Title: Young women’s perspectives on a user-friendly self-sampling intervention to improve
the diagnosis of sexually transmitted infections in underserved communities in KwaZulu-Natal
South Africa
Version: 0 Date: 28 Dec 2023
Reviewer's report:
This is an interesting manuscript that addresses gathering perspectives of young women in
underserved areas on barriers to conducting self-sampling for STI detection and possible
strategies to address these barriers. Given the high rates of STIs among young women in the
studied province, this is an important study that could help further progress towards addressing
this epidemic.  Reviewer suggests several edits and changes to strengthen the manuscript.
p. 4, line 65-66, Motherhood is not the only value young women bring- suggest discuss potential
consequences to young women who are infected with STIs, e.g., pelvic pain, infertility, and that
young women as a human right are entitled to good health free of infection, access to health
care, etc. so that they may pursue their life in whatever way they want to contribute. The way
currently written suggests young women's value in the world comes only from their ability to
bear children and parent them.
p. 4, line 98, Define DCE
Line 130 on p. 6 contains a typo, an incomplete sentence.
p. 7, lines 152-154, “There is a smaller risk of confident participants dominating the knowledge
creation process, Multiple responses to the research question are generated.” Appears to be a
run-on sentence.  I believe the authors are trying to express two different ideas and if so, each
idea should be in a separate sentence. Also, “smaller” than what? If smaller than in traditional
focus group settings, the authros should complete the sentence to reflect that idea.
p. 161, p. 7/ The use of “co-creation” is confusing. It is used once here and once in the abstract.
It is never defined. Suggest just using NGT since co-creation is not defined. Suggest perhaps
something like, “The NGT, conducted on February 17, 2023, was performed in four consecutive
phases.”
p. 7, 161-165. Suggest using a word different than “determining.” It seems the authors
were assessing perspectives, identifying perspectives, or something similar to that. “Assessing
barriers…”, “identifying what features might promote efficient delivery method…”
p. 8, lines 171-175, the process described does not include silent generation. Did silent generation
happen? Also, was there round-robin sharing? These were two of the stages described in lines
156-158.
p. 8, Lines 178-182: Did the PI and researcher group the results during the same session? If
so, should state that. What did the participants do while the authors were doing the grouping?
Define “cross-check”.
p. 8, ” All eight participants were between 18–24 years of age.” Since the includsion criteria
was that a woman must be between 18 and 24 this doesn’t tell us very much. Consider giving
the average age.
p. 9, line 193, “The same approach was used to identify the least important from the most the
strategy according to the participants.” This sentence does not make sense, perhaps a typo. Please
revise.
Fig 1 needs a legend. Colors are there but not labeled in the legend.
The barriers described in the paper are the “themes” that were identified by the authors, correct?
It would be nice to see the actual words of the participants as examples of the responses that led
to the author-determined themes. For instance, what were some of the exact quotes related to
the stigma of STIs. This would help to make the paper more transparent and also richer.
Authors go into detail about the suggestions for promoting self-sampling. This is great. Would
be nice to have parallel section about what participants said about barriers to accessing STI care.
“Online system to assess symptoms and register to receive or collect self-sampling kits to
accommodate people with disabilities” on page 12. This isn’t a wholly accurate label. According
to the paper, particioants suggested this would help preserve confidentiality and anonymity.
So, suggest changing this suggestion to read something more like, “Online system to assess
symptoms and register to receive or collect self-sampling kits to preserve confidentiality and
anonymity and also to accommodate special groups such as people with disabilities.”
Line 278, suggest adding, “Participants also suggested that Electronic communication of results
would help to maintain confidentiality.”
p. 14, line 306, at least one reference is needed for this sentence.
p. 14, line 311, “prone to denying that they had an STI.” This is the first mention of such a
finding. This is not included in the results section.
p. 16, “The use of various electronic (eHealth) platforms including SMS, email, and online
systems to access healthcare services is well documented and has proven useful for everyone
and in places where access to basic services is limited.” This sentence needs at least one citation
and also, “has proven useful to everyone” is hardly likely. Suggest striking this phrase.
p. 16- “Several studies have further demonstrated the usefulness of eHealth solution is improving
access even for people living with disabilities [50].” Suggest the citations for this sentence be
the actual studies themselves, not the cited reference which is largely a position piece.
p. 17;- “The current NGT is a build-up of NGT, which addressed the same questions, but
was conducted among healthcare workers employed in primary healthcare facilities in similar
underserved communities. By involving participants comprising of healthcare workers and
young women from different underserved urban communities the study captured a range of
experiences and perspectives, which enhances the generalizability of the findings and potential
applicability of the interventions that may be developed in response.” Nothing about healthcare
workers has been mentioned until this point. The authors must be referring to a different paper/
study? Up until this paragraph, readers have only been informed of young women participants.
Authors need to address this.
p. 18, line 401-  Not clear how the authors “co-created strategies to deliver self-sampling
interventions.” Suggest revising and not using term “co-create” unless this is defined and well
explained in the methods section of the manuscript.