Reviewer's report
Title:Determinants of women's likelihood of vaginal self-sampling for human
papillomavirus to screen for cervical cancer in Taiwan: a cross-sectional study
Version:2Date:20 August 2014
Reviewer: Hanh Nguyen
Reviewer's report:
To the authors:
Major revision:
1. According to the Data collection, “if a woman had not heard of HPV, her data
were not included in the analysis of determinants of women’s likelihood to
self-sample for HPV”, but “all women were asked about their willingness to
self-sample for HPV and extent of HPV knowledge” (p5-6). Willingness to
self-sample for HPV and extent of HPV knowledge are among the four factors to
be mentioned in this study. Is it correct that all the data of the women who had
not heard of HPV were not included in the analysis of determinants of women’s
likelihood to self-sample for HPV? If so, why asked them about their willingness
to self-sample for HPV and extent of HPV knowledge? In addition, it does not
make sense to ask people the extent of knowledge of something that they have
never heard about.
2. To which source was the extent of knowledge categorize based on? In my
opinion, the moderate scale is rather small (60%-69%), while the low is quite
large (0%-59%). There should be some balance between these two scales. (and
if so, the result of the impact of HPV knowledge on the likelihood of HPV
self-sampling may change)
3. According to the result, the number of women who had had Pap test is 331
and who had heard of HPV is only 297 (p.7). Is it possible that someone has a
Pap test without hearing anything about HPV?
4. The Bivariate analyses part indicated four significant factors associated with
self-sampling for HPV but then mentioned only two.
5. It was written in the Discussion that the findings of the study highlighted the
importance of disseminating information about HPV to emphasize its role as the
causative agent for cervical cancer (p.10) but actually the result of the study did
not imply that, because 97.3% of the respondents have already understood that
HPV can cause cervical cancer (p.7).
6. If Pap test can be replaced by self-sampling for HPV as noted, the effort to
increase the acceptability of self-sampling for HPV should not target women who
have had a pap test only because the discomfort and embarrassment existing as
barriers to pap testing may not disturb women who want to uptake self-sampling
for HPV.
7. The authors wrote that the bivariate analyses revealed that self-sampling for
HPV was not significantly associated with demographic characteristics. But table
2 showed that age and income may have some association.
Minor revision:
8. In the Bivariate analyses, it was written that 69 women had self-sample for
HPV, but in the Limitations, the number is 67. Which one is correct?
9. This sentence in the Discussion “they misunderstood important information
about the virus, such as condom use cannot fully protect against transmission of
HPV and HPV cannot be transmitted by exchange of bodily fluids” (p.10) may
cause misunderstanding that those knowledge are not true.
10. In the Background, it was emphasized that the reimbursement policy had led
to an increase in Pap test in Taiwan implicating that cost is an important factor
impacting uptake of Pap test or cervical cancer screening. The study also found
that “a majority (78.8%) of women were concerned about cost regarding priority
consideration for HPV self-sampling” (p.7). But concern about cost was only
mentioned as additional factor and was not analyzed in this study.
11. The Bivariate analyses part just mentioned the four factors associated with
self-sampling for HPV but the detail content for these were written in the next part
(Determinants of the likelihood of self-sampling for HPV). In my opinion, these
two parts could be combined.
12. The abstract should not be divided into “background, methods, results and
conclusion”. The second sentence in the background of the abstract does not
seem to make sense, the “likelihood of HPV self-sampling was unknown” does
not have anything to do with the reimbursement for HPV.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare that I have no competing interest