain training apps were games made by Nintendo for the Handheld Nintendo DS console. However, since the previous study (
                <xref ref-type="bibr" rid="ref29">Torous 
                    <italic toggle="yes">et al.</italic>, 2016</xref>) only focused on smartphone apps, it does not provide any information about how widely used Nintendo BT games are in US consumers. Nintendo BT games are popular globally, however: 
                <italic toggle="yes">Brain Age: Train Your Brain in Minutes a Day!</italic> (the most used game among Japanese participants in the present study) was among the 
                <ext-link ext-link-type="uri" xlink:href="https://www.ign.com/articles/2007/01/12/best-selling-games-december-2006">10 best-selling video games of 2006</ext-link> in the US. It is therefore likely that many of the participants in 
                <xref ref-type="bibr" rid="ref29">Torous 
                    <italic toggle="yes">et al.</italic>&#x2019;s (2016</xref>) study also had experience of using this BT game.</p>
            <p>The results presented here also support previous findings that people&#x2019;s perceptions of the positive effects of BT are not strongly related to their experience of using BT. 
                <xref ref-type="bibr" rid="ref29">Torous 
                    <italic toggle="yes">et al.</italic> (2016)</xref> found that US consumers&#x2019; positive beliefs about BT were only weakly correlated with the number of BT apps they had used. Similarly, 
                <xref ref-type="bibr" rid="ref19">Rabipour 
                    <italic toggle="yes">et al.</italic> (2018)</xref> found that people with experience of BT had similar expectations about its effectiveness to people with no experience. In other research, 
                <xref ref-type="bibr" rid="ref20">Robb 
                    <italic toggle="yes">et al.</italic> (2018)</xref> found that parents of children with intellectual disabilities had positive beliefs and attitudes regarding BT and had high intentions to support the use of BT by their children, despite the fact that the sample had very little experience with BT programs. Taken together, these results present mounting evidence that experience of using BT is not strongly associated with positive beliefs about the effectiveness of BT. The fact that participants in both the present and previous studies (
                <xref ref-type="bibr" rid="ref18">Rabipour &amp; Davidson, 2015</xref>; 
                <xref ref-type="bibr" rid="ref29">Torous 
                    <italic toggle="yes">et al.</italic>, 2016</xref>, 
                <xref ref-type="bibr" rid="ref19">Rabipour 
                    <italic toggle="yes">et al.</italic>, 2018</xref>, 
                <xref ref-type="bibr" rid="ref20">Robb 
                    <italic toggle="yes">et al.</italic>, 2018</xref>) have very positive beliefs about the effectiveness of brain training (whether or not they have actual experience of using BT), combined with the lack of evidence that BT is actually effective (
                <xref ref-type="bibr" rid="ref24">Simons 
                    <italic toggle="yes">et al.</italic>, 2016</xref>; 
                <xref ref-type="bibr" rid="ref23">Sala 
                    <italic toggle="yes">et al.</italic>, 2019</xref>; 
                <xref ref-type="bibr" rid="ref1">Aksayli 
                    <italic toggle="yes">et al.</italic>, 2019</xref>), illustrates the importance of investigating the role of psychological factors such as motivation, effects of being observed during training and testing, and placebo effects in BT research. It has been shown that users' perceptions about BT can be relatively easily influenced by biased messages regarding their effectiveness (
                <xref ref-type="bibr" rid="ref18">Rabipour and Davidson, 2015</xref>; 
                <xref ref-type="bibr" rid="ref19">Rabipour 
                    <italic toggle="yes">et al.</italic>, 2018</xref>), and placebo effects have been found in previous BT research (
                <xref ref-type="bibr" rid="ref3">Boot 
                    <italic toggle="yes">et al.</italic>, 2013</xref>; 
                <xref ref-type="bibr" rid="ref9">Foroughi 
                    <italic toggle="yes">et al.</italic>, 2016</xref>). Future trials of BT programs would benefit from accounting for such potential confounding factors.</p>
        </sec>
        <sec id="sec9">
            <title>Limitations</title>
            <p>To facilitate a direct comparison between Japanese and American users of BT, this study used a direct translation of the questionnaire developed by 
                <xref ref-type="bibr" rid="ref29">Torous 
                    <italic toggle="yes">et al.</italic> (2016</xref>). In this questionnaire, the items referring to participants&#x2019; positive and negative beliefs about BT (e.g., &#x201c;Do you think brain training apps and games can improve memory?&#x201d;) were phrased as questions requiring yes/no answers. However, in retrospect, it may have been more informative to adapt the questionnaire to have Likert-style responses. This would still have allowed some comparison with previous research but could have also facilitated more nuanced analysis of the results. This represents the major limitation with the current study.</p>
            <p>While the use of crowdsourcing platforms such as CrowdWorks to recruit participants is becoming more common in recent research, there remain some potential limitations associated with this approach. Firstly, it is recognized that crowdsourced participants may not always be representative of the population of interest (
                <xref ref-type="bibr" rid="ref27">Stewart 
                    <italic toggle="yes">et al.</italic>, 2017</xref>). In the present study, this issue is most obvious when considering the ages of the participants: in 2015, 26.6% of the Japanese population were over 65 (
                <xref ref-type="bibr" rid="ref26">Statistics Bureau of Japan, n.d.</xref>), whereas in the sample analyzed here, only 9 of 818 participants were over 60. Given that BT is often considered as a potential intervention for people with age-related cognitive decline (
                <xref ref-type="bibr" rid="ref5">Buitenweg 
                    <italic toggle="yes">et al.</italic>, 2012</xref>), the habits and attitudes of this demographic are clearly important. Secondly, it may be suggested that data collected from crowdsourcing platforms is of low quality (e.g., due to participants answering questions without fully reading or considering them). However, previous research has found data collected via the crowdsourcing platform Amazon Mechanical Turk is of comparable quality to other methods (
