Reviewer’s report
Title: 
Acceptability, simplicity, and relevance of the new Human
papillomavirus/DNA test among 35- year-old ever-married women in a district
of Sri Lanka: Focus group discussions
Version: 
1 
Date: 
24 Sep 2020
Reviewer's report:
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REVIEWER'S COMMENTS ON THE MANUSCRIPT "ACCEPTABILITY,
SIMPLICITY AND RELEVANCE OF THE NEW HPV/DNA SCREENING
IMPLEMENTATION AMONG 35 YEAR AGE COHORT EVER MARRIED
WOMEN IN A DISTRICT OF SRI LANKA: FOCUS GROUP DISCUSSIONS
"
I wish to appreciate the authors for a study which has potential to be very good.
My comments are made with the intention for it to be so and are purely 
of
constructive 
intent.
SN LOCATION/ TEXT COMMENT/ RECOMMENDATION
1 TITLE You need to explain clearly why you selected the 35 year old women
and why they had to be married to be included in the study. There is nothing
peculiar about this age and marital status when it comes to HPV infection and
cervical cancer susceptibility. 
2 
Please explain the connection between 
24 (ie. 3 x 8) and 89 as mentioned. It is
not clear.
3 Page 5, Paragraph 1, Line 3 Change "them" to "the virus"
4 Page 5, Paragraph 2, Line 3 The statement requires a reference
5 Page 5, Paragraph 3 You need to provide evidence of low coverage in Sri
Lanka
6 Page 5, Paragraph 4, Line 2 Needs to be rewritten for better clarity. Change
"i.e." to "these include…"
7 Page 6, Paragraph 2 You mentioned "some" but have only have a single
reference. It will look like you are referencing another study which mentioned
several sources instead of individually mentioning them yourself.
8 Page 6, Paragraph 2, Line 4 Please explain "≥ ASCUS".
The objective of this study makes it sound as if the women are experts who
scientifically determined the reliability , accuracy, simplicity and suitability of
the DNA test. This is a misleading impression which recurs throughout the
manuscript.
The only quality of the test which these women can confirm with full veracity is
how acceptable it is to them. Every other property of the new test is measured "as
perceived" by them. This needs to be made very clear so that readers can
understand and so that the authors are not accused of making spurious
conclusions. 
9 Page 7, Paragraph 2, 
You mentioned that the framework was developed based
on existing literature and by experts. It will be helpful to mentioned some key
documents that aided this process. This will aid other researchers who may want
to do same.
Also mention the background and area of expertise of the experts to support the
quality of tool development.
10 Page 7 You mentioned 6 informative questions. Please briefly mention them.
Also the process of obtaining informed consent needs to be explained.
Was there any attempt to pilot the study tool before deployment? This should be
mentioned briefly.
11 
I would prefer the word "lead author" or "principal investigator" to "first
author". This is the truth even if the lead author is junior in rank to others, as is
seen in this project.
What was the method of analysis? Was it manual content or by use of software
like NVivo? Please clarify.
12 
Please note that "Theoretical saturation" is used when conducting 
Key
informant interviews and not FGDs. You stop KIIs when 3 subsequent
interviews have not yielded new information. In FGDs the number and duration
are predetermined. I suggest you remove that statement.
13 RESULTS 
Section For ease of understanding, each new finding you identify
should be presented in a new paragraph.
14 
Please explain what you mean by a neutral test, and how these women could
be in a position to determine this. It is a bit confusing.
15 
Following stratification of respondents into urban, estate and rural, where
there any differences in perception and understanding of the test across the 3
groups. That could provide important information on how socio demographics
affect perception.
Also, what is peculiar about the "estate" group?
16 
Was this a mixed method study or strictly FGD based? I must say that you
have reported some of your findings as if there is a quantitative component. The
methodology of an FGD does not allow each participant to answer every
question individually. It is based on consensus. So your presentation of responses
to each question does not look appropriate or even feasible.
It also raises vital questions. If there is any form of 
quantitative data collection
here, it will be deemed invalid because the sample size used cannot be
considered representative of the study population in such a situation. Please
address this.
17 
It would have been nice to see the FGD guide. It would help the reader
understand the nature of the discussions.
18 DISCUSSION The discussion section needs to improve beyond just restating
findings. There are key questions which an inquisitive reader wants answered.
What are the possible explanations for what you have observed? Why have your
findings differed from/ tallied with those of others? What are the implications
for public health practice in Sri Lanka and other developing countries?
I would like to recommend an article available online "How to Write a Strong
Discussion in Scientific
Manuscripts by Rita N, PhD " published by BioScience writers. It is quite useful.
19 Page 17, Paragraph 1 Please avoid making statements not backed by your
results or available literature (with references).
20 GENERAL STATEMENT There missing words and grammatical errors
throughout the manuscript which made comprehension challenging. I would like
to recommend "GRAMMARLY", a free app available online which I have found
to be very useful in my own work.
21 
Overall I found the manuscript quite interesting and would like to thank the
authors for a good job.
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Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
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from apparent manipulation?
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