Reviewer ’s report  
 
Title: Exploring the feasibility of using mobile phones to improve the management of clients 
with cervical cancer precursor lesions.  
 
Version: 0 Date: 05 Sep 2018  
 
Reviewer: Kristopher Lamore  
 
Reviewer's report:  
Comments to the Authors:  
The study investigate the the feasibility of mobile health (mHealth) phone technology to i mprove 
management and follow -up of clients with cervical cancer precursor lesions. Authors have 
conducted a mixed study with two qualitative design: individual interviews and focus groups. 
The research is very interesting and innovative. As an example, act ual research in cancer 
prevention in France are focusing on eHealth tools.  
Authors have undergone an important work with a strong methodology. However, I think the 
results section could be better presented and clearer for the reader. Also, some information  need 
to be added to the manuscript. As authors expect an international readership, it is important to 
not just target South Africa context but to compare it to other countries. It will underline why the 
present study is important.  
Below you will found sev eral comments to improve your manuscript:  
 
Comments'  
Abstract:  
 
1. The abstract is well written. However, to better understand the results, it could be useful 
to have more information in the method regarding what questions are asked in the survey 
and what  themes were discussed in the qualitative part of your study. Such information 
could really facilitate the reading of the results, only with short information on what you 
investigated in both the quantitative and qualitative part of your research.  
 
2. Maybe , add the word "prevention" and "eHealth" in your keywords.  
 
Introduction  
 
3. Page 4, Line 4 : please indicate what HIV means (= The human immunodeficiency virus)  
 
4. Page 4, Line 6 : At the end of the sentence, maybe add a sentence like "Indeed, HPV is 
one of the major cause of cervical cancer" and add a reference.  
 
5. Page 4, 2nd paragraph : At the end of the first sentence, delete "in SA". Pap smear is used 
in seve ral countries around the world as an effective screening tool. Add international 
references. Like this, your introduction is not only specific to SA but more international.  
 
6. Page 5 : In France, for example, Pap Smear is recommended to women over 25 years . If 
the test is negative, a new test is recommended 3 years after. Thus, you can compare what 
is proposed in SA and in developed regions or in developing countries. It will had a 
comparison to an international level.  
 
7. Page 5 : Can you provide a short de finition of what is a colposcopy?  
 
8. The reference 13 is an international review ? If you, you can add in your manuscript that 
"Various strategies and interventions have shown in several countries ..."  
 
Methods  
 
9. I am not sure to understand the following sentence : "Women were consecutively 
sampled until the sample size was reached". You expected to include respectively 187 
and 177 women?  
10. What were the "home language" of the participants? Please specify in the article.  
 
11. The interviews conducted were  semi -structured or structured interviews? Please specify 
in the article.  
 
12. Regarding focus groups, have you also analysed the interactions between the 
participants? One of the key element of this method is to explore participants interactions, 
but thema tic analysis do not provide such information.  
 
Results  
 
13. In table 1, why have you done parametric (Fischer exact test) and non -parametric test 
(Kruskal -Wallis test)? It wasn't possible to perform only parametric tests?  
 
14. Same question, in Table 2, the  tests performed are not clear ... as you indicate some p -
value as a result of Fisher exact test. What about others?  
 
15. After each verbatim, please indicate participants age and profession or if it was a patient.  
 
16. The results are clear and the verbatim  well chosen. However, as you conducted a 
qualitative study, it would be needed to first present how many themes emerged from the 
individual interviews and from the focus -groups. You can add this information just after 
the 'participants profiles' section.  
 
17. The first sentence of the results section is helpful. However, more information on the sub -
sections discussed could be helpful for the reader. However, such information should be 
presented after participants description and themes found in the qualita tive studies.  
 
18. For individual interviews, have you reached data saturation?  
 
Discussion  
 
19. Second paragraph: Authors focus on their positive results. However, it is needed to also 
indicate that participants can be reluctant to use mHealth (e.g., infor mation provided by 
SMS is short and can be unclear, the SMS can be read by another person).  
 
20. Page 21, 1st paragraph : the word 'protect' is written twice : "In addition, development of 
relevant data security policy that protects protect client informati on ...".  
 
21. Other limitations can be added: data analysis for individual interviews (data saturation 
not reached) and for control groups (interactions between the participants not analysed). 
Furthermore, participants interviewed in the qualitative studies  are young compared to 
the mean age at cervical cancer diagnosis.  
 
Conclusion  
 
22. I am not sure that it is 'good' to write "the use of SMS text based messaging has the 
potential to improve follow -up and management". Your research allows you to state on 
participants willingness to receive information by SMS. Please, rephrase your sentence. 
For example, it can be said : "Results from this study demonstrate that mHealth 
interventions, specifically the use of SMS textbased messaging is perceived positively by  
the majority of the women interrogated".  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
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.  
 
Yes 
 
Are you able to assess any statistics in t he manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy 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 ma nuscript:  
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing in terests, 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, e ither 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 relatin g 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 int erests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
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