                <xref ref-type="bibr" rid="ref13">Kees 
                    <italic toggle="yes">et al.</italic>, 2017</xref>). In the present study, several indicators were used to identify potentially automated or low effort responses (see section Participants and Procedure). A total of 182 responses (18.2%) were removed before analysis, which is comparable to the rate of 14% automated and low effort responses found in a study of Amazon Mechanical Turk workers by 
                <xref ref-type="bibr" rid="ref4">Buchanan &amp; Scofield (2018</xref>).</p>
            <p>A final limitation may arise from the translation and adaptation of the original questionnaire used by 
                <xref ref-type="bibr" rid="ref29">Torous 
                    <italic toggle="yes">et al.</italic> (2016)</xref>. Although the translation process involved three independent translators and the production of a back-translation which was compared with the original questionnaire, it remains possible that the meaning of some items was altered in a way that affected the results.</p>
        </sec>
        <sec id="sec10">
            <title>Future work</title>
            <p>Due to the low number of participants over 60 years old, the present study cannot provide any reliable information on the attitudes and habits regarding BT in the elderly population in Japan. Future research investigating this topic would be important. Future research could also benefit from using Likert-style items, as discussed in the section Limitations. Further research will also be required to understand more completely the factors that influence people&#x2019;s attitudes towards BT, and the role of psychological confounders such as placebo effects in BT research. Finally, one important finding of the present study is the popularity of BT games produced by Nintendo, emphasizing the importance of games consoles in the BT market, at least in Japan. Since the previous major study of BT habits in western users only focused on smartphone applications (
                <xref ref-type="bibr" rid="ref29">Torous 
                    <italic toggle="yes">et al.</italic>, 2016</xref>), future research should investigate if BT programs on games consoles, such those produced by Nintendo, are as widely used in countries other than Japan.</p>
        </sec>
        <sec id="sec11" sec-type="conclusion">
            <title>Conclusion</title>
            <p>This preliminary study contributes to a growing literature investigating the expectations, attitudes, and habits of potential users of brain training applications and games. There are two main findings. Firstly, similarly to previous research conducted in the US, Japanese consumers have positive beliefs about brain training which do not seem to be strongly associated with the amount of experience they have using such programs. Secondly, the most widely used brain training software among Japanese participants are two games made by Nintendo and played on the handheld Nintendo DS console.</p>
        </sec>
        <sec id="sec12">
            <title>Data availability</title>
            <sec id="sec13">
                <title>Underlying data</title>
                <p>Open Science Framework: Attitudes and habits regarding brain training games and apps in Japan, 
                    <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.17605/OSF.IO/CW5AG">https://doi.org/10.17605/OSF.IO/CW5AG</ext-link> (
                    <xref ref-type="bibr" rid="ref22">Robb, 2021</xref>).</p>
                <p>This project contains the following underlying data:
                    <list list-type="simple">
                        <list-item>
                            <label>-</label>
                            <p>raw-data-retrieved-4-24-2020.csv (File exported from CrowdWorks)</p>
                        </list-item>
                        <list-item>
                            <label>-</label>
                            <p>raw-data-jp (Spreadsheet of questionnaire responses in Japanese)</p>
                        </list-item>
                        <list-item>
                            <label>-</label>
                            <p>raw-data-en (Spreadsheet of questionnaire responses in English)</p>
                        </list-item>
                    </list>
                </p>
            </sec>
            <sec id="sec14">
                <title>Extended data</title>
                <p>Open Science Framework: Attitudes and habits regarding brain training games and apps in Japan, 
                    <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.17605/OSF.IO/CW5AG">https://doi.org/10.17605/OSF.IO/CW5AG</ext-link> (
                    <xref ref-type="bibr" rid="ref22">Robb, 2021</xref>).</p>
                <p>This project contains the following extended data:
                    <list list-type="simple">
                        <list-item>
                            <label>-</label>
                            <p>questionnaire-v3-final_jp.pdf (Questionnaire in Japanese)</p>
                        </list-item>
                        <list-item>
                            <label>-</label>
                            <p>questionnaire-v3_en-back-translation.docx (Questionnaire back-translated to English)</p>
                        </list-item>
                    </list>
                </p>
                <p>Data are available under the terms of the 
                    <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/publicdomain/zero/1.0/">Creative Commons Zero &#x201c;No rights reserved&#x201d; data waiver</ext-link> (CC0 1.0 Public domain dedication).</p>
            </sec>
        </sec>
        <sec id="sec15">
            <title>Competing interests</title>
            <p>No competing interests were disclosed.</p>
        </sec>
    </body>
    <back>
        <ack id="ack1">
            <title>Acknowledgements</title>
            <p>Tomonori Hasegawa assisted with the translation of the questionnaire into Japanese.</p>
        </ack>
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</person-group>:
                    <article-title>Crowdsourcing samples in cognitive science.</article-title>
                    <source>

                        <italic toggle="yes">Trends Cogn Sci</italic>
</source>
                    <year>2017</year>;<volume>21</volume>(<issue>10</issue>):<fpage>736</fpage>&#x2013;<lpage>748</lpage>.
