Title: The Effect of Nutrition Education for Cancer Prevention Based on Health Belief Model
on Nutrition Knowledge, Attitude and Practice of Iranian Women
Version: 0 Date: 25 Feb 2022
Reviewer's report:
General comments: I would like to gratulate the authors with this interesting research. This
is an interesting study. However, I am worried about the quality of the manuscript. I have
multiple comments/suggestions and I would like to highly encourage the authors to ask a native
speaker for critical language check after including the comments listed below, since the current
manuscript is of poor quality.  I wish the authors best of luck with the further procedure.
Regarding my comments, I included 'line numbers' so I can better specifically indicate the line
numbers I am referring to within my comments below. In addition, I would highly recommend
the authors to ask a native speaker to have a critical look through the whole article. I am also
a non-native speaker, but tried to make some suggestions on wording, but the article would
definitely benefit from another proper language check.
Specific comments:
Abstract
Line 28-32: I miss the explanation for 'why particularly in low- and middle- income countries
and why women', please add briefly.
Line 34: I wonder: the three sessions of education --> delivered by who? Also, I would
recommend to add the time it took: say for example; ''three 30-minute sessions''.
Line 34: please add 'the' before HBM, since it stands for 'model' so it needs a 'the' beforehand.
Line: 34: When HBM used for the first time, please write in full and not 'HMB', I noticed the
authors state the full Health Belief Model in the following sentence, please adjust.
Line 35: similar to previous comment, please write NUTCANKAP full, so the reader knows
the meaning.
Line 36-37; wording, please revise, write something like 'A 24-hour dietary recall was conducted
(ADD HOW; by phone? self-reported questionnaire?) on three different days,  before and one
month post intervention'.
Line 33-37: what measures where measured? Knowledge, grain intake, fat, nuts, please add in
the sentence including NUTCANKAP.
Line 43: what does 'HBM structures' mean? Not clear to me, please clarify/rephrase.
Line 44: wording; please write 'Nutrition education had a positive impact' OR 'Participation in a
nutrition education program', besides, I believe the last part of the conclusion sentence could use
some revision. Suggestion: write something like 'and can contribute to the prevention of cancer'
instead of 'towards dietary factors related to cancer prevention'.
Introduction
Line 50: suggestion: please add a few examples of 'cancer-causing behaviors' since this is a
broad term, but related to the main purpose of this study so it could use a few examples (e.g.,
unhealthy eating behavior?).
Line 50: where does GLOBOCAN stands for? Please write as full.
Line 51-53: Interesting, so now I wonder even more why the authors decided to have women as
target population. Please include somewhere in the article.
Line 55; suggestion; I would write 'Previous research suggests that..' instead of 'Published studies
have estimated'
Line 56: please add 'having a healthy body weight' instead of 'healthy body weight'
Line 56: I assume the author mean 'a healthy diet' instead of just 'diet'? since diet can also refer
to an unhealthy diet, which is obviously not contribution to cancer prevention.
Line 56-57; does the author mean a combination of these factors (PA AND healthy body weight
AND diet?) can prevent one third? If so, please add the word 'combination' to clarify.
Line 57-59; the author state this has been investigated, but what was the conclusion of reference
6-8? Any results/relationships between these components and risk of cancer? Please add.
Line 59; I miss a word at the beginning of the sentence, like 'In addition', or 'Furthermore', how
it is written now it is a bit out of the blue.
Line 61: Please write 'could help to increase nutrition knowledge and improve dietary behaviors'.
Line 63-64: I think this sentence can use some rephrasing; maybe write something like 'The
Health Belief Model (HBM) is one of the most recommended models in the field of nutrition
education programs [10]'.
64-66: please rephrase 'In this model, individuals find out the risk of unhealthy behaviors', write
something like 'This model describes the risks of unhealthy behaviour and the related...and can
be used as motivation to reduce risks [11]''
Line 66: The components of the model are very important, and I would like to encourage the
authors to explain every component by adding at least one example/short description of each
component. For example, write '' The components of this model are 1) perceived susceptibility
(i.e., ..... ADD), 2) perceived severity (i.e., ..... ADD), etc.etc.
Line 68-69; but what are the 'benefits of using this model'? Please add.
Line 69; please write 'the HBM' and check whole article on consistency.
Line 69-70: I would remove this last sentence 'In addition, ..education' and just simply add/
change the first sentence of this paragraph into 'cancer prevention education programs'. To
prevent repetition.
Subjects and Methods
Line 78; wording; please add something like 'located in Iran' instead of the current '.., Tehran,
Iran'.
Line 79: suggestion; I would recommend to rephrase and write ' All women who visited public
health centers where invited for participation in the study through convenience sampling'.  But
please add the approach; through a flyer? poster?
Line 80: write ''The participating women'' or '' The participants'' instead of 'Women'
Line 82-83- how collected? Online? Self-reported? via Phone? Face-to-face? Please clarify.
Line 83-96: I would like to highly encourage the author to create a table with all the measures,
and a few example questions from the questionnaire, including the references from the validated
research. This will improve transparency of the used method and will increase quality of the
article.
Line 96-99: I would start the Subjects/Methods section with this information about the subjects,
that is what the reader expects to start reading.
Line 100: write 'three' instead of '3', everything under 10 should we written.
Line 109; wording.. please rephrase 'In the third session, using of food nutrition labels'; incorrect
English; write something like ''information on food nutrition labels and the five food groups
based on the [ADD REFERENCE/SOURCE] was discussed'
Line 110: Please add the resources, the food pyramid, is this the current source? Please refer to
the sources and state the official title & date. As far as I know the food pyramid is very out-
dated and I expect other future readers would think the same.
Results
General comment for all results listed in this section: I would highly encourage the author to
list all changes of the measures, like; how much did it increase/decrease? It is nice to see it is
significance, but it is at least as interesting for the reader to also see in the text the difference,
please add. Because it is indeed interesting to see if it is significant, but then, even more
interesting HOW MUCH does it impact it. I hope this makes sense.
Line 123: please write 'nutritional practice' like mentioned earlier in the article, instead of
'practice', and check the whole article on consistency.
Line 141:  Please clarify/ explain what 'Question 17' includes, this is a bit out of the blue.
Discussion
Line 144: Grammar; 'to use HBM' should be 'that used the HBM'
Line 146: nutritional practice
Line 150-151: this is exactly what I was missing in the results section, to see the impact in the
numbers.
Line 152; I am used to 'non-significant' instead of 'insignificant', and 'small sample size' instead
of 'low sample size', also, I wonder if this is adding something? I believe 229 is not that small.
Maybe leave this part out? ''There was an... sample size''.
Line 154: What does the author mean with 'the difference had a decreasing trend between
socioeconomic groups'? Please rephrase/clarify.
Line 158-159: what does the author mean with 'food costs may be considered as the only optional
part of household expenses, and the extra money is usually allocated to food'? Please clarify.
LIne 161: Add year (Ahn et al. [YEAR]), check whole paper as I noted this same lack of year
in Line 196 also.
Line 196' Higher' should be 'higher', and I would write 'higher intake of ...' instead of 'higher ....
intake'
Line 204: please rephrae 'We asked the cause... questionnaire', this is not how you phrase it in a
scientific article. Write something like 'Participants' vegetable intake was assessed through the
questionnaire'.
Line 206: important note: write 'were LISTED AS the main causes', because how it is written
now, it is a strong statement which cannot be done based on the results.
Line 224: I would like to encourage the author to be consistent in what is stated, here the author
list 'a large sample size' as a strength, while earlier in the article it is written as 'this can be
explained by the small sample size', please be careful and make sure all statements are in one
line. Check the whole article on this.