Reviewer ’s report  
 
Title: Perceived seriousness mediates the influence of cervica l cancer knowledge on screening 
practices among female university students in Ghana  
 
Version: 0 Date: 18 Dec 2018  
 
Reviewer: Megan Huchko  
 
Reviewer's report:  
 
The abstract starts by stating that knowledge, awareness and perceptions can influence screening 
behaviors, but then goes on to justif y the study as filling a hole in the literature in these areas. 
Unclear what is novel about the study. It also seems that the mediation models are more of a 
statistical exercise than an exploration of something with clinical or public health significance. 
The authors have not done a great job explaining what the clinical significance of this is —their 
conclusions swing back to just providing more factual information about cervical cancer for this 
cohort, which would help students change their beliefs, behavi ors and perceptions.  That is 
certainly not grounded in theories of health beliefs and behaviors, and isn't supported by the 
evidence presented in the paper.  
 
 
Intro:  
 
Lines 15 -17: It's unclear what the authors are saying here. Be clear that HPV is responsibl e for 
almost all cervical cancers, and it is linked to increased number of partners, early age at first 
intercourse, etc.  
 
Line 17: This repeats what was written above about the growth of irregular cells, so can be 
removed.  
 
 
Methods:  
 
Description of participa nts includes information that should be presented in results 
(demographics).  
 
Under measures, the authors state that behavior was assessed using 4 items from prior research, 
however they then state that there were 8 items. Clarify.   
 
Why was behavior, which  is the main outcome variable, measured as a composite of 4 (or 8) 
items? Would recommend picking 1 or 2 (prior screening or intent to screen) as the main 
outcome variable to seek an association with behaviors.  
 
Would include the Cronbach's alpha result in results, as it is part of the results. If including, is 
this representative of how these items have performed in the past?  
Results:  
 
First paragraph should start with some general description of the study population, including 
what is now in the methods' se ction. Would also include a description of the scores, and refer to 
table 1.  
 
Table 1 is unclear —how are the results weighted? On scales with 15 items, there are means that 
are much greater.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work incl ude the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, f ees, funding, or salary 
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future?  
3. Do you hold or are you currently applying for any patents  relating to the content 
of the manuscript?  
 
4. Have you receiv ed reimbursements, fees, funding, or salary from an organization 
that holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
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below. If your reply is yes to any, please give details below.  
 
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