                    <pub-id pub-id-type="pmid">28803699</pub-id>
                    <pub-id pub-id-type="doi">10.1016/j.tics.2017.06.007</pub-id>
                </mixed-citation>
            </ref>
            <ref id="ref28">
                <mixed-citation publication-type="journal">
                    <person-group person-group-type="author">

                        <name name-style="western">
                            <surname>Taatgen</surname>
                            <given-names>NA</given-names>
                        </name>
</person-group>:
                    <article-title>The nature and transfer of cognitive skills.</article-title>
                    <source>

                        <italic toggle="yes">Psychol Rev</italic>
</source>
                    <year>2013</year>;<volume>120</volume>(<issue>3</issue>):<fpage>439</fpage>.
                    <pub-id pub-id-type="pmid">23750831</pub-id>
                    <pub-id pub-id-type="doi">10.1037/a0033138</pub-id>
                </mixed-citation>
            </ref>
            <ref id="ref29">
                <mixed-citation publication-type="journal">
                    <person-group person-group-type="author">

                        <name name-style="western">
                            <surname>Torous</surname>
                            <given-names>J</given-names>
                        </name>

                        <name name-style="western">
                            <surname>Staples</surname>
                            <given-names>P</given-names>
                        </name>

                        <name name-style="western">
                            <surname>Fenstermacher</surname>
                            <given-names>E</given-names>
                        </name>

                        <etal/>
</person-group>:
                    <article-title>Barriers, benefits, and beliefs of brain training smartphone apps: an internet survey of younger US consumers.</article-title>
                    <source>

                        <italic toggle="yes">Front Hum Neurosci</italic>
</source>
                    <year>2016</year>;<volume>10</volume>:<fpage>180</fpage>.
                    <pub-id pub-id-type="pmid">27148026</pub-id>
                    <pub-id pub-id-type="doi">10.3389/fnhum.2016.00180</pub-id>
                    <pub-id pub-id-type="pmcid">PMC4837324</pub-id>
                </mixed-citation>
            </ref>
        </ref-list>
    </back>
    <sub-article article-type="reviewer-report" id="report165598">
        <front-stub>
            <article-id pub-id-type="doi">10.5256/f1000research.77695.r165598</article-id>
            <title-group>
                <article-title>Reviewer response for version 2</article-title>
            </title-group>
            <contrib-group>
                <contrib contrib-type="author">
                    <name>
                        <surname>Maulana</surname>
                        <given-names>Herdiyan</given-names>
                    </name>
                    <xref ref-type="aff" rid="r165598a1">1</xref>
                    <role>Referee</role>
                    <uri content-type="orcid">https://orcid.org/0000-0001-9137-8583</uri>
                </contrib>
                <aff id="r165598a1">
                    <label>1</label>Faculty of Psychology, Universtias Negeri Jakarta, Jakarta Selatan, Indonesia</aff>
            </contrib-group>
            <author-notes>
                <fn fn-type="conflict">
                    <p>
                        <bold>Competing interests: </bold>No competing interests were disclosed.</p>
                </fn>
            </author-notes>
            <pub-date pub-type="epub">
                <day>28</day>
                <month>3</month>
                <year>2023</year>
            </pub-date>
            <permissions>
                <copyright-statement>Copyright: &#x00a9; 2023 Maulana H</copyright-statement>
                <copyright-year>2023</copyright-year>
                <license xlink:href="https://creativecommons.org/licenses/by/4.0/">
                    <license-p>This is an open access peer review report distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
                </license>
            </permissions>
            <related-article ext-link-type="doi" id="relatedArticleReport165598" related-article-type="peer-reviewed-article" xlink:href="10.12688/f1000research.42125.2"/>
            <custom-meta-group>
                <custom-meta>
                    <meta-name>recommendation</meta-name>
                    <meta-value>reject</meta-value>
                </custom-meta>
            </custom-meta-group>
        </front-stub>
        <body>
            <p>Thank you for having me as a reviewer for this paper. I would like to appraise the author for very interesting paper as it is focused on cross-cultural perspective on brain training application in the non-Western country perspective, as well as utilizing sufficient large sample size participant.&#x00a0; When I get assigned to this paper I am aware that two prior peer reviewers have sought their response as unfavorable output to the author. I am trying my best to provide the review as objective as I can based on those prior reviews. Please kindly find my following comments and feedback below.</p>
            <p> </p>
            <p> f1000 research is a highly reputable research outlet that requires paper published in this journal to meet certain standards in terms of novelty of the topic, recent methodological approach, number of sample size, and implication of the study&#x2019;s findings. Based on my thorough reading of this article, I am afraid that the paper has not been met the f1000 highest standards, particularly in offering the novelty of the topic and complexity of the analysis. I am all aware that cross-cultural study has been always interesting issue to explore, however, the author needs to work more in presenting further arguments supported by deep psychological theoretical ground about why it is important to conduct such study. For example, the authors stated that;</p>
            <p> </p>
            <p> &#x201c;
