Reviewer's report
Title:"If you can't treat HPV, why test for it?" Women's attitudes to the changing
face of cervical cancer prevention - a focus group study.
Version:1Date:13 January 2014
Reviewer: samuel O Obi
Reviewer's report:
Below are my comments on the manuscript which are mostly ‘Discretionary
Revision’
1. Topic: I think the first aspect of the topic ‘If you can’t treat HPV why test for it’
should be deleted to make the title more focused.
2. Introduction (last paragraph). The justification for the study should be more
specific:
a) Whether the study wants to look at women’s view on all aspects of cervical
cancer prevention (cytology screening, HPV testing and HPV vaccination)
b) Whether the study is specifically examining co-testing (primary screening HPV
and cytology test)
c) Whether the process of co-testing is already been practiced in Ireland or if it is
still in the process of been introduced.
d) Are there previous studies in Ireland or within the region on women’s view on
the subject matter? If such studies exist, the authors must highlight the findings
to further provide justification for the current study.
3. Methods
a) 1st paragraph “cervical check was rolled out in September 2008………..” (i) Is
the country in the process of introducing co-testing to warrant the study? (ii) Any
prior sensitization of the populace on the new form of testing before embarking
on the focus group discussion? (iii) A brief description of the area of the study, its
population, people etc will not be out of place.
b) What sampling technique was used to ensure that the populace in the area
under study (urban, mixed and rural) was equally recruited?
c) How did you reduce bias in selection of participants in the focus group
discussion? Was the selection only based on the women showing interest? Do
you think advertisement on the media (electronic etc.) would have resulted in a
more broad based participation in the study?
d) Are the 59 women involved in the study the only ones that indicated interest in
the study or did some drop out after initially indicating interest? If the latter is true,
how many?
e) Any calculated sample size for the study?
f) I have some reservations on the time interval between provision of information/
education on HPV for the participants and the subsequent focus group
discussion. (i) I personally think the participants should have been provided with
all the necessary information on HPV etc. at least 1-2 months earlier to enable
them sought for clarifications on the subject matter from different experts before
arrangements for the focus group discussion is scheduled. The low level of
knowledge about HPV by the participants most probably is attributable to the
short interval (90-150 minutes) between provision of information and focus group
discussion. This must have affected the findings in the primary and the
sub-themes in the study. (ii) Furthermore, bias on the part of the trained
facilitators cannot be ruled out completely.
4. Table 1 (last segment)
a) Private patients constituted about 70% of participants. (i) What are the cost
implications of screening for both private and public patients especially for HPV
testing? (ii) Is it possible that preponderance of private patient in the study could
bias the view expressed?
5. Discussion
a) Conflicting statement: In 2nd paragraph “while a national cervical cancer
screening programme was not in place in Ireland at the time of this
study…………” In 1st paragraph in method “Organized cervical screening
commenced in the Mid-western area in 2000 and the national programme,
cervical check was rolled out in September 2008…………”
b) Role of HCPs and government (1st paragraph): The majority of women
deferred responsibility for health……… NOT …deferred responsibly……..
c) Knowledge of HPV infection and HPV testing (1st paragraph) (i) Do you think
that the many unanswered questions about HPV infection and cervical cancer
would have been addressed with provision of information on HPV etc. over a
longer time? (ii) Do you think that the psychological effect of HPV testing
reported in the study is related to the short interval between provision and
assimilation of information on HPV by the participants?
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
'I declare that I have no competing interests'