1. Role and Responsibilities of Reviewers

Peer reviewers are invited to evaluate the scientific, methodological, ethical, and scholarly merits of manuscripts assigned by the Editorial Office. Their principal responsibility is to provide an independent expert assessment that assists the journal in reaching an informed editorial decision.

Reviewers must:

• Provide Independent Assessment: Evaluate manuscripts impartially and without inappropriate personal, institutional, commercial, or disciplinary bias.
• Assess Scientific Quality: Examine the suitability of the research design, analytical methods, evidence, and interpretation.
• Evaluate Scholarly Contribution: Consider originality, conceptual or methodological advancement, clinical relevance, and other contributions appropriate to the manuscript type.
• Identify Substantive Limitations: Explain important weaknesses, uncertainties, unsupported claims, and reporting deficiencies.
• Provide Constructive Recommendations: Suggest scientifically justified and feasible improvements that would strengthen the manuscript.
• Respect Confidentiality: Protect unpublished manuscripts, research materials, author information, and the editorial process.
• Disclose Relevant Interests: Identify relationships or circumstances that may compromise, or reasonably appear to compromise, independent evaluation.
• Observe Agreed Deadlines: Respond promptly to invitations and communicate anticipated delays.
• Support Editorial Judgment: Provide a reasoned recommendation while respecting the editor's responsibility for the final decision.

1.1 Expertise and Acceptance of Invitations

Reviewers should accept assignments only when they possess sufficient expertise to evaluate the principal subject matter and relevant research methods. A reviewer who can assess only part of a manuscript should disclose this limitation when responding to the invitation or preparing the review.

Where a manuscript requires expertise beyond the reviewer's competence, the reviewer should inform the Handling Editor rather than provide unsupported judgments on unfamiliar methods or subject areas.

2. Confidentiality

Manuscripts submitted to Health Nexus are confidential scholarly communications. Reviewers must protect manuscript content, associated research materials, review correspondence, and other information obtained through the peer review process.

Reviewers must not:

• Share, circulate, publish, or publicly discuss an unpublished manuscript without authorization.
• Use unpublished findings, ideas, methods, images, data, or other manuscript content for personal research or professional advantage.
• Disclose confidential manuscript content to colleagues, students, trainees, or external consultants without editorial permission.
• Upload manuscript files, supplementary materials, reviewer reports, or confidential correspondence to unauthorized external services.
• Disclose another reviewer's identity, private editorial comments, or information concerning the manuscript's editorial status.
• Retain or reuse manuscript materials for purposes unrelated to the authorized review.

2.1 Consultation and Review Assistance

A reviewer who wishes to consult a colleague, trainee, or specialist must obtain prior authorization from the Editorial Office. Authorized contributors must comply with the same confidentiality and conflict-of-interest requirements as the invited reviewer.

The reviewer must disclose the identity and contribution of any approved individual who substantively assists with the assessment. Responsibility for the review remains with the formally invited reviewer.

2.2 Secure Handling of Manuscript Materials

Reviewers should use appropriate secure storage and communication practices when handling manuscript files. Local copies and notes containing confidential content should be securely deleted or disposed of after completion of the review, unless continued retention is specifically authorized or legally required.

The obligation of confidentiality continues after the reviewer has submitted a report or the editorial process has concluded. Publication of an article does not automatically authorize disclosure of confidential reviewer correspondence or editorial deliberations.

3. Conflict of Interest

Reviewers must disclose any financial, institutional, personal, professional, intellectual, or other interests that could reasonably influence, or appear to influence, their independent judgment.

Potential conflicts may include:

• Financial relationships with organizations, commercial entities, or research sponsors relevant to the manuscript.
• Recent or ongoing research collaborations with individuals reasonably believed to be involved in the work.
• Close personal, supervisory, employment, or institutional relationships.
• Direct academic or commercial competition that may materially affect impartiality.
• Strong personal or professional interests that could compromise objective evaluation.
• Prior involvement in the study, manuscript preparation, data analysis, or associated research project.