                <italic>While this research reveals important information about the attitudes, habits, and expectations of a range of potential consumers of BT, it is primarily focused on Western users. It is widely recognized that much research involving human subjects may be biased towards certain demographics (Henrich et al., 2010). In the case of understanding attitudes and habits regarding BT, the largest previous study was conducted in the United States (Torous et al., 2016). To fully understand the attitudes of BT users, it is vital that a global perspective is considered</italic>&#x201d;</p>
            <p> </p>
            <p> The authors did not explain what kind of bias implied from the existing studies that would impact how we understand when the BT is exercised in different cultural settings. Article quoted by the author, Henrich et al (2010) is focusing on general perspective about the importance of doing research out of WEIRD population group, but not focusing on the use of BT in specific. Referring to Torous et al (2016) is a good point, however, the author may need to be more specific in explaining which part of the Torous et al (2016) study has relevance to the study conducted by the author. The author may explain how specific cultural and social context (e.g., collectivist vs individualistic perspective) from both countries associated with different habit, response to stimulus on BT, or perception on the stimuli of the BT based on more solid evidences from prior studies.</p>
            <p> </p>
            <p> The authors mentioned that this study provides preliminary findings/data about how Japanese consumers perceived the BT program. This statement make me convinced that this article might fall into a pilot study type. A title refinement by adding &#x201c;pilot study&#x201d; should be a good idea.</p>
            <p> </p>
            <p> More consistent interpretation to the results also needs to be drawn as the authors inferred that;</p>
            <p> </p>
            <p> &#x201c;
                <italic>Taken together, these results present mounting evidence that experience of using BT is not strongly associated with positive beliefs about the effectiveness of BT</italic>&#x2019;</p>
            <p> </p>
            <p> I am bit worried about this over-statement made by the author, since this study only focusing on cross-sectional approach, which the causal effect of using BT&#x00a0; to participant belief of BT effectiveness cannot be inferred from such approach.</p>
            <p> </p>
            <p> In the conclusion section, the author mentioned &#x201c;
                <italic>the most widely used brain training software among Japanese participants are two games made by Nintendo and played on the handheld Nintendo DS console</italic>&#x201d;. I think this conclusion is too vague, it is better to break down and explain what features that differentiate the BT application used in both cultures and how these feature differences implicate to varied individual&#x2019;s response/experiences to BT training instead mentioning the brand/platform used by the participants.</p>
            <p>Is the work clearly and accurately presented and does it cite the current literature?</p>
            <p>Yes</p>
            <p>If applicable, is the statistical analysis and its interpretation appropriate?</p>
            <p>Yes</p>
            <p>Are all the source data underlying the results available to ensure full reproducibility?</p>
            <p>Yes</p>
            <p>Is the study design appropriate and is the work technically sound?</p>
            <p>Partly</p>
            <p>Are the conclusions drawn adequately supported by the results?</p>
            <p>Yes</p>
            <p>Are sufficient details of methods and analysis provided to allow replication by others?</p>
            <p>Partly</p>
            <p>Reviewer Expertise:</p>
            <p>Social psychology, Experimental approach, Social cognition, Tele-mental health study</p>
            <p>I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above.</p>
        </body>
        <sub-article article-type="response" id="comment9785-165598">
            <front-stub>
                <contrib-group>
                    <contrib contrib-type="author">
                        <name>
                            <surname>Robb</surname>
                            <given-names>Nigel</given-names>
                        </name>
                        <aff/>
                    </contrib>
                </contrib-group>
                <author-notes>
                    <fn fn-type="conflict">
                        <p>
                            <bold>Competing interests: </bold>No competing interests were disclosed.</p>
                    </fn>
                </author-notes>
                <pub-date pub-type="epub">
                    <day>21</day>
                    <month>6</month>
                    <year>2023</year>
                </pub-date>
            </front-stub>
            <body>
                <p>Thank you very much for taking the time to review this article. I appreciate your thoughtful and constructive comments. I have revised the article to address the issues you identified:</p>
                <p> </p>
                <p> I have revised the introduction section, to include more theoretical background regarding relevant cultural differences between the US and Japan based on existing studies.</p>
                <p> </p>
                <p> I have requested to change the title to include the word "preliminary".</p>
                <p> </p>
                <p> I have softened some of the language. For example, in the discussion section, I have changed "Taken together, these results present mounting evidence that experience of using BT is not strongly associated with positive beliefs about the effectiveness of BT" to "There is therefore a continuing lack of evidence that experience of using BT is associated with positive beliefs about the effectiveness of BT."</p>
                <p> </p>
                <p> I have added a paragraph to the discussion section discussing the differences between 
                    <italic>Lumosity </italic>and 
                    <italic>Brain Age: Train Your Brain in Minutes a Day!</italic>, and making recommendations for future research in this area.</p>
            </body>
        </sub-article>
    </sub-article>
    <sub-article article-type="reviewer-report" id="report97827">
