Title: Knowledge, attitude and practice of female university students regarding human
papillomavirus and self-sampling in KwaZulu-Natal, South Africa: a cross-sectional survey
Version: 1 Date: 03 Dec 2021
Reviewer's report:
Reviewer Notes - 03 December 2021
BMC Women’s Health
Ref: Submission ID c9e6168d-4643-4170-a9a8-9bac818f0676
Full Title: Knowledge, attitude and practice of female university students regarding human
papillomavirus and self-sampling in KwaZulu-Natal, South Africa: a cross-sectional survey.
General comments:
This is a really important study on knowledge, attitudes and practices of HPV. Although the
paper is very well written, I suggest the authors consider including these recommendations to
help strengthen their argument.
1. Please consider including more information on how ‘knowledge’ and ‘attitude’ were
constructed and the rationale underlying that
2. Please consider including a second and third level analyses to explore factors associated with
knowledge of HPV and expand on those findings
3. Please consider including literature that speaks to KAP globally and SSA and interrogate the
factors associated with KAP in those studies.
Kindly see the details comments and suggested reading below to assist.
Background
• The Background could use more literature on KAP of HPV globally and in SSA. What happens
in other parts of the world? What did these other studies on KAP of HPV find and more
importantly what were the gaps that this present study is trying to contribute to? In short to
strengthen your argument as to why this study is necessary?
• Line 57,58 and 60, HPV prevalence in SSA, your reference is from 2008, please check for
more recent prevalence figures
• Line 89, if could please give more details on what these limitations are, where geographically
were they encountered and what have they done about addressing them?
• Line 108 – 111, please give references to support this this statement about knowledges and
attitudes of students in health-related colleges towards HPV
Methodology
• Line 104, please separate each subheading to contain its own content
• Lines 112-113, please give more details on the respective gatekeeper institutions (e.g. studies
organizations?) and the ethics board to which the study was submitted, also include the approvals
reference numbers
• How were the participants recruited? Please elaborate
• What was the inclusion criteria? Any female student in the college of humanities?
• Please elaborate on any theoretical frameworks which informed the development of the
knowledge and attitude questions? See Mapanga, et al 2019 below
Results
• Table 1,  “Matric/others”  - what does the  “others” include?
• Tables 3, 4, 5 - It is not very clear how the variables ‘Knowledge about HPV’ and ‘knowledge
about HPV self-sampling’ were constructed. This can help explain the term ‘knowledge score’
from line 202 onwards.
• Tables 2, 6,7 – these are not simple to read, in the current form it is not easy to tell which
responses belong to which question, each question and the responses should be in the same row
Here below some literature to assist:
1. Leung, J., & Law, C. K. (2018). Revisiting knowledge, attitudes and practice
(KAP) on human papillomavirus (HPV) vaccination among female university students
in Hong Kong. Human vaccines & immunotherapeutics, 14(4), 924–930. https://
doi.org/10.1080/21645515.2017.1415685
2. Lee, A., Ho, M., Cheung, C. K., & Keung, V. M. (2014). Factors influencing adolescent girls'
decision in initiation for human papillomavirus vaccination: a cross-sectional study in Hong
Kong. BMC public health, 14, 925. https://doi.org/10.1186/1471-2458-14-925
3. Swarnapriya, K., Kavitha, D., & Reddy, G. M. (2015). Knowledge, Attitude and Practices
Regarding HPV Vaccination Among Medical and Para Medical in Students, India a Cross
Sectional Study. Asian Pacific journal of cancer prevention : APJCP, 16(18), 8473–8477. https://
doi.org/10.7314/apjcp.2015.16.18.8473
4. Gupta, S., Palmer, C., Bik, E. M., Cardenas, J. P., Nuñez, H., Kraal, L., Bird, S. W., Bowers,
J., Smith, A., Walton, N. A., Goddard, A. D., Almonacid, D. E., Zneimer, S., Richman, J.,
& Apte, Z. S. (2018). Self-Sampling for Human Papillomavirus Testing: Increased Cervical
Cancer Screening Participation and Incorporation in International Screening Programs. Frontiers
in public health, 6, 77. https://doi.org/10.3389/fpubh.2018.00077
5. Reasons for non-attendance to cervical cancer screening and acceptability of HPV self-
sampling among Bruneian women: A cross-sectional study
Liling Chaw, Shirley HF Lee, Nurul Iffah Hazwani Ja’afar, Edwin Lim, Roslin Sharbawi
medRxiv 2021.03.30.21254670; doi: https://doi.org/10.1101/2021.03.30.21254670
6. De Pauw, H., Donders, G., Weyers, S. et al. Cervical cancer screening using HPV tests on
self-samples: attitudes and preferences of women participating in the VALHUDES study. Arch
Public Health 79, 155 (2021). https://doi.org/10.1186/s13690-021-00667-4
7. Mapanga, W., Girdler-Brown, B. & Singh, E. Knowledge, attitudes and practices of young
people in Zimbabwe on cervical cancer and HPV, current screening methods and vaccination.
BMC Cancer 19, 845 (2019). https://doi.org/10.1186/s12885-019-6060-z