Title: Sexual function index adaptation for breast cancer patients (FSFI-BC)- Translation and
Psychometric properties of Persian version
Version: 2 Date: 19 Feb 2023
Reviewer's report:
Thank you for the opportunity to read and comment on the study entitled 'Sexual function index
adaptation for breast cancer patients (FSFI-BC)- Translation and Psychometric properties of
Iranian version'.
since we need instruments to assess the sexual function index adaptation for breast cancer
patients that are adapted in as many languages as possible in order to enable comparative studies
in this field. Nevertheless, the manuscript does not seem to be in a high-quality version yet.
Besides some issues with formatting and grammar, there are several points where you need to
elaborate more on the literature as well as on the implications of your analyses. Additionally, I
find additional analyses concerning items and reliability necessary.
Please find my detailed comments below;
1. in your title Iranian version is not correct, Iran is a pluralistic country with Kurdish, Turkish,
Arabic, and other linguistic ethnic groups. Instead, write the Persian version of the tool...  in
the Iranian sample.
2. The article needs native translation, it is not fluent.
3. I would suggest that in the abstract, the methods should be fully addressed before moving on
to discuss the key results.
4.  please check the journal formatting.
5. The text should undergo additional proofreading since there are some spaces left, Please check
the text thoroughly.
6.  in the Background section I don't understand the following sentence
(This condition is as distressing as cancer itself [2, 8-11])
7. In the sentence (prevalence of sexual dysfunction following the diagnosis and treatment of
cancer varies between 15 and 100%)
Is it really possible to rely on a study that showed the prevalence 100%?
8.  in the Background section(Health care providers also have  difficulty to enter their patient's
sexuality worlds)
you might elaborate on the cultural aspects of this finding in Iran.
9.  in the Background please also elaborate on the general form of the (FSFI-BC) (number of
items, how was it developed, etc.) as well as on general psychometric properties of the scale
such as item characteristics and reliability.
also, the research aim is very vague. I would prefer to see, at the end of the Intro, a clear
statement regarding the aims, methods, and criteria that would infer ‘acceptable’ performance.
For example, What is the expected factor analytic solution?
10.  I do not think that the EFA is a necessary part of the analysis and the CFA is done at the
scale, rather than item, level. The  (FSFI-BC)  has a clear factor structure based on the scoring
of the scale, and there have been numerous studies that have reported support for this using
CFA. I suggest that an item-level CFA is conducted, and adding a second-order model as well
(as this may be implied by high first-order factor correlations). The factor loadings and factor
correlations should be reported.
11.  A ‘Data Analysis’ section should be added so that the analytic strategy is presented a priori,
rather than being revealed in the Results section. for example, it should include the fit indices
used in the factor analysis, the cut-off criteria which would indicate acceptable or good model
fit,  etc.
12. Further detail is required on the demographic characteristics of the sample, and more
descriptive information is needed throughout the results. The means (and SDs) for all scales and
subscales should be reported early in the Results section.
13. the data collection remains fairly unclear to me.  Where were the participants recruited? Did
they sign an informed consent? How was the procedure of the study? Did they get anything in
return for participation? How was the dropout of the study? How representative is the sample
for the all-women with breast cancer population? What were the occupation and educational
levels of participants? How long did it take for the participants to fill out all questionnaires that
are presented in the study?
14.  Remove the demographic information from the table and explain it briefly in the text.
15. You have not mentioned the main method of your study.
16. The results section needs a major revision.
17. Power analysis gives information about the minimum effect size that will be correctly
detected with the given sample size. Please elaborate on the magnitude of test power with your
sample size.
18. The discussion section has not established a proper link with the introduction because the
literature on the tool is not well-reviewed in the introduction.