        <front-stub>
            <article-id pub-id-type="doi">10.5256/f1000research.77695.r97827</article-id>
            <title-group>
                <article-title>Reviewer response for version 2</article-title>
            </title-group>
            <contrib-group>
                <contrib contrib-type="author">
                    <name>
                        <surname>Kotozaki</surname>
                        <given-names>Yuka</given-names>
                    </name>
                    <xref ref-type="aff" rid="r97827a1">1</xref>
                    <role>Referee</role>
                    <uri content-type="orcid">https://orcid.org/0000-0002-4659-1200</uri>
                </contrib>
                <aff id="r97827a1">
                    <label>1</label>Iwate Medical University, Morioka, Japan</aff>
            </contrib-group>
            <author-notes>
                <fn fn-type="conflict">
                    <p>
                        <bold>Competing interests: </bold>No competing interests were disclosed.</p>
                </fn>
            </author-notes>
            <pub-date pub-type="epub">
                <day>9</day>
                <month>11</month>
                <year>2021</year>
            </pub-date>
            <permissions>
                <copyright-statement>Copyright: &#x00a9; 2021 Kotozaki Y</copyright-statement>
                <copyright-year>2021</copyright-year>
                <license xlink:href="https://creativecommons.org/licenses/by/4.0/">
                    <license-p>This is an open access peer review report distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
                </license>
            </permissions>
            <related-article ext-link-type="doi" id="relatedArticleReport97827" related-article-type="peer-reviewed-article" xlink:href="10.12688/f1000research.42125.2"/>
            <custom-meta-group>
                <custom-meta>
                    <meta-name>recommendation</meta-name>
                    <meta-value>reject</meta-value>
                </custom-meta>
            </custom-meta-group>
        </front-stub>
        <body>
            <p>Although it has been corrected, there seems to be a fundamentally serious problem with this study.</p>
            <p> The results obtained are also very weak, so it will be very difficult to accept them as they are.</p>
            <p>Is the work clearly and accurately presented and does it cite the current literature?</p>
            <p>Yes</p>
            <p>If applicable, is the statistical analysis and its interpretation appropriate?</p>
            <p>Partly</p>
            <p>Are all the source data underlying the results available to ensure full reproducibility?</p>
            <p>Yes</p>
            <p>Is the study design appropriate and is the work technically sound?</p>
            <p>Partly</p>
            <p>Are the conclusions drawn adequately supported by the results?</p>
            <p>Yes</p>
            <p>Are sufficient details of methods and analysis provided to allow replication by others?</p>
            <p>Partly</p>
            <p>Reviewer Expertise:</p>
            <p>NA</p>
            <p>I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above.</p>
        </body>
        <sub-article article-type="response" id="comment7407-97827">
            <front-stub>
                <contrib-group>
                    <contrib contrib-type="author">
                        <name>
                            <surname>Robb</surname>
                            <given-names>Nigel</given-names>
                        </name>
                        <aff/>
                    </contrib>
                </contrib-group>
                <author-notes>
                    <fn fn-type="conflict">
                        <p>
                            <bold>Competing interests: </bold>No competing interests were disclosed.</p>
                    </fn>
                </author-notes>
                <pub-date pub-type="epub">
                    <day>9</day>
                    <month>11</month>
                    <year>2021</year>
                </pub-date>
            </front-stub>
            <body>
                <p>Thank you for reading the second version of the article. Could you please clarify what the fundamentally serious problem with the article is, as I would like to see if I can address it?</p>
            </body>
        </sub-article>
    </sub-article>
    <sub-article article-type="reviewer-report" id="report77995">
        <front-stub>
            <article-id pub-id-type="doi">10.5256/f1000research.45191.r77995</article-id>
            <title-group>
                <article-title>Reviewer response for version 1</article-title>
            </title-group>
            <contrib-group>
                <contrib contrib-type="author">
                    <name>
                        <surname>Prena</surname>
                        <given-names>Kelsey</given-names>
                    </name>
                    <xref ref-type="aff" rid="r77995a1">1</xref>
                    <role>Referee</role>
                    <uri content-type="orcid">https://orcid.org/0000-0002-6972-1899</uri>
                </contrib>
                <aff id="r77995a1">
                    <label>1</label>Emerging Media Studies, College of Communication, Boston University, Boston, MA, USA</aff>
            </contrib-group>
            <author-notes>
                <fn fn-type="conflict">
                    <p>
                        <bold>Competing interests: </bold>No competing interests were disclosed.</p>
                </fn>
            </author-notes>
            <pub-date pub-type="epub">
                <day>15</day>
                <month>2</month>
                <year>2021</year>
            </pub-date>
            <permissions>
                <copyright-statement>Copyright: &#x00a9; 2021 Prena K</copyright-statement>
                <copyright-year>2021</copyright-year>
                <license xlink:href="https://creativecommons.org/licenses/by/4.0/">
                    <license-p>This is an open access peer review report distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
                </license>
            </permissions>
