Title: Barriers and facilitators for adherence to follow-up by HR-HPV-positive women with
premalignant cervical lesions: a mixed-design study in Mexico
Version: 2 Date: 27 Jun 2024
Reviewer's report:
Abstract:
First sentence of background can be revised so that it’s more concise, for example: Mexico has
low rates of follow-up completion for women with abnormal cervical cancer screening.
First sentence of methods should read “A mixed methods study…”
In Results, rather than “distant facilities”, perhaps saying “facilities at a great distance”; for
“insufficient dissemination of service hours”, does this mean clinic hours that are not suitable
to women’s schedules?
Background:
I think the first paragraph should begin with the focus of rates on Mexico, rather than worldwide,
which is currently the second paragraph. I don’t know that the first paragraph is necessary.
Lines 74-81: More references are needed, as it is difficult to determine if this information comes
from previous studies or existing literature.
Methods:
You may want to include ethical board approval information towards the beginning of this
section, rather than at the end.
Please include information on who was administering the informed consent forms – was it a
staff member, faculty, etc.
How were translations done? I’m assuming all surveys and interviews were administered in
Spanish, please include details on how translation to English was carried out.
Line 114: Please clarify what is meant by “Women attending consultation for the first time were
excluded”. Is this referring to new vs. established patients? It’s a bit unclear.
Lines 135-139: Was this checklist to be completed for their unit or the entire clinic? It’s unclear
what information was used by the health personnel to complete the checklist.
Lines 141-150: Who completed the qualitative interviews? Were they in-person or virtually/by
phone? Were they audio or video recorded (I saw this on line 181, but needs to be in the earlier
section). This section needs more detail.
Lines 163-169: Same as above – need detail on how these groups were conducted and who was
facilitating.
In general, I think the survey and interview sections need to be re-worked to be a bit clearer.
Perhaps breaking up into: 1) Patient Surveys and Interviews and 2) Health Personnel Checklist.
It gets a bit confusing for the reader.
Results:
Table 2: Long waiting times for testing – noticed it wasn’t labeled as Barrier or Facilitator for
Operational Health Personnel.
Table 2: Scarce dissemination of service hours – should read “Institutions are sometimes only
open from Monday to Friday…”
Table 2: Dignified treatment by CAPASAM health personnel – unclear what is meant by “Did
not identify him/herself” under Operational Health Personnel. Is there no information to include?
Table 2: Fear of receiving a positive test result – should read “When they told me that the Pap
smear results were abnormal…”
Table 2: A positive attitude among users, when making  decisions and Unfamiliarity with the
disease – again clarify what is meant by “Did not identify him/herself”
Overall, the Results section needs to be tightened up. It’s a lot of information with the narrative
portion and the table and could be more efficiently summarized to highlight the main points and
those that were repeated.
Discussion:
This section definitely needs to be written more crisply – again it is very long and needs to be
shortened.
Are there any other studies in Mexico that can be used as a point of comparison?
Conclusion:
Strengths and limitations should be included in the Discussion section.
This section can also be shortened.