Title: Perception about human papillomavirus vaccination among middle adolescent school
girls in Addis Ababa, Ethiopia 2023: qualitative study
Version: 1 Date: 15 Aug 2023
Reviewer's report:
General comment
This study is scientifically valid, technically sound and makes an original contribution to the
literature.
But the manuscript has had a lot of editorial and grammar problem
Other comments
# The title of this study better if modified as: “Perception toward human papillomavirus
vaccination among adolescent school girls in Addis Ababa, Ethiopia 2023”. A qualitative study.
And better to include the vaccine uptake in this study.
# There were no Authors detail, and Authors email address in the title page. So, better to see
the BMC guideline.
# Abbreviation like HPV, is not allowed in abstract, so write in complete
# In conclusion part of abstract…..The main barriers to vaccine uptake and acceptance were;
lack of awareness, misconceptions, and myths, lack of credible information sources of vaccines,
perception of poor vaccine quality, Poor family support, and cultural and religious perspectives.
This is not in line with the objective of your study. Have you assessed vaccine uptake and
acceptance rate and factors associated with them? I think no.
# Add school girls in key words
Background
# Many nations have chosen HPV vaccination as a primary option for lowering the burden of
cervical cancer as a result of regulatory bodies in North America and Europe approving HPV
vaccines and the World Health Organization prequalifying them(1).
# Please avoid HPV and write in ful phrases  like human papilloma virus (HPV) if you use for
the first time.
# There should be space between references and the last word.
# The background of this manuscript mainly talks about knowledge, attitude, uptake, acceptance
etc rather than perception. So, you need to show the gap of the study by focusing on perception.
Methods
Under study area and period
# The official middle adolescent girl’s school age is from 14 to 17 years old. What is your base
or do you have reference?  See the standard classification of adolescents.
# Addis Abeba is different from Addis Ababa. So, please be consistent.
Study design
# Phenomenological study design was used. This is enough
The participants
#  Why you didn’t include all adolescent school girls? Since you study focused on high school
girls. You should, unless you have any justification
Exclusion criteria
Those students who are not willing to participate in the study and who have problem of hearing
were excluded.
# These are not exclusion criteria. Because you can use sign language for those having hearing
problem.
# Since you have used convenience sampling, is there any-body not willing to participate? You
must convince them also.
Operational Definition
# Operational definition need reference
# Should not be defined randomly. So, need revision
# There should be measurement for perception as good perception of the HPV vaccine, and poor
perception.
Data collection
# Focused group discussion was conducted among purposively selected female adolescent girl
students from secondary schools.
# Do you think convenient sampling and purposive sampling the same? They have used
interchangeably.
# Female adolescent girl? What does it mean?
# You better add IDI (in depth interview) to explore more perception
Data analysis
# Better to tell us the steps involved during thematic analysis. Mention the themes and sub-
themes formed.
Results
# Not well written
# When we write results in qualitative age, sometimes sex should be included like A 16 year
old school girl said “My mother is working in the hospital. I asked her about the benefits of the
vaccine. She told me that the HPV vaccine can prevent cervical cancer” (FG2P3)
Discussion
# Almost all the finding of this study was similar with previously conducted study. So, why you
conducted this study, since you didn’t came with new finding and new recommendation?
Limitation
# This study has some limitations, cause-and-effect relationship between the diverse perceptions
of the HPV vaccine and their reported implications cannot be established because this is a
qualitative study. Only females who were enrolled in school and who had received vaccinations
were included in our study. As a result, selection bias may exist, and results may not be applicable
to females who do not attend school.  Convenience sampling was used, which would also have
limited generalization.
# I don’t think these are limitations. Because from the beginning the objective of this study was
not ascertain or establish cause-and-effect relationship between the diverse perceptions of the
HPV vaccine and their reported implications.
Recommendation
# Not in line with the research objective. ……. raise knowledge about the HPV vaccine. Have
you planned and assessed knowledge? Not your objective.
# …..rising awareness and attitude toward HPV vaccination in school girls.
# But no conclusion and recommendation on major objective of this study. That is “perception”
Ethical
# The study had approvals by Department of Nursing Ethics Committee, CHS, Addis Ababa
University (Reference: AAU MF 008)…..I don’t think so.
# Ethical committees are not established at each departments. Rather you can say….An
institutional review board of AAU.
# An official letter was written to Addis Ababa Health Bureau. Why?  since the study was
conducted in high school/ education bureau.
# Written informed consent/assent was taken from the study participants and their parents or
guardian after telling the objective of the study. When and where did you tell them the objective
of the study?
# Have you taken consent from adolescents or from parents? Identify these issues clearly.
# Major revision is needed under this heading.
Acknowledgements
# The study participants of this research must be acknowledged.