            <related-article ext-link-type="doi" id="relatedArticleReport77995" related-article-type="peer-reviewed-article" xlink:href="10.12688/f1000research.42125.1"/>
            <custom-meta-group>
                <custom-meta>
                    <meta-name>recommendation</meta-name>
                    <meta-value>reject</meta-value>
                </custom-meta>
            </custom-meta-group>
        </front-stub>
        <body>
            <p>The article summarizes 818 participants&#x2019; opinions about brain training games, arguing a Japanese sample makes the paper unique. I compliment the comprehensive review of current research in the beginning of the paper and detailed but clear and concise results section. My comments are listed below.</p>
            <p> </p>
            <p> 
                <bold>Major comments:</bold> 
                <list list-type="order">
                    <list-item>
                        <p>The author gives no theoretical support for why they chose Japan (though it does look like grant money may have been involved). A sound theoretical foundation would have provided a framework for anticipating differences across cultures (as the author tries to make claims about in the discussion section). Lack of this foundation, and lack of hypotheses in consideration of this framework, indicates that this study is going to primarily summarize the market rather than make greater contributions to the discipline&#x2019;s landscape. Furthermore, without this theoretical support, the paper&#x2019;s method, results, and discussion become more of a free-for-all for the author to pick and choose. Other concerns related to this major comment include:</p>
                        <p> </p>
                        <p> -&#x00a0;Why did the author select the particular age groups listed in Figure 1? They seem extraordinarily broad and hide important detail from the reader.</p>
                    </list-item>
                    <list-item>
                        <p>The author indicates that it can be concluded that Japanese consumers aren&#x2019;t concerned about clinical recommendations, privacy of health, or negative side effects when considering brain training games. I do not think they can draw this conclusion based on the method. This was not analyzed in the results section, or discussed in the method section, and the conclusion feels very random. I have reviewed the survey items, and do not believe this can actually be concluded based on the questions provided. Lack of answer does not equate to lack of concern. Similar arguments can be made for other conclusions listed here:</p>
                        <p> </p>
                        <p> -&#x00a0;The author includes the following comment in the conclusion: 
                            <italic>"the present study suggests that, at least in terms of attitudes to BT, variation between people from different socio-cultural backgrounds may also be minor."</italic> This cannot be concluded by the current method. There were no questions asked or analyzed to draw this conclusion.</p>
                        <p> </p>
                        <p> -The author indicates major differences between the Western and Japanese BT markets as a core conclusion to the article. However, they later consider&#x00a0;in the discussion that these differences might be because of differences in software availability. I&#x2019;m not sure that this conclusion really contributes to the paper, and I don&#x2019;t believe it can be concluded accurately without further research.</p>
                    </list-item>
                    <list-item>
                        <p>The author uses single-item variables for all measures, most of them with answer options of simply &#x201c;yes&#x201d; or &#x201c;no.&#x201d; I know this is in replication of a heavily cited other study (Torous 
                            <italic>et al</italic>., 2016
                            <sup>
                                <xref ref-type="bibr" rid="rep-ref-77995-1">1</xref>
                            </sup>), but there are many problems with this methodology and question the integrity of the validity of the measure. The author, appropriately, includes this as a limitation&#x00a0;but&#x00a0;it&#x2019;s a major one. I have a hard time trusting that these questions get at the true answers, and yields this study&#x2019;s conclusions as preliminary rather than substantial.</p>
                    </list-item>
                </list> 
                <bold>Minor comments:</bold> 
                <list list-type="order">
                    <list-item>
                        <p>Is brain training actually synonymous with cognitive training? In some cases it can be, but the author makes this claim and then presents a slightly different definition of brain training in the third paragraph.</p>
                    </list-item>
                    <list-item>
                        <p>It&#x2019;s my understanding that Spearman&#x2019;s Rho should only be used with rank-order variables, and we have dichotomous variables here, not rank-order variables.</p>
                    </list-item>
                </list>
            </p>
            <p>Is the work clearly and accurately presented and does it cite the current literature?</p>
            <p>Yes</p>
            <p>If applicable, is the statistical analysis and its interpretation appropriate?</p>
            <p>Yes</p>
            <p>Are all the source data underlying the results available to ensure full reproducibility?</p>
            <p>Yes</p>
            <p>Is the study design appropriate and is the work technically sound?</p>
            <p>No</p>
            <p>Are the conclusions drawn adequately supported by the results?</p>
            <p>No</p>
            <p>Are sufficient details of methods and analysis provided to allow replication by others?</p>
            <p>Yes</p>
            <p>Reviewer Expertise:</p>
            <p>Communication neuroscience, video games, learning, memory</p>
            <p>I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above.</p>
        </body>
        <back>
            <ref-list>
                <title>References</title>
                <ref id="rep-ref-77995-1">
                    <label>1</label>
                    <mixed-citation publication-type="journal">
