Reviewer's report
Title:Motivations and barriers to cervical cancer screening among HIV infected
women in HIV care: a qualitative study
Version:1Date:5 March 2015
Reviewer: Megan Huchko
Reviewer's report:
This is a really important paper because it explores women's feelings towards
and experiences with cervical cancer screening in an open-ended way, providing
a wealth of information. I would like to see some reorganization of the categories
to ensure that the comments/examples given are actually examples of the
themes the authors have defined. Specific comments are given below.
1. Line 81: Please explain the statement that “parallel HIV and sexual and
reproductive health (SRH) services including cervical screening are prominent
barriers to cervical screening.” Are there references to support this? Perhaps
lower wait times, less HIV-related stigma and more specialized health care
providers may make non-integrated services attractive to some HIV-infected
women. Minor essential revision
2. I would like to see more information about how much cervical cancer
education women had received prior to undergoing the interviews. Was there
education provided as part of the routine clinical care? Line 310 mentions that
Mildmay had integrated cervical cancer education—this should be moved to a
description of the study setting. Discretionary Revision
3. Line 108/109: It would be important to see the interview guides or samples of
questions. The document could be submitted as an appendix, or a sample of the
questions could be included as a table. Minor Essential
4. Line 119: How were the interview guides pre-tested? Minor Essential
5. Line 165: The sentence starting with “whereas they knew..” is unclear. It may
help to know what question prompted this response. Minor Essential
6. Line 281: Myths and Misconceptions seems to have significant overlap with
the fears, including the same statement about fears of having parts of her body
removed. Should these be combined into the same category, or can the authors
further develop the theme of myths and misconceptions in a way that is different
from the fears. Major Compulsory
7. Line 341: Lack of clear information about importance of repeat screening—this
runs along the same theme as “inadequate education about cervical cancer
screening” and could be collapsed into a single theme. Major Compulsory
8. Line 361: I would include this sentence in the above paragraph about the lack
of reminders. Discretionary
9. Line 363: The lack of knowledge about the need for regular screening should
be moved either to “inadequate education” or “information about cervical cancer,
prevention and management. Major Compulsory
10. Overall, the distinction between the client-related factor “information about
cervical cancer, prevention and management” and the facility-level factor
“inadequate education about cervical cancer screening” is not clear. Obviously
there is a direct relationship and some overlap, so how are the authors
separating the two thematically?
11. Line 392: Much of the content raised in the “inadequate space” is actually
related to fears for privacy. Inadequate space specifically would mean
overcrowding, lack of available beds, etc. Please ensure the answers are
correctly classified.
12. Line 432: Should read “never screened” instead of “never screening.”
13. The end of the discussion and the conclusion could more strongly reflect the
finding that the biggest barriers to screening were related to fears,
misconceptions and lack of knowledge about cervical cancer—things that could
all be addressed with well-designed, context specific and rigorously tested
cervical cancer education. This should be targeted at both providers and clients
to ensure that women understand the importance of what they are being offered,
and the providers clearly understand their role in providing these services and
can counsel women in a sensitive and effective way.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
I declare that I have no competing interests.