Title: The Role of Health Beliefs and Health Literacy in Women's Health Promoting Behaviours
based on the Health Belief Model: A descriptive study
Version: 1 Date: 26 Jul 2021
Reviewer's report:
Thank you for the opportunity to review this paper and congratulations to the authors on the
much needed research conducted in this area.
As there was no line or page numbers, I have included my suggested edits according to each
section of the paper below:
Abstract Section
Methods – to include the number of items in the research-developed questionnaire.
Results – Include which of the health belief model constructs predicted the 52.1% of preventive
behaviours.
Background Section
2nd paragraph: This sentence: ‘As many as 7-10 objectives of the objectives by the World
Health Organization (for the beginning of the third millennium) are related to the reproductive
system’s health’ Please consider revising this sentence as it is very unclear to the reader what
these objectives are and their significance.
3rd paragraph: Please consider revising the length of the first sentence and the order of the points
about the definition and reference of WHO. The next sentence ‘ H.L. is an important element in
a woman’s ability to engage in health-promoting activities’ Reference for this is missing, please
do add it in.
4th paragraph: Please do revise this paragraph to highlight the points that the authors may be
trying to make, if it is about the different factors that contribute to women’s physical activity,
it is currently unclear that it is the main point.
5th paragraph: These two sentences: ‘This model shows the relationship between beliefs and
behaviors and is based on the assumption that preventive behaviors, based on personal beliefs
(including susceptibility to disease, the effect of disease on a person’s life, and the effect of
health measures) are likely to be effective in decreasing disease susceptibility and severity [17].
Perceived susceptibility, severity, benefits, barriers, and self-efficacy, and cues to action are
among the main constructs of this model [17].’  Please do consider revising these two sentences
as it is key for the reader to understand what the health belief model is about. The definition and
explanation of the health belief model and the directionality of the influence of the constructs
may be better represented with a diagram and accompanying text. The next sentence of this
paragraph about the study on pre-university students in Tehran is missing the information about
which health behaviour they were reporting on.
6th paragraph: Please consider including the common diseases (from the rest of the paper, it
seems to suggest that they are breast cancer, anaemia and menstrual disorders) in the aims of
the study.
Methods Section
Data collection tools:
The component of the Health Literacy assessment questionnaire with 41 questions was clearly
explained. The section on the measurement of the constructs of the health belief model should be
revised to provide greater clarity to the readers firstly about each of the constructs to be measured
and the number of questions for each construct.
The summary about ‘The Beliefs and Behaviour Assessment Questionnaire’ and the reporting of
validity and reliability could be improved with a brief explanation of the content validity index
and ratio by the 14 experts. The test-retest reliability with 17 students could also be revised to
indicate if this was during the pilot of the questionnaire. A copy of the full questionnaire should
be included as a supplementary file for the reader to be able to replicate the study.
Results Section
The clarity in the reporting of the findings of the significant correlations could be improved if the
authors could include relevant headings and grouping of the reporting of the different variables.
Currently, it can appear confusing to the reader and the main points are not clearly articulated.
Discussion Section
The first paragraph of this section: Propose for the authors to revise and report on what was found
for the HL score in their study, and if it is consistent with other studies with similar cohorts and
in comparison, with those studies conducted with different cohorts (e.g. different age groups)
the different results found. Plausible reasons for the difference in findings could be included.
The second paragraph on correlations between HL and health-promoting behaviours and the
third paragraph on the constructs from the health belief model as predictors of health-promoting
behaviours. I would suggest to the authors to clarify or add when comparing or citing other
studies to support their findings to also include each of the study’s cohorts if they were similar
on female colleague students or other age groups.
Another suggestion is to have a section on the implication of the findings for practice or policy
to clearly state how these findings can be applied.
In the last paragraph on limitations, it is unclear why electronic data collection is a limitation
and would need more explanation. The strength of the study could also be further explained,
making a clearer link on the application of the health belief model to promoting self-efficacy
in women’s health.