                        <person-group person-group-type="author"/>:
                        <article-title>Barriers, Benefits, and Beliefs of Brain Training Smartphone Apps: An Internet Survey of Younger US Consumers.</article-title>
                        <source>
                            <italic>Front Hum Neurosci</italic>
                        </source>.<year>2016</year>;<volume>10</volume>:
                        <elocation-id>10.3389/fnhum.2016.00180</elocation-id>
                        <fpage>180</fpage>
                        <pub-id pub-id-type="pmid">27148026</pub-id>
                        <pub-id pub-id-type="doi">10.3389/fnhum.2016.00180</pub-id>
                    </mixed-citation>
                </ref>
            </ref-list>
        </back>
        <sub-article article-type="response" id="comment7145-77995">
            <front-stub>
                <contrib-group>
                    <contrib contrib-type="author">
                        <name>
                            <surname>Robb</surname>
                            <given-names>Nigel</given-names>
                        </name>
                        <aff/>
                    </contrib>
                </contrib-group>
                <author-notes>
                    <fn fn-type="conflict">
                        <p>
                            <bold>Competing interests: </bold>No competing interests were disclosed.</p>
                    </fn>
                </author-notes>
                <pub-date pub-type="epub">
                    <day>14</day>
                    <month>9</month>
                    <year>2021</year>
                </pub-date>
            </front-stub>
            <body>
                <p>Thank you for your review. My apologies for the delay in my response. I've updated the manuscript now to address your comments. I've made the following changes:</p>
                <p> </p>
                <p> 
                    <bold>Major comments</bold>
                </p>
                <p> 1. I've added more detail to the introduction about the justification for using a Japanese sample. Specifically, I have shown that there is evidence from previous research that, when it comes to mobile app use behaviors and attitudes, it is reasonable to anticipate differences between users from Japan and from the US. So, since the previous study focused on American users and Japan is a highly-developed brain training market, I think it is justified to study Japanese consumers. To clarify, the funding from the Japanese funder (Kaken grant) was awarded 
                    <italic>after</italic> the data collection in the present study was completed, so grant money in no way influenced the decision to choose Japan. 
                    <list list-type="bullet">
                        <list-item>
                            <p>&#x00a0;I have changed the age groups in Figure 1, now using seven categories.</p>
                        </list-item>
                    </list> </p>
                <p> 2. I've reworded the interpretation of the results to soften my claims about Japanese consumers' concerns regarding BT. 
                    <list list-type="bullet">
                        <list-item>
                            <p>&#x00a0;I have reworded the interpretation of the results regarding socio-cultural differences and changed the language to emphasize that this is a preliminary study with limited findings</p>
                        </list-item>
                        <list-item>
                            <p>&#x00a0;I have removed the claim that there are major differences between the Japanese and US BT markets and instead just pointed out the differences between this and the previous study in this respsect.</p>
                        </list-item>
                    </list> </p>
                <p> 3. I agree this is the major limitation of the study, and I've made that more explicit in the limitations section. I have also changed the language throughout the paper to emphasize that these results are preliminary and that hypothesis-testing in future research would be required.</p>
                <p> </p>
                <p> 
                    <bold>Minor comments</bold>
                </p>
                <p> 1. I removed the point about BT being synonymous with cognitive training.</p>
                <p> </p>
                <p> 2. In this case, Spearman's Rho, Pearson's r, and the phi-coefficient are all equivalent. However, I agree that it would be better to report the statistic in a way that is more recognized as appropriate for binary variables, so I have changed these results to report the phi-coefficient (although the values remain the same).</p>
                <p> </p>
                <p> Again, thank you for your help in improving the manuscript. Your feedback is greatly appreciated.</p>
            </body>
        </sub-article>
    </sub-article>
    <sub-article article-type="reviewer-report" id="report77997">
        <front-stub>
            <article-id pub-id-type="doi">10.5256/f1000research.45191.r77997</article-id>
            <title-group>
                <article-title>Reviewer response for version 1</article-title>
            </title-group>
            <contrib-group>
                <contrib contrib-type="author">
                    <name>
                        <surname>Kotozaki</surname>
                        <given-names>Yuka</given-names>
                    </name>
                    <xref ref-type="aff" rid="r77997a1">1</xref>
                    <role>Referee</role>
                    <uri content-type="orcid">https://orcid.org/0000-0002-4659-1200</uri>
                </contrib>
                <aff id="r77997a1">
                    <label>1</label>Iwate Medical University, Morioka, Japan</aff>
            </contrib-group>
            <author-notes>
                <fn fn-type="conflict">
                    <p>
                        <bold>Competing interests: </bold>No competing interests were disclosed.</p>
                </fn>
            </author-notes>
            <pub-date pub-type="epub">
                <day>5</day>
                <month>2</month>
                <year>2021</year>
            </pub-date>
            <permissions>
                <copyright-statement>Copyright: &#x00a9; 2021 Kotozaki Y</copyright-statement>
                <copyright-year>2021</copyright-year>
                <license xlink:href="https://creativecommons.org/licenses/by/4.0/">
                    <license-p>This is an open access peer review report distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
                </license>
            </permissions>
            <related-article ext-link-type="doi" id="relatedArticleReport77997" related-article-type="peer-reviewed-article" xlink:href="10.12688/f1000research.42125.1"/>
            <custom-meta-group>
                <custom-meta>
                    <meta-name>recommendation</meta-name>
                    <meta-value>reject</meta-value>
                </custom-meta>
            </custom-meta-group>
        </front-stub>
        <body>
            <p>
                <list list-type="bullet">
                    <list-item>
                        <p>You are using the Japanese translation of the questionnaire used by Torous et al. (2016). Before conducting this survey, did you verify that the results obtained from the Japanese translated version of the questionnaire are equivalent to the original questionnaire?</p>
                    </list-item>
                    <list-item>
                        <p>In the case of a manuscript, even if the product name is in Japanese, I think it would be better to describe it in English (or in romaji, etc.).</p>
                    </list-item>
                    <list-item>
                        <p>As for the correlation, if it is around 0.2, it is almost uncorrelated rather than weakly correlated, isn't it?&#x00a0;Generally speaking, 0 to less than 0.3: almost no correlation, 0.3 to less than 0.5: very weak correlation, 0.5 to less than 0.7: correlation, 0.7 to less than 0.9: strong correlation, and 0.9 or more: very strong correlation.</p>
                    </list-item>
                    <list-item>
                        <p>Should the impact of gender differences not be considered? If the difference between men and women was not examined because there was no significant difference, I think an explanation to that effect and presentation of the results would be necessary.</p>
                    </list-item>
                </list> I think it is an interesting study, but I think it needs to be carefully examined again for more detailed results and correlations.</p>
            <p>Is the work clearly and accurately presented and does it cite the current literature?</p>
            <p>Yes</p>
            <p>If applicable, is the statistical analysis and its interpretation appropriate?</p>
            <p>Partly</p>
            <p>Are all the source data underlying the results available to ensure full reproducibility?</p>
            <p>Yes</p>
            <p>Is the study design appropriate and is the work technically sound?</p>
            <p>Partly</p>
            <p>Are the conclusions drawn adequately supported by the results?</p>
            <p>Yes</p>
            <p>Are sufficient details of methods and analysis provided to allow replication by others?</p>
            <p>Partly</p>
            <p>Reviewer Expertise:</p>
            <p>NA</p>
            <p>I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above.</p>
        </body>
        <sub-article article-type="response" id="comment7144-77997">
            <front-stub>
                <contrib-group>
                    <contrib contrib-type="author">
                        <name>
                            <surname>Robb</surname>
                            <given-names>Nigel</given-names>
                        </name>
                        <aff/>
                    </contrib>
                </contrib-group>
                <author-notes>
                    <fn fn-type="conflict">
                        <p>
                            <bold>Competing interests: </bold>No competing interests were disclosed.</p>
                    </fn>
                </author-notes>
                <pub-date pub-type="epub">
                    <day>14</day>
                    <month>9</month>
                    <year>2021</year>
                </pub-date>
            </front-stub>
            <body>
                <p>Thank you very much for taking the time to review the article, and I apologize for taking so long to respond to your comments. I've updated the manuscript now to address your concerns as follows: 
                    <list list-type="order">
                        <list-item>
                            <p>&#x00a0;Apart from the rigorous translation/back-translation process, there were no further checks to verify that the results obtained are equivalent to the original English questionnaire. Given that (1) the questionnaire does not really have multiple items measuring the same construct and (2) it is possible that there are differences between Japanese and American respondents, it may not be feasible to do this kind of verification. I have added some text to the limitations to make this clear.</p>
                        </list-item>
                        <list-item>
                            <p>&#x00a0;I've changed all the product names to either romaji or English.</p>
                        </list-item>
                        <list-item>
                            <p>&#x00a0;I have altered the interpretation of the correlation coefficients slightly and added citations to justify the interpretations used here. I agree that several of the correlations found here are negligible, so I have used this word to clarify that. I do think that it is reasonable in this context to interpret a correlation of &gt;0.4 as weak to moderate (Akoglu, 2018).</p>
                        </list-item>
                        <list-item>
                            <p>&#x00a0;I analysed the impact of gender differences and added these results into the manuscript.</p>
                        </list-item>
                    </list> </p>
                <p> Thank you again for your helpful comments, I really appreciate the feedback.</p>
                <p> </p>
                <p> References</p>
                <p> Akoglu H. User's guide to correlation coefficients. Turkish journal of emergency medicine. 2018 Sep 1;18(3):91-3.</p>
            </body>
        </sub-article>
    </sub-article>
</article>
