Reviewer’s report
Title: 
Determinants Factors to Pap smear Screening Among Married Women in
a City of Sout Iran: Applying the BASNEF Model
Version: 
1 
Date: 
20 Oct 2019
Reviewer's report:
Title
There is a typo in the title (south)
Introduction
First line: "Cervical cancer occurs when abnormal cells are produced and spread
in the cervix (1)." This sentence is not useful and somewhat 
imprecise.
Fourth line: Spread of cytological screening occurred not only in "recent years".
Lines 7-8: "which indicates the importance of cervical cancer among Iranian
women", actually 4.5/100000 is below 
the threshold of rare cancers.
Third paragraph: the sentence "Cervical cancer prevention methods include the
Pap smear test, proper nutrition, genital health care, circumcision of baby-boys
in childhood, visiting a physician in case of noticing danger signs, and
compliance with ethical and familial principles" is misleading: some of these are
protective factors (or better absence of risk factor as for proper nutrition or
compliance with ethical principles) and not preventive methods. Furthermore,
the possible impact of some of these interventions have never been scientifically
measured and are probably small, compared to screening and vaccination. I
suggest to drop this sentence.
Last paragraph second line: the authors say "very low" coverage, but do you
have any idea? Previous studies? Number of Pap done yearly? In the discussion
the authors cite some previous works on Pap test coverage. 
Last paragraph: I suggest not 
to use "effective" for factors.
In general the introduction is not well-framed with some concepts repeated in
different section. For example, but not exclusively, the sentence "According to
previous studies, early diagnosis and treatment in the precancerous phase can
prevent cervical cancer." at the end of first page has not reference and repeat a
concept that has been introduced in at least three points before.
Finally, I did not find a clear statement about the objective of the study. This
makes also difficult too understand the first two paragraphs of the methods.
Methods
First paragraph: Sample size calculation should be reported in detail with the
assumptions used, intraclaster correlation or design effect estimates, prevalence
estimates…. It is not clear if the study base is all the population or only that of
two centres: is a two-step sampling? Only 2 primary sample units have been
selected? Out of how many? With 2 primary sampling units the estimate will be
very imprecise.
Second paragraph: the authors mention "absence in more than one training
sessions" among exclusion criteria, but training has not been mentioned and it
not intuitive why a survey aimed at describing the population should exclude
those not attending a program.
Please, if there was a training program, describe in detail the intervention.
Results
Table 2: I suppose 
column n. 6 is a mistake.
Multivariate analysis: what does it mean 
"based on different BASNEF model
structures"?
I do not understand table 3 at all.
Table 4: what the coefficients (and thee ORs) represent? Are they for the unitary
incremental? If yes you should report what is the unitary increase and what is the
entire range. 
Discussion
Last sentence of the first paragraph: "In Dayyer, most women did not attend the
Pap
smear screening because they cared about their children more than themselves,
did not devote sufficient
time to self-care and check-ups, felt ashamed of vaginal examination, had no
access to laboratories, and
could not afford the high costs of the examination" it is not clear if this is a new
finding, an hypothesis or a finding from a previous study, please clarify.
Third paragraph: "In a cross-sectional study in the US," why mentioning one
study conducted in US? There are hundreds 
of studies and thousands of routine
statistics from industrialized countries, why 
reporting this one? The comment is
somewhat obvious. I suggest to drop this sentence or to better develop the
discussion about differences between industrialized and non-industrialized
countries. 
In the limits section you should also discuss the possible selection of the
population. I cannot understand the possible effect of selection bias since I did
not understand exactly the exclusion criteria.
Conclusions
The sentence "Cervical cancer can be detected at earlier stages" is imprecise,
actually cervical cancer can be prevented through identification and treatment of
pre-invasive lesions. 
.
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
No
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the
authors.
Yes
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Yes
Are you able to assess any statistics in the manuscript or would you
recommend an additional statistical review?
If an additional statistical review is recommended, please specify what aspects
require further assessment in your comments to the editors.
I am able to assess the statistics
Quality of written English
Please indicate the quality of language in the manuscript:
Not suitable for publication unless extensively edited
Declaration of competing interests
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