Title: The Effectiveness of Educational Intervention based on the Health Action Model )HAM)
in Improving Breast Cancer Screening Behaviors
Version: 4 Date: 21 Jan 2023
Reviewer's report:
The authors have significantly improved the manuscript, however, a big issue remeans in
the results and methods sections. Really, the authors need to take enough time to review the
manuscript and all authors have to contribute significantly and equally before they resubmit it.
I think if they collaborate well the issues we find can be successfully adressed and facilitate the
future review.
The following issues need to be adressed.
1. Unify the study or writing the ideas on good order to make the idea of each paragrapgh more
understandable. This means that each sentence must complete each other. Do not lose your focus/
expression when  you are writting your ideas. Do not mix the ideas in one paragrapgh. There
remains many sentences and paragraphs uncomplete within this manuscript. An example; the
paragraphs of abstract are incomplete.
The results presented in the abstact are poor and not fitting your study design and results section.
They are not informative to the readers and not responding to your study objective.
3. Introduction :
Please, rephrase your second sentence of the introction. You cannot start with numnber « 1.7
million new breast cancer ...» It is better to say « More than 1.7 million new cases of breast
cancer… ».
Methods:
Why did you choose semi-experimental study design? Why not quasi-experimental design?
Indeed, the subheading should not be type of the study; it should be study design.
4. Results
What do you mean when you say « Diploma and under, Associate and upper » in education?
Why canyou not use grade or year of education? Please, more clarifications are essential.
The following variables are confusing (in table 3). « Income » is it monthly income or weekly?
The results section has good results but it is poorly interpreted which has an impact in the results
reported in the abstract and discussion parts.  For example; the results from the table 4 and table 5
are not interpreted. Please, try to improve and include real interpretations and then try to include
some statistical values to support your interpretations in the results section.
For example , you can present your results as follows (for table 4).
Our results indicated that those who were assigned to the interventions and those who were not
assigned presented no significant difference in knowledge; but those who who benefited from
the intervention (M=10.64, SD=1.5, p<0.001) had higher level of knowledge with a significant
mean difference (Mean diff.=2.28, SD=-0.69, p<0.001) after 3 months of the intervention than
those who were not assigned to the intervention (M=7.46, SD=2.7, p<0.001). Later, a significant
mean difference of knowledge after six months was also found with a higher level of knowledge
among those who were assigned to the intevention (M=11.57, SD=0.74, p<0.001) than their
counterparts (M=6.89, SD=2.6p<0.001).
5. Discussion
This section is not starting well. Please, you can start with your aim and then discuss your ideas
approprietly.
Minor errors :
1. write Health Action Model (HAM)
2. write « study limitations and strengths » as one subheading.
3. Remove the subheading « recomendations » after conclusion (but keep the sentences of
recommendations).
4. All key words must be started with a capital letter.
5. As you used ‘Background’ in the abstract, please, use replace introduction by ‘Background’
in the subheading of the main text of the manuscript. Or you can use introduction in the abstract
and then body of your text.
6. Please, pay attention to use the characters such &, / in your text. They can be replaced with
‘and’ or ‘or’. For example; « midwives/physicians’ can be written as ‘midwives and physicians’
7. On page 4; the adverbs « but unfortunately » are the same. Please, rephrase this paragraph.
8. In the last paragraph, there is a gramatical errors in the following sentence there was neither a
study on cancer screening behaviors regarding this model, nor a comprehensive study on three
screening behaviors…. ». I can suggest you to remove the use of « neither » to avoid confusion.
9. Please, when you write the abbreviation at the first time, you have write it in full and then
abbreviation. In the next parts, you can be allowed to use the abbreviation. Example; check the
methods section « NCSS PASS »
10. Font size is not the same. Please, check page 12.
11. The subheading ‘Findings’ in abstract and in the main text can be replaced with ‘Results »
12. In table 4, you can remove #0.0001 and then write <0.001 for high statistical significance;
#0.002 can be replaced with <0.01.