Title: Experiences of Women Living with Cervical Cancer in Ghana: Challenges and Coping
Strategies
Version: 1 Date: 14 Oct 2024
Reviewer:  Chinomso Ugochukwu Nwozichi
Reviewer's report:
This manuscript  presents a significant contribution to understanding the lived experiences of
women with cervical cancer in Ghana. However, a few key areas of weakness require attention
to improve clarity, flow, and overall impact. Below are the primary areas for improvement:
1. Structure and Coherence:
Abstract: The abstract provides an overview but lacks concise detail regarding the study's
methodology. It should specify the sampling method (purposive) and briefly describe the data
analysis (thematic analysis using Braun & Clarke’s framework). More focus on results and
implications rather than the broader background is recommended.
Introduction: The background contains extensive global statistics but is lacking in contextual
relevance to Ghana. More emphasis should be placed on why Ghana was chosen as a setting
and how it differs from the global situation regarding cervical cancer. The introduction could
be more cohesive if it explicitly discusses gaps in literature related to the experiences of women
living with cervical cancer, as this is the study's focus.
2. Theoretical Framework:
The study employs an interpretivist philosophy but does not adequately explain the philosophical
rationale or link it to the research questions. Clarifying the choice of interpretivism and
aligning it with the study's aim will strengthen the theoretical underpinnings. More references
to qualitative research theory (e.g., phenomenology ) may add depth to the study's foundation.
3. Methods:
Sampling: While the sampling method is purposive, the manuscript lacks justification for the
chosen sample size of 16 participants. A more detailed discussion of how the researchers reached
data saturation is necessary to validate the sample size.
Data Collection: The manuscript mentions that data was collected through semi-structured
interviews. However, there is little information about the interview guide's development,
piloting, or modification based on pilot results. Clarifying how the questions were tailored to
meet the study objectives will enhance the methodological rigor.
Ethical Considerations: The ethical approval and participant confidentiality process are
mentioned, but further details on participant consent and assurances for voluntary participation
should be elaborated. Including a reference to data storage and handling procedures would
improve the ethical transparency of the study.
4. Results:
Overgeneralization of Themes: Some of the themes (e.g., support, coping strategies) feel
overly generalized, reducing the richness of participants’ individual experiences. Consider
highlighting more specific examples or using more participant quotes to illustrate variability
among responses. For instance, breaking down "support" into subthemes like emotional,
financial, and spiritual support could provide a deeper exploration.
Linking Themes to Literature: Although the results are discussed in comparison to previous
literature, some themes (e.g., spiritual coping mechanisms) are only lightly discussed in the
context of existing studies. It would be beneficial to more thoroughly connect findings to global
and Ghanaian-specific cervical cancer research to enhance the study's relevance.
5. Discussion:
Implications and Limitations: The discussion should emphasize more practical
recommendations derived from the findings. The authors mention broad implications for
policy (e.g., expanding insurance coverage), but a more targeted action plan that addresses the
challenges faced by these women (e.g., specific programs to improve access to care) would
strengthen the paper. The limitations section acknowledges the sampling method as a potential
source of bias, but it does not provide alternatives or ways to mitigate this in future studies.
Depth of Analysis: The authors note the emotional responses of participants, but the emotional
and psychological burden of cervical cancer could be more deeply explored. For example, why
did some women experience more anxiety than others, and how might that influence care-
seeking behaviors? Drawing on psychological or sociological theories might
add value to the discussion.
6. Language and Grammar:
The manuscript contains several grammatical errors, particularly in the verb tense and sentence
structure. For instance, there are awkward phrasings like “support base from the perspective of
the patients” and inconsistent verb tenses in some paragraphs. A careful review and revision of
the manuscript's language for clarity and flow will improve readability.
7. Conclusion:
The conclusion restates the findings but could offer stronger, more forward-thinking
recommendations. The suggestion to include cervical cancer in Ghana's National Health
Insurance Scheme is appropriate, but additional, specific suggestions on how to increase
community-level awareness and support might be helpful.
8. Figures and Tables:
The manuscript includes only one table for socio-demographic characteristics, and while it is
useful, it would benefit from more visuals. Consider including a table that summarizes key
themes, subthemes, and corresponding participant quotes to make the results section more
accessible to readers.
There are a few issues with adherence to reporting guidelines like COREQ (Consolidated
Criteria for Reporting Qualitative Research) in the manuscript. COREQ is designed to improve
the transparency and rigor of qualitative research by ensuring that researchers provide essential
information in three domains: Research Team and Reflexivity, Study Design, and Data Analysis
and Reporting.
Here’s how the manuscript aligns with or deviates from COREQ:
1. Research Team and Reflexivity (COREQ Domain 1):
Researcher Characteristics: The manuscript does not provide enough information about the
role of each researcher and their potential influence on the study. COREQ emphasizes the
need for details on the interviewer’s background (e.g., occupation, training, relationship with
participants). While the authors are listed, there is no information on their prior relationship with
the participants or any potential bias they might bring to the interviews.
Reflexivity and Personal Characteristics: COREQ also requires researchers to reflect on their
own influence during data collection and analysis. There is no mention of whether researchers
engaged in reflexivity to understand how their own perspectives could have influenced data
interpretation. Adding a reflexivity statement would improve transparency and align with
COREQ.
2. Study Design (COREQ Domain 2):
Participant Selection: The manuscript briefly describes the purposive sampling technique and
mentions that participants were recruited based on eligibility criteria. However, more specific
details on how participants were identified and approached (e.g., the use of the Oncology Unit
register) should be provided in line with COREQ.
Setting: While the study was conducted at Komfo Anokye Teaching Hospital, the manuscript
does not mention whether participants were interviewed in a private space or whether the setting
might have influenced participants’ responses. COREQ asks for details about the environment
where interviews were conducted to assess the possibility of social desirability bias.
Saturation: The manuscript mentions that data saturation was reached after interviewing
14 participants, but the criteria for determining saturation are not clearly defined. COREQ
guidelines suggest that saturation should be explicitly described in terms of how it was assessed
during data collection.
Repeat Interviews and Field Notes: There is no mention of whether repeat interviews were
conducted or whether field notes were taken, which are important for ensuring a comprehensive
understanding of the data. COREQ encourages reporting on whether interviews were recorded,
field notes taken, and how this data was integrated into the analysis.
3. Data Analysis and Reporting (COREQ Domain 3):
- Data Coding: The manuscript mentions that thematic analysis was used, following Braun and
Clarke’s six-step framework. However, COREQ requires more detail on who was involved
in coding the data and whether multiple researchers independently coded the data to enhance
credibility (triangulation). Describing how discrepancies were handled or how consensus was
reached during the coding process would align with COREQ’s expectations.
- Participant Quotations: The manuscript includes participant quotes to illustrate themes, which
is a good practice. However, COREQ asks for clarity on how the authors chose which quotes
to include. The manuscript could benefit from more information on how representative quotes
were selected to ensure that diverse perspectives are reflected.
- Verification of Findings: While the manuscript briefly mentions the use of member checking
to ensure credibility, the details on how and when this was conducted are sparse. COREQ
expects more comprehensive reporting on verification techniques like member checking, peer
debriefing, or triangulation to validate findings.
Other Reporting Gaps:
Ethical Considerations: The manuscript provides ethical approval details and discusses consent,
but COREQ expects clarity on whether participants received feedback or results from the study
post-data collection, which is not mentioned.
Participant Characteristics Table: While the manuscript includes a table outlining socio-
demographic characteristics, it does not provide in-depth information on how these
characteristics were used to ensure diversity or representation in the sample. COREQ
emphasizes understanding how participant characteristics may influence the findings, especially
in terms of how different subgroups experience cervical cancer challenges.
Suggestions for Improvement:
- Include a statement on reflexivity to demonstrate how the researchers’ backgrounds,
assumptions, or roles might have influenced the data collection and analysis.
- Provide more details on the data saturation process and how the authors ensured they had
reached saturation.
- Expand on the coding process, including who coded the data, how discrepancies were handled,
and whether any form of triangulation was used.
- Clarify whether any repeat interviews or field notes were used and, if so, how they contributed
to the analysis.
- Include more details on the use of member checking or other validation strategies like peer
debriefing to increase credibility.