Title: The Effectiveness of Educational Intervention based on the Health Action Model )HAM)
in Improving Breast Cancer Screening Behaviors
Version: 5 Date: 14 Apr 2023
Reviewer's report:
Report
There is significant improvement, however, I still have some questions to pose the authors before
I recommend that this manuscript can be accepted for publication. First of all, I recommend
the authors to read the manuscript carefully for adressing all the typos and gramatical errors
that remain questionable. Secondly, the analyis is not responding to the research question or
hypotheses. The authors are examining the effectiveness of the intervention, but the methods
section and results do not respond to this. Further comments are provided below :
Though not sure, but in my opinion, the title could be short as « Effectiveness of Educational
Intervention based on the Health Action Model on Breast Cancer Screening Behaviors in women
». importantly, the use of « The » and abbreviation « HAM » is not necessary.
In the abstract, HAM needs to be used in full words at the first followed  with its abrreviation.
When you start the main work, you also write full words followed with the abbreviation. The
remain part, you continue using abbreviations. For example; you sans ay « Health Action Model
(HAM) » in the background of abstract and then keep using only abbreviation « HAM » in the
remaining parts of abstract. This must be applied in all sections of the study. For example; check
the word « Health Action Model » in the body of the text. Please, try to be consistent when you
write the Health Action Model.
The results of the abstract are not indicating effect of the intervention. The authors are indicating
the results from the descriptive analyses which need to be supported by the advanced analyses.
Please, write Kashan instead of kashan.
Write in full « SPSS » in the abstract.
To perform well interpretations in the results sections, you can