Title: Co-designed, culturally tailored cervical screening education with migrant and refugee
women in Australia: A feasibility study
Version: 1 Date: 25 May 2022
Reviewer's report:
Introduction
- Line 47-50 – the references provided to outline a disparity in cervical screening participation
between Aus born and CALD participants will need updating. Reference 8 (Weber et al 2014)
is a paper that does not provide cervical screening participation rates in Australia. Downs et al
is a US focused paper. I recognise that the data on cervical screening participation in Australia
by cultural identity is very patchy however I suggest that you check out Yeasmeen et al (2019).
Alam et al (2022 – Women’s Health SAGE) provides self-reported rates in cervical screening
for South Asian women in Aus. There are other older data linkage studies in NSW (early 2010’s)
which also demonstrate a disparity in participation for specific population groups.
- Given that this study has been submitted to a journal with international readership, I suggest
that somewhere in lines between 59-52, that the geographical location of New South Wales in
Australia is explained. Suggest also explaining the abbreviation of NSW when first introduced
in the manuscript.
Methods
- Line 89-90 reads: “One event that was expecting over 100 participants was due to be held the
day after the lockdown was announced”. Would you be able to explain whether this event took
place (or not)?
- In line 216, I suggest noting the total number of participants in forums and outlining the
participation rate/% of those who completed the evaluation vs attending forums
- To strengthen the data analysis section, I suggest outlining whether data saturation was reached
and how this was determined.
Results and discussion
- No comment on the results and discussion. Results are very well presented with appropriate
use of data to support themes. Discussion provided embeds manuscript with current evidence
and provides important and timely recommendations. A very important contribution to the
literature on program design, acceptability and implementation of co-designed and tailored
health promotion around cervical screening + other health concerns of the community
Overarching comment
- I am surprised at the absence of inclusion around self-collection cervical screening in both the
program design, delivery and evaluation. Given that self-collection cervical screening was made
available for under-screened and never-screened participants (i.e. hard to reach populations,
like this study aimed to engage) in Australia in December 2017/January 2018, I think it an
imperative that researchers and program implementers in cervical screening are acutely aware
of all initiatives to improve participation and engage with this. Given the studies findings around
participants fear and concern around the cervical screening test (line 390 provides a quote from
a participant “too embarrassed and ashamed to go to the doctor for this”), if self-collection
was not discussed in forums, this from my point of view, presents as a missed opportunity
to provide alternative solutions to forum attendees especially given that self-collection will be
available as a choice for all cervical screeners in Australia from 1 July 2022. Lastly, there is
evidence from international settings that self-collection is acceptable to African and Middle-
Eastern populations.