Title: Factors influencing the uptake and utilization of cervical cancer screening services among
women attending public health centers in Addis Ababa, Ethiopia:  Mixed methods study  
Version: 3 Date: 22 Apr 2023
Reviewer's report:
Reviewer Comments
Overall Comments
• Cervical cancer is a significant public health issue in Ethiopia. Therefore, the results of this
study have the potential to make a significant contribution to the literature.
• There are a significant number of errors in the manuscript. Please see specific comments below.
• Also, please consider reviewing these resources for writing about qualitative and mixed
methods research:
o Mixed Methods Article Reporting Standards (MMARS): https://apastyle.apa.org/jars/mixed-
table-1.pdf
o Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for
interviews and focus groups: https://academic.oup.com/intqhc/article/19/6/349/1791966
o Good Reporting of A Mixed Methods Study (GRAMMS) Checklist: https://cdn-
links.lww.com/permalink/pq9/a/pq9_1_1_2021_03_23_dewan_20-00190_sdc1.pdf
Areas for Improvement:
• Title:
o Mixed methods studies typical have the term “mixed methods” in the title.
• Abstract
o Review and correct the grammatical errors.
• Background
o The first sentence in the background section is not accurate. There are tremendous global
efforts being made to reduce the cancer incidence and mortality rates. And the reference is not
accessible via the url included in the reference list.
o What year are you referring to with the following statement “Cervical cancer screening service
utilization was 5.47%”
• Methods
o You state that this was a mixed methods study, however, it seems like you are reporting two
different projects, which no clear discussion about how the data from each phase were integrated.
o There is no justification for the sample sizes for both projects.
o There is no mention of data saturation.
o There is no mention of how the questions for the interview guide or survey were developed.
Was there a theoretical or evaluation framework?
o  There is no mention of the validation of the qualitative study results.
o There is no mention of the interviewer characteristics.
o Where were the FGDs conducted?
• Results
o There is no clear integration of the results from both projects.
• Discussion
o This sample may not be representative of the general population because you recruited them
from cervical cancer screening clinics.
o Other key limitations of the study, such as lack of generalizability of the results and social
desirability bias were not listed.
General comments:
• There are numerous grammatical and formatting errors throughout the manuscript.
• A major missing piece is information about the participant’s HIV status. You mentioned that
some participants learned about cervical cancer screening through the ART clinic. Therefore, an
important demographic characteristic to include in your demographic tables and in the analyses
is HIV status since cervical cancer is an AIDS-Related malignancy. PLWH have higher risks
for cervical cancer.
•  Table 3. Please review the table to correct grammatical errors
o For example: Rate should be rating; Meet should be met or meets
• Additional file 1:
o Please review and correct the grammatical errors. For example, should “When did you decide
on cervical cancer screening at the facility?” be “Why did you decide on cervical cancer
screening at the facility?”?
•