Reviewer's report
Title:Awareness of Pap testing and factors associated with intention to undergo
Pap testing by level of sexual experience in unmarried university students in
Korea
Version:5Date:1 January 2014
Reviewer: Deborah Helitzer
Reviewer's report:
Comment:
This is a well-written manuscript that provides interesting information about the
knowledge, attitudes and intentions of Korean university students regarding the
Pap test and HPV vaccine. The topic is very relevant to researchers and program
planners. The comments below reflect concerns about the choice of theoretical
model, the analytical approach, and the resulting conclusions.
Major Compulsory Revisions
Methods:
1. Explain why the Theory of Planned Behavior was chosen as a theoretical
basis for the investigation.
2. Explain what is meant by “questionnaire was validated by three experts – what
kind of validation (e.g., content validity) and the process used to validate the
questionnaire or the constructs; similarly, the manuscript should report the
inter-rater reliability standard of acceptable reliability (for example, k=#0.70) and
the resulting value of the Fleiss’ kappa (used when agreement is used for more
than two raters) leading to the assessment satisfactory validity.
3. After factor analysis, how many questions were eliminated?
Results:
1. The data for 5 students were missing; why were these not eliminated in the
original round (e.g., 485 to 480)?
2. Why was “sexual experience” the primary variable of analysis? What about
other factors such as age, geographic region, year in university (e.g., freshman
vs. senior)?
3. Were women who “didn’t know” about Pap testing (38.6%) and those who had
no opinion about it (40/3%) removed from the analysis about attitudes towards
the Pap test (e.g., TPB variables)? If not, what was the rationale for allowing
them to remain in thee analyses?
4. What is the question that provides data on “heard of HPV vaccine”? Is “HPV
vaccinated/not vaccinated being used as a proxy for HPV vaccine awareness or
knowledge? Were students who had not heard of HPV vaccine removed from
subsequent analyses about attitudes to the HPV vaccine?
Discussion
1. The conclusion that “the study confirmed the usefulness of the TPB framework
to explain the intention to undergo Pap screening” is fallacious. The
questionnaire forced responses into that framework. The only way that a theory
could be considered “useful” is if a separate questionnaire relying on a different
theory (for example the Health Belief Model) was employed and the results
compared. Since that is not possible, to reach a conclusion of value it would be
important to provide the rationale for selecting TPB in the first place (see
Methods #1 above).
2. The explanation for the differences found for the individual items is not
sufficient. For example, why would sexually experienced women be more
concerned with cost of the examination for the Pap test? The data suggest they
have a significantly higher monthly allowance, so why would they be more
concerned about budget? How is the conclusion reached that “the greatest
barrier” for sexually experienced women is financial? This conclusion is based on
a comparison between the two groups, not in a ranking of barriers.
3. Other significant differences between the groups such as: “I take notice of the
opinions of family and friends” and “I can undergo a Pap test without abnormal
signs” and “guilt about having a gynecological examination” were not discussed.
4. The limitation presented that “some important influencing factors [may not
have been] included in the study” speaks to the potential inapplicability of the
theory to the problem of barriers to Pap testing.
Minor Essential Revisions
None identified
Discretionary Revisions
None identified
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.