3.1 Disclosure and Recusal

Reviewers should disclose relevant interests before accepting an invitation. Where a possible conflict becomes apparent during the review, the reviewer must notify the Handling Editor promptly and await further instructions.

Reviewers must decline or withdraw from an assignment when a conflict prevents fair and independent assessment. The Handling Editor may determine whether a disclosed relationship permits continued review or requires reassignment.

3.2 Maintaining Impartiality

Reviewers must not favor or disadvantage a manuscript because of the perceived reputation, geographical origin, institutional affiliation, academic seniority, medical tradition, personal characteristics, or professional relationships of its authors. Reviews must focus on the quality and relevance of the submitted scholarship.

4. Ethical Considerations

Reviewers play an important role in identifying potential research and publication ethics concerns. They should report specific, evidence-supported concerns confidentially to the Handling Editor rather than make unsupported allegations or independently attempt to establish misconduct.

Relevant concerns may include:

• Originality: Potential plagiarism, inappropriate duplicate publication, or misleading reuse of previously published work.
• Research Data: Possible fabrication, falsification, material inconsistencies, or unexplained analytical irregularities.
• Research Images: Potentially misleading manipulation, duplication, inappropriate reconstruction, or misrepresentation of scientific images.
• Ethics Approval: Apparent deficiencies involving institutional review, animal welfare, informed consent, or publication consent.
• Trial Registration: Missing or inconsistent registration information where applicable.
• Clinical Safety: Material concerns involving unsafe research procedures, unsupported therapeutic claims, or misleading descriptions of medical interventions.
• Competing Interests: Apparent undisclosed relationships or sponsor involvement relevant to the interpretation of findings.
• AI-Related Integrity: Possible fabrication of references, synthetic evidence presented as authentic data, or other materially misleading AI-assisted content.
• Reporting Transparency: Material omissions affecting the reproducibility, validity, or interpretation of the work.

4.1 Reporting Ethical Concerns

Reviewers should describe relevant concerns precisely, identify the affected manuscript sections or supporting evidence, and explain why the issue may require further investigation.

Sensitive concerns should ordinarily be communicated through the confidential comments to the editor. Reviewers must not independently contact the authors, their institutions, study participants, or other external parties concerning allegations arising from the confidential manuscript.

4.2 Proportionate Assessment

A potential inconsistency, automated screening result, or unusual manuscript feature does not automatically establish misconduct. Reviewers should distinguish between methodological shortcomings, reporting errors, uncertainty, and potentially deliberate misrepresentation. Formal investigations and editorial determinations are handled under the journal's Publication Ethics Policy.

5. Review Criteria

Manuscripts must be evaluated according to their article type, research objectives, scientific or scholarly methods, evidentiary basis, and relevance to Health Nexus. Reviewers should apply appropriate disciplinary criteria rather than impose methodological expectations unrelated to the actual research design.

5.1 Scientific Quality

Reviewers should assess:

• Whether the research question, objective, or scholarly problem is clearly defined.
• Whether the selected study design or analytical approach is appropriate.
• Whether sampling, recruitment, measurements, interventions, or source selection are adequately described where applicable.
• Whether statistical, qualitative, computational, clinical, historical, or theoretical methods are appropriate to the study.
• Whether the results or arguments are supported by credible evidence.
• Whether uncertainty, limitations, potential biases, and alternative interpretations are adequately discussed.
• Whether the conclusions remain proportionate to the strength and scope of the evidence.

Reviewers must not require quantitative statistical analysis for manuscripts whose legitimate research contribution is theoretical, historical, interpretive, or otherwise non-quantitative. Conversely, empirical claims must be supported by the appropriate methods and evidence.

5.2 Originality and Novelty

Reviewers should consider:

• The scholarly contribution relative to relevant existing literature.
• The significance of new findings, improved methods, critical synthesis, or conceptual development.
• Whether the study adds meaningful knowledge to its research field.
• Whether originality claims are accurate and appropriately qualified.
• Whether the contribution is suitable for the selected article category.

Originality is not limited to experimental novelty. Rigorous evidence synthesis, methodological clarification, critical theoretical argumentation, clinically informative observations, and well-supported scholarly perspectives may constitute valuable contributions.

