Peer Review Report For: The Effects of Hospital Noise Pollution and Noise Sensitivity on Patient`s Acoustic Comfort, Noise Annoyance, and Intention to Leave [version 1; peer review: 2 approved with reservations]

Introduction Hospitals are intended to serve as healing environments; however, they are frequently characterized by high levels of environmental noise pollution that can contradict their therapeutic purpose. This study aimed to investigate the complex relationships among hospital noise pollution, individual noise sensitivity, and significant patient-centered outcomes, including acoustic comfort, noise annoyance, and intention to leave the hospital. Methods This descriptive-analytical cross-sectional study was conducted in 2024 at a public hospital in Saveh, Iran. A stratified random sampling method with proportional allocation was used to select a sample of 226 hospitalized adult patients. Objective day-evening-night noise levels (L den ) were measured over 24 hours, while subjective data on noise sensitivity, acoustic comfort, noise annoyance, and intention to leave the hospital were collected using standardized questionnaires. Bayesian Network modeling combined with delta-p sensitivity analysis was applied to examine the relationships among the variables. Results The mean L den in the studied hospital was found to be 57.95 dB (±6.61). The Bayesian Network analysis revealed that under conditions of high Level L den , the probability of high annoyance, low acoustic comfort and high intention to leave increased by 12.4%, 6.3% and 5%, respectively. Under conditions of high-Level Sensitivity, the probability of these variables increased by 9.1%, 6.2 and 4.7 %, respectively. While these two variables are at high level, the most substantial positive variations occurred in high annoyance, low acoustic comfort and high intention to leave, with increases of 26.1%, 13.1% and 10.6%. Conclusion Noise levels in the hospital exceed international standards, negatively affecting acoustic comfort, increasing annoyance, and influencing individuals’ intent to leave. Personal noise sensitivity further intensifies these effects.