Title: Breast Self-Examination Practice and Predictors among Female Secondary School
Teachers in Addis Ababa, Ethiopia: Using the Health Belief Model
Version: 2 Date: 02 May 2022
Reviewer:  Mesafint Abeje Tiruneh
Reviewer's report:
1. Title
1) Line No. 1-2: The title lacks clarity. Breast self-examination should be “breast self-
examination practice”.
2) Line No. 1-2: The content of the manuscript talks about both practice and predictors. However,
the title indicates only predictors. Therefore it is better to amend the title as “Breast self-
Examination practice and predictors among female secondary school teachers in Addis Ababa,
Ethiopia: using the Health Belief Model”.
2.  Abstract
Background:
1) Line No. 27: The study reports included both practice and predictors. However, the objective
indicates only predictors. Therefore, it is better to correct as “…this study aimed to assess Breast
self-Examination practice and predictors among female secondary school teachers using the
health belief model (HBM)”.
Methods:
1) Line No. 29: “Method” shall be “Materials and methods”
2) Line No. 33: multi-variable logistic regression is not clear. There are three types of logistic
regression analysis methods; binary logistic regression, ordinal logistic regression and nominal
logistic regression. For which regression analysis method you used multi-variable analysis?
Please indicate the specific logistic regression analysis method you employed during data
analysis.
3) Line No. 34: “breast self-examination” should be breast self-examination practice”.
Result:
1) Line No. 38-40: Better to use two digits after the decimal point for AOR and CI.
Conclusion:
1) Line No. 42-43: the statement “The perceived self-efficacy of female teachers was found
to significantly affect the practice of BSE” is not clear.  Please include all factors which had
significant association.
2) Line No. 43-46: The recommendation should be based on the overall finding of the study not
for a single predictor.
3. Background
1) There are some similar studies conducted in Ethiopia including Addis Ababa. However, no
justification stated why you need to conduct this study. You have to indicate the limitation/gaps
of the previous studies and what is new in your study.
2) Line No. 94-95: Please revise the objective to address both practice and predictors.
4. Methods and materials
Sample size determination
1) Line No. 108-109: “a single population” should be “ a single population proportion”.
2) Line No. 109-113: You calculated sample size only for the proportion/practice not for
predictors (associated factors). It was expected to calculate sample size for predictors using
double population formula. The sample size you used for proportion might not be representative
for predictors. Therefore, your sample size might not be representative to identify predictors.
Measurements
1) Line No. 124-150: It is a long paragraph. Please breakdown it to different paragraphs based
on the content.
2) Line No. 144-150: The statements included here should be part of “Data management and
analysis” section.
Operational definitions:
1) There should be operational definition for key terms. Eg. Breast examination practice,
knowledge, etc.
Data management and analysis:
1) Line No. 167: “multivariable logistic regression” should be multivariable binary logistic
regression”.
2) Line No. 170-171: You did model adequacy test. However, the finding is not reported whether
the model was fitted for the data or not.
5. Results
Socio-demographic characteristics of the study participants:
1) Table 1: Age frequency is not placed in the right row,
2) Line No. 197-198: Figure 1; the figure title has no year and n.
Breast self-examination (BSE) Practice of the respondents:
1) This title shall be “Breast self-examination (BSE) Practice”.
2) Line No. 200-201: Percent of the practice shall be reported with 95% confidence interval (CI).
3) This section should be next to Perception towards BSE
Predictors of breast self-examination practice:
1) Line No. 214-215:  First of all you have to indicate all variables which had significant
association at 25% level of significance bivariate binary logistic regression analysis and at 5%
level of significance multivariable binary logistic regression analysis. It is not necessary to say
among socio-demographic variables.
2) You have to interpret variables which had significant association at 5% level of significance
multivariable binary logistic regression analysis with AOR and 95% CI in different paragraphs
3) When you interpret the findings you have to put the AOR as it is not the approximate value.
You use the approximate value for discussion purpose.
4) Line No. 220-224: Since knowledge is not operationally defined the interpretation is not clear.
5) Better to use two digits after the decimal point for AOR and CI.
6) AOR and CI shall be in a single bracket.
7) No need of saying controlling possible confounding variables. Because it is a multivariable
analysis and already known.
8) Table 4:
• One column shall be added next to category for cross-tabulation of breast self-examination and
values shall be included for all variables.
• COR shall be “COR (95% CI)”.
• P is not necessary for COR.
• AOR shall be “AOR (95% CI)”.
• P for AOR shall be “p-value)
• Better to use two digits after the decimal point for COR, AOR and CI.
6. Discussion
1) You have to use separate paragraphs for each finding/discussion point.
2) Line No. 240 and 275: Please specify where the study conducted in Ethiopia.
3) Before discussing the finding, you have to put the interpretation of the result section directly
without AOR and CI. Then, you can compare with other studies and justify the discrepancies.
4) The discussion should be according to the order of findings reported in the result section.
9) Line No. 244-250: Since the interpretation is not clear, the discussion is very vague. Please
see it again.
5) Line No. 270-272: the interpretation is not the same as the result and it is not clear.
6) For all predictors: In addition to comparing with other studies, you have to also discuss and
justify why one group of the study participants practiced more than the other group.
7) Line No. 286-287: The statement “The findings of this study may not be representative of
all teachers in Ethiopia as female teachers who only work in public secondary schools were
selected” cannot be limitation of your study. Because it is already known. Limitation should be
within the scope of your study.
8) Please revise the interpretations of significant factors based on the comment given in the
result section.
9) Please discuss the prevalence and each significant variable in separate paragraphs.
10) Before you discuss the significant variables you have to put the interpretation of the finding
based on the result section.
11) You have to justify why one group had more odds ratio than the other group for each
significant variable.
3) Line No. 292-296:
7. Conclusion
1)  Line No 298: “among the socio-demographic variables” is not necessary phrase, please delete
it.