5.3 Disciplinary Relevance and Interdisciplinary Contribution

Reviewers should evaluate:

• Relevance to the journal's scope and the manuscript's declared discipline.
• Appropriateness of the disciplinary concepts, source materials, methods, and interpretations.
• Clinical, scientific, theoretical, methodological, or public health significance where relevant.
• For interdisciplinary manuscripts, whether the integration is conceptually coherent and methodologically justified.
• For TCM or integrative medicine manuscripts, whether clinical and therapeutic claims are consistent with the available evidence and applicable research standards.

Interdisciplinary contribution should be evaluated when authors claim such a contribution or when interdisciplinary analysis is central to the study. It must not be imposed as an additional requirement on otherwise eligible independent disciplinary research.

5.4 Clarity and Structure

Reviewers should assess:

• Logical organization and consistency of the manuscript.
• Clarity of the research objectives, methods, findings, and conclusions.
• Appropriate terminology and accurate presentation of scientific or scholarly concepts.
• Adequacy of tables, figures, references, and supplementary explanations.
• Compliance with relevant reporting standards and article-type requirements.

Reviewers should distinguish language-editing deficiencies from substantive methodological or scientific weaknesses. Recommendations concerning language and formatting should be proportionate to their effect on scholarly comprehension.

5.5 Ethical Compliance and Transparency

Reviewers should consider, where relevant:

• Ethics committee approval, documented exemptions, and informed consent requirements.
• Clinical trial registration and relevant study reporting information.
• Confidentiality, patient privacy, and appropriate publication consent.
• Transparent research methods, limitations, and analytical reporting.
• The availability or appropriate restriction of supporting research data.
• Relevant AI-use disclosures and sufficient reporting of AI-based research methods.
• Appropriate reporting guidelines, including CONSORT, PRISMA, STROBE, CARE, STRICTA, ARRIVE, or other applicable standards.

A mandatory Data Availability Statement is required for submissions to Health Nexus; however, reviewers must not assume that all underlying data must be publicly accessible. Ethical, legal, privacy, and institutional restrictions may justify controlled or restricted access.

6. Review Report Structure

Review reports should be structured, specific, evidence-based, and sufficiently detailed to assist authors in understanding the reviewer's assessment and the editor in reaching a well-supported decision.

6.1 Summary and Overall Assessment

Reviewers should provide a concise description of the manuscript's research objective, methodological approach, principal contribution, and overall strengths and limitations. The summary should demonstrate an accurate understanding of the work without unnecessarily repeating its abstract.

6.2 Major Comments

Major comments should address substantive issues affecting:

• Validity of the research design or methodological approach.
• Adequacy of evidence, analysis, interpretation, or theoretical reasoning.
• Scientific or clinical reliability of the conclusions.
• Important limitations, confounding factors, bias, or uncertainty.
• Essential missing methodological or reporting information.
• Material ethical or research integrity issues requiring editorial attention.

Major comments should explain why each issue matters and, where feasible, identify a scientifically appropriate means of addressing it. Reviewers should distinguish problems that can be resolved through revision from fundamental weaknesses requiring a different research design.

6.3 Minor Comments

Minor comments may address terminology, explanatory detail, reference accuracy, figure captions, table presentation, language clarity, formatting, and other issues that do not independently undermine the principal scholarly findings.

6.4 Recommendation

Reviewers should select an appropriate recommendation and provide reasoning consistent with the manuscript's strengths, limitations, and the seriousness of unresolved concerns.

Review recommendations are advisory. Reviewers should avoid stating that a particular editorial outcome is guaranteed or final.

6.5 Confidential Comments to the Editor

Reviewers may use confidential comments to communicate potential ethical concerns, conflicts, limitations of their own expertise, or other matters requiring editorial consideration that should not be disclosed directly to authors at that stage.

Substantive scientific criticisms that authors must address should ordinarily be included in comments visible to the authors. Reviewers should not present a positive assessment to the authors while privately recommending rejection on unrelated or undisclosed grounds.

6.6 Subsequent Review Rounds

When assessing a revised manuscript, reviewers should consider the authors' point-by-point responses, changes made, and remaining substantive concerns. New requirements should generally be limited to issues arising from the revisions or matters that could not reasonably have been identified during the earlier review.

7. Timeliness

Timely peer review is essential to effective scholarly communication. Reviewers should respond promptly to invitations and complete accepted assignments within the agreed timeframe.

Reviewers are expected to:

• Accept or decline invitations promptly.
• Consider expertise, workload, and availability before accepting an assignment.
• Complete the review within the agreed timeframe.
• Notify the Editorial Office promptly if circumstances may cause a delay.
• Request an extension in advance where additional time is reasonably necessary.
• Inform the Handling Editor promptly if the reviewer can no longer complete the assignment.

The journal's overall external review period may differ from an individual reviewer's deadline because of invitation responses, specialist availability, additional expert assessment, and other editorial circumstances. Scientific quality must not be sacrificed solely to achieve an administrative time target.

8. Use of Artificial Intelligence (AI)

Health Nexus recognizes that artificial intelligence may support limited scholarly and administrative tasks. However, confidential manuscript assessment requires strict information protection, independent human judgment, and transparent disclosure of authorized AI assistance.

8.1 Requesting Authorization

A reviewer requesting permission to use AI must identify:

• The AI tool, provider, and model or software version where available.
• The proposed purpose and scope of the AI assistance.
• The categories of manuscript or review information that would be processed.
• Relevant confidentiality, security, retention, and data protection arrangements.
• How the reviewer will independently verify AI-assisted output.

If a proposed external AI service cannot assure the confidentiality of submitted materials, the manuscript must not be processed through that service without the necessary author permission and other applicable authorizations. Editorial permission alone does not override legal or ethical confidentiality obligations.

8.2 Human Responsibility

Where limited AI assistance is authorized, reviewers must:

• Independently assess the scientific evidence and methodological quality of the manuscript.
• Verify the accuracy, relevance, and fairness of AI-assisted output.
• Disclose the use of AI to the Editorial Office.
• Avoid unsupported or fabricated criticisms, references, analyses, or recommendations.
• Protect confidential and potentially identifiable research information.
• Accept full responsibility for the final reviewer report and recommendation.

8.3 Prohibited AI-Assisted Review Practices

Reviewers must not use AI to:

• Replace substantive expert judgment or independently determine the reviewer recommendation.
• Attempt to identify blinded authors or reveal reviewer identities.
• Generate fabricated or unsupported assessments of a manuscript.
• Disclose confidential clinical, institutional, or unpublished research information.
• Evade the journal's review integrity or confidentiality requirements.

8.4 Automated Detection Results

Reviewers must not treat an automated AI-content detection score as conclusive evidence of plagiarism, fabrication, undisclosed AI use, or other misconduct. Relevant concerns should be communicated to the editor with specific supporting observations and should be assessed through appropriate editorial procedures.

Additional requirements are provided in the journal's AI & Research Integrity Policy.

9. Constructive Feedback

Reviews must be professional, respectful, specific, and focused on the scientific or scholarly content of the manuscript. Constructive criticism helps authors understand material concerns and enables editors to distinguish resolvable weaknesses from fundamental limitations.

Reviewers should:

• Identify precise concerns and explain their implications for the manuscript.
• Distinguish major validity concerns from minor presentation issues.
• Provide proportionate and actionable recommendations where feasible.
• Recognize genuine strengths as well as limitations.
• Avoid insulting, dismissive, discriminatory, or personally directed language.
• Avoid unnecessary requests for additional experiments, analyses, or manuscript expansion.
• Recommend relevant references for scholarly reasons rather than to increase citations to the reviewer's own publications.
• Respect differences in legitimate disciplinary methods and research traditions.

9.1 Proportionate Revision Requests

Reviewers should distinguish between corrections that are essential to establish the reliability of the findings and suggestions that would improve the manuscript but are not necessary for publication.

Where limitations cannot reasonably be removed through the available research design, reviewers should consider whether transparent acknowledgment and appropriately qualified conclusions would provide a scientifically acceptable resolution.

9.2 Professional Conduct

Reviewers must not use their position to advance personal disputes, demand inappropriate citations, pressure authors toward a preferred theoretical position without scholarly justification, or impose unrelated methodological requirements. Any disagreement must be expressed in professional, evidence-based terms.

10. Anonymity and Peer Review Model

Health Nexus employs a double-blind peer review model for research manuscripts selected for external assessment.

10.1 Responsibilities of Reviewers

• Do not attempt to identify authors through unnecessary investigation, external searches, or other deliberate identification methods.
• Do not include the reviewer's name, affiliation, signature, or identifying personal information in comments intended for authors.
• Avoid identifying information in review file names, document properties, and uploaded attachments.
• Do not contact authors directly concerning a manuscript under review.
• Notify the Handling Editor if author identity becomes apparent and a relevant conflict of interest may exist.

10.2 Limitations of Anonymity

Although the journal takes reasonable measures to protect anonymity, double-blind review does not guarantee that authors will be impossible to identify. Publicly available preprints, specialized research topics, prior publications, or other contextual information may permit recognition.

Incidental recognition does not automatically invalidate an assessment, but reviewers must disclose any resulting conflict or circumstance that could compromise impartiality.

10.3 Article-Type Exceptions

Editorials and Commentaries may be assessed editorially without mandatory external peer review. Where external expert assessment is arranged, applicable confidentiality, conflict-of-interest, fairness, and review integrity requirements continue to apply.

11. Editorial Decision

Peer reviewers provide independent expert assessments and recommendations. Their reports inform editorial judgment but do not themselves constitute a final decision.

The Handling Editor evaluates the manuscript, considers relevant reviewer reports, examines unresolved methodological or ethical concerns, and may recommend an appropriate editorial outcome.

The final decision is made by the Editor-in-Chief or an editor formally authorized to exercise delegated decision-making authority.

Editorial decisions may include:

• Accept.
• Minor Revision.
• Major Revision.
• Reject.

Editors may seek additional reviewers, specialist advice, or further clarification when reviewer opinions conflict or significant concerns remain unresolved.

11.1 Editorial Independence

Editorial decisions must be based on academic merit, scientific validity, ethical compliance, and the journal's published standards. Reviewers and editors must not allow article processing charges, waiver requests, financial interests, or publisher commercial considerations to influence the scientific assessment of manuscripts.

11.2 Respecting the Editorial Process

Reviewers should not independently communicate acceptance or rejection decisions to authors. Disagreement with another reviewer's conclusions or the final editorial decision does not authorize disclosure of confidential review information or interference with the journal's formal procedures.

12. Recognition of Reviewers

Health Nexus recognizes the professional contribution of peer reviewers to the quality, integrity, and reliability of scholarly publishing. Review activity constitutes an important form of academic service and should be acknowledged in a manner consistent with confidentiality and the journal's review model.

Depending on the journal's available administrative arrangements, reviewer recognition may include:

• Annual Acknowledgments: Publication of a general list of participating reviewers where appropriate and with the individuals' consent.
• Certificates of Review: Issuance of appropriate documentation confirming completed review service upon request and subject to editorial verification.
• Professional Service Records: Confirmation of review activity through authorized mechanisms that respect manuscript confidentiality and reviewer anonymity.
• Editorial Appreciation: Appropriate recognition of consistent, constructive, timely, and academically rigorous reviewer contributions.

12.1 Protection of Reviewer Anonymity

Reviewer recognition must not disclose the connection between an individual reviewer and a specific confidential manuscript without appropriate authorization.

Annual acknowledgments should not identify the manuscript titles, author names, confidential reports, or editorial outcomes associated with particular reviewers.

Review certificates and authorized professional service confirmations should be limited to information necessary to verify legitimate review activity. They must not expose information protected by the journal's double-blind review procedures.

12.2 Voluntary Participation and Integrity

Public recognition should be voluntary and must not compromise the independence of peer review. The quality of reviewer reports and compliance with professional and ethical requirements take precedence over the number of reviews completed or the recommendation outcomes.