Reviewer’s report
Title: Assessing Fidelity: Balancing Methodology and Reality in a Woman's Jail Intervention
Version: 2 Date: 30 Apr 2018
Reviewer: Jaimie Meyer
Reviewer's report:
This  a  description  of  a  fidelity  assessment  of  a  sexual  health  and  cervical  cancer  prevention  
intervention implemented for women in a jail setting.  The authors use quantitative and qualitative data  
from the fidelity assessors to discuss the challenges adhering to core intervention content in the jail  
setting.  Missing from the manuscript, however, is a thorough discussion on how these issues might be  
addressed in future interventions for women in criminal justice settings.
1.  Methods:  It is unclear from the existing description of the Intervention whether (and how) it  
was developed or adapted specifically for this population of women in jail.  Some more details  
would be helpful here (e.g. recruitment procedures, inclusion/exclusion criteria), beyond just  
referring readers to the previously published manuscript on intervention development and pilot  
testing.  In fact, it is interesting that, (on my review of the referenced article) given the amount  
of preparatory work in developing and piloting the intervention, that some of the issues noted  
here with intervention fidelity did not arise sooner.  The issues identified here have been noted  
in multiple prior interventions for women in criminal justice settings.
2.   Instruments:   It  might  be  helpful  to  include  the  facilitator  quality score  sheet  as  online  
Supplementary material so readers can review and reference.
3.  Data management:  On page 8, 1st para, the authors discuss how their own opinions on  
appropriateness of the findings were incorporated into the final analysis.  This seems highly  
subjective and not in keeping with validated approaches for qualitative data analysis.
4.  The authors identify major and diverse challenges to intervention delivery, in terms of physical  
space, interactions with jail staff, "distractible" participants, and "heaviness" of discussions.  Yet  
the only real solution they identify seems to be to hire skilled and flexible facilitators.  While  
this is certainly important, one might also identify other potential solutions such as: involving  
stake holders (e.g. facility administrators and staff) to sort out logistics for the intervention that  
allow it to be incorporated into the jail setting with minimal disruption; developing content that  
is trauma-informed; delivering the intervention to smaller groups (if the group dynamic is  
disruptive)  or  in  shorter  time  frames  (if  attention  span  is  limited);  developing  fidelity  
assessments that are more realistic, etc.  The Discussion needs to be flushed out to address these  
issues and might be more complete if the authors added a table that listed each identified major  
barrier and potential solutions to help guide future interventions. 
There are also some minor issues with the manuscript that should be addressed prior to publication:
1. Careful review for spelling, grammar and punctuation (see for example page 4 last 3 lines to  
page 5 first two lines; page 10 "conductive" vs. "conducive", etc.)
2.  Format  references  for  this  journal  as  specified  by  the  Instructions  for  authors  (bracketed  
references not superscript)
3.  Tables 1A and 1B technically show means, not averages.  Consider also adding standard  
deviations where appropriate.
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
No
Does the work include 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 manuscript or would you recommend an additional  
statistical review?
If an additional statistical review is recommended, please specify 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:
Needs some language corrections before being published
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, fees, funding, or salary from an  
organisation  that  may  in  any  way  gain  or  lose  financially  from  the  publication  of  this  
manuscript, either now or in the future?
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose financially  
from the publication of this manuscript, either now or in the future?
3. Do  you  hold  or are  you  currently applying  for  any patents  relating  to  the  content  of  the  
manuscript?
4. Have you received 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?
6. Do you have any non-financial competing interests in relation to this paper?
If you can answer no to all of the above, write 'I declare that I have no competing interests' below. If  
your reply is yes to any, please give details below.
I declare that I have no competing interests'
I agree to the open peer review policy of the journal. I understand that my name will be included on my  
report to the authors and, if the manuscript is accepted for publication, my named report including any  
attachments I upload will be posted on the website along with the authors' responses. I agree for my  
report to be made available under an Open Access Creative Commons CC-BY license  
(http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments which I do not wish to  
be included in my named report can be included as confidential comments to the editors, which will not  
be published.
I agree to the open peer review policy of the journal