Title: Reliability and validity of the Sidaamu Afoo version of the Pelvic Organ Prolapse
Symptom Score questionnaire
Version: 2 Date: 15 May 2023
Reviewer:  Tadesse Belayneh
Reviewer's report:
Thank you for allowing me to review your manuscript. The authors have submitted a research
paper regarding translation and validation of the questionnaire POP-SS in Sidaamu Afoo.
Overall, the manuscript is well written and easy to understand but a language review would
be prefer. The use of present/past Tense should be revised. I have some specific remarks in
particular lines below:
Abstract:
• Word count is above recommended, adhere to the word limit.
• Line 22:”…. the main language…” I think I know what you mean, but difficult to understand
for other reader. Please revise the word ‘main’.
• Line 19-21: (the second sentence) needs revision.
• Line 25: Do you followed any adaptation procedure to translate? If yes, please include it.
Which questionnaire is completed by symptomatic women?
• Line 44: Change the word Reliability and Validity, they are already in title.
Introduction
# Overall introduction is brief, and clear, and easy to follow. But, authors ignore the inclusion
of available evidence on magnitude and its impact globally/in Ethiopia/in specific study area.
Moreover, authors poorly justify why they start to conduct this study (translation/ validation).
What is the importance of validating POP-SS in that area? The mere absence is not a strong
justification. What type of tool is POP-SS, for what purpose it was designed for? These all needs
elaboration.
# Line 47-51: Good to revise the definition (one or more of…into or out of…). Where is reference
#1? Is 50% of all women or specific population? What do you mean by diagnostic criteria, is
that by pelvic examination or self-reported? Prevalence in LMICs exceeds 60%, where did you
get this evidence, even Ref#6, 7 doesn’t support this. I would suggest revision and avoiding a
hasty generalization.
# Line 54-58: Better to shorten it without losing its meaning.  I would suggest rewriting.
# Line 66-68: Are you interested to validate POP-SS and then to use as a screening tool? I
would suggest revision. It is also better to include which psychometric properties you wanted to
evaluate. Please specify the aims of the study by explicitly stating which types of psychometric
properties (reliability and validity) you intended to assess.
Methods and materials
• Line 72: It is worth mentioning to include study design and the phases, if any.
• Line 75: In fact, you repeat the sentence form the introduction, Line 54. Don’t repeat idea/s.
• Line 87: Why cultural? Do women have different culture in the study area?
• Line 82: I believe you need to insert "and" – and 7) A feeling of…
• Line 91-94: I am not clear with these sentences. Better to move it to Introduction or Discussion
section.
• Line 101-102: Why referred back to translators and others? Do you think these person/s
know the intended content/meaning of the tool (conceptual equivalence)? Why not referred
back to original developer/s? What changes were made after referring to translators and others,
anyways?
• Line 106: What modification was made?
• Line 107-108: Who are these six experts? Are they content experts? Which version was
evaluated by these experts?
• Line 109: It is not clear which version was used, is that V1 or V2, if any?
• Line 110: Please specify the qualification and experience of the person performing pre-testing
of the questionnaire. Also add the results of pre-testing/ piloting (ether in Result or Method
section). What were the changes made, if any, after the pilot testing to improve the readability
of the questionnaire? Which items underwent changes, if any? Did the response option match
with each item of the scale?
• Line 109-112: Where is the final version that was used for psychometric evaluation?
• Line 113: I would suggest to have some heading before study participants, probably
psychometric evaluation.
• Line 115-116: In fact, you repeat the sentence form Line 72-73.  Don’t repeat same idea.
• Line 114-116: Inclusion criteria is mentioned but not the exclusion criteria. Please specific
what were your criteria to exclude participants from the study?
• Line 126-129: Was one or both symptom/s was used to define symptomatic POP? Who
assessed the presence of this symptoms? Who did pelvic examination, which staging system
used and why? Was pelvic examiner (HCP) involved during interview?
• Line 129-131: Describe how the test retest data collection was performed: Which version of
the questionnaire was used for data collection? Where was the place (home or hospital)? Who
collected the data, were they blinded? Were patient stable, or have a change in outcome? How
and by whom stability or change was assessed? Why two weeks, why not one week?
• Line 141-147: Better to move to Result section. Is there a difference between face and content
validity?
• Line 156-161: Which type of analysis was used during EFA/PCA? Why both eigenvalues and
Scree plot was used together? Better to remove one.
• Line 171: Kruskal-Wallis’s VS Spearman’s rank correlation?? Are the outcome variable
normally distributed? Please use appropriate measurement scale in Result section.
Results
Socio -demographic characteristics
• Be economical in using words. Avoid repeated words and those which doesn’t add value to
the sentence. Reduce the text, because the information is also in the Table.
• Line 198-201: The text included are not found in Table1, why? Please also make a correction on
mean (SD), e.g. age, #childbirth on Table 1. Please add Table 1 to main document that annexed.
• Line 204: What were these few modification made? Elaborate it.
• Table 2: Better to annex it.
• Line 217-218: Good to include 95% CI with p-value.
• Line 228: " based on their accessibility through their mobile phones" – redundant
• Line243-247, 252-253: Naming of the Components were missed, why? Better to include total
% variance, eigenvalue and % variance in Table 5. Better to remove scree plot figure and text.
• Please reduce the number of Tables via merging or deleting– make it a max of 4
• Line 254-258: Redundant – avoid it
• Line 269-274: There are redundant sentences (similar with Method section) – avoid it.
Discussion
• Line 279-286;  Need revision,
• Line 308-320: I think there is a disagreement between body texts in Result section (Line
243-247). Naming needs revision.
Annex
• Good to attach (annex) the Sidaamu Afoo version.