Title: Effectiveness of a Culturally Tailored Text Messaging Program for Promoting Cervical
Cancer Screening in Accra, Ghana: A Quasi-experimental Trial
Version: 4 Date: 26 Oct 2023
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research
question(s) (brief or other article types: is there a clear objective)?
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
Yes - the approach is appropriate
EXECUTION - Are the experiments and analyses performed with technical rigor to allow
confidence in the results?
Yes - experiments and analyses were performed appropriately
STATISTICS - Is the use of statistics in the manuscript appropriate?
Not sure - I am not able to assess the statistics in this study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
Yes - the author's interpretation is reasonable
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically
sound? If not, can revisions be made to make the work technically sound?
Probably - with minor revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: Thank you for the opportunity to review this very thoughtful and
impactful manuscript on the authors’ study of a tailored SMS program for promoting cervical
cancer screening. It was evident that the authors had made a series of changes and additions to the
submission following the previous reviews.  The manuscript contained many areas of strength.
The narrative was well articulated and adequately structured with robust use of references to
support the authors’ case. Further structure to parts of the paper would have been welcome. For
example, adding in signposts within the ‘Discussion’ to indicate transitions in the narrative.
While a general background on the burden of cervical cancer is provided there are a few missed
opportunities to provide the reader with required information. The authors may wish to provide
further information on the patient pathway for screening and treatment to better illustrate where
and how the SMS push messaging fits into current care. The authors did make a strong case for
the importance of screening and why this SMS system was considered.
The section on ‘Methods’ adequately described the authors’ process and the foundations for the
study .  Within the study population, it would have been helpful to understand further why the
authors felt that bank employees were their population of interest rather than other job categories
that would bring in participants from a similar socio-economic group.
The team of authors did a good job presenting the results of the study in a clear and manageable
manner. In certain cases it would have been good to see the  narrative  expanded around certain
results that surfaced during the study. For example, having better detail around ‘ Willingness to
undergo screening’ would have been useful. Outside of this one point the authors presented the
results in an effective and impactful format.
The discussion of the findings for the study stood out as a an area of strength. Here the
authors surfaced several important areas for discussion and briefly presented those. The
discussion around the limitations of the study was thoughtful and showed the authors’ careful
reflection on the challenges with the process. The authors surfaced several specific, actionable
recommendations and research priorities that emerged as a result of the study. The authors may
wish to revisit this section and add in signposts to indicate transitions in the narrative as this
would generate a more impactful manuscript.  For example, when they present the ‘Limitations’
of the study.
REQUESTED REVISIONS:
While a general background on the burden of cervical cancer is provided there are a few missed
opportunities to provide the reader with required information. The authors may wish to provide
further information on the patient pathway for screening and treatment to better illustrate where
and how the SMS push messaging fits into current care. The authors did make a strong case for
the importance of screening and why this SMS system was considered.
The section on ‘Methods’ adequately described the authors’ process and the foundations for the
study .  Within the study population, it would have been helpful to understand further why the
authors felt that bank employees were their population of interest rather than other job categories
that would bring in participants from a similar socio-economic group.
The team of authors did a good job presenting the results of the study in a clear and manageable
manner. In certain cases it would have been good to see the  narrative  expanded around certain
results that surfaced during the study. For example, having better detail around ‘ Willingness to
undergo screening’ would have been useful. Outside of this one point the authors presented the
results in an effective and impactful format.
The discussion of the findings for the study stood out as a an area of strength. Here the
authors surfaced several important areas for discussion and briefly presented those. The
discussion around the limitations of the study was thoughtful and showed the authors’ careful
reflection on the challenges with the process. The author surfaced several specific, actionable
recommendations and research priorities that emerged as a result of the study. The authors may
wish to revisit this section and add in signposts to indicate transitions in the narrative as this
would generate a more impactful manuscript.  For example, when they present the ‘Limitations’
of the study.
ADDITIONAL REQUESTS/SUGGESTIONS:
Overall recommendations:
-In the Introduction, provide a brief background on the current pathway for cervical cancer
screening in Ghana.
-Consider adding in further signposts within the manuscript to indicate transitions in the
narrative. For example in the Introduction and Discussion.
-Expand on certain Results that surfaced in the study such as ‘Willingness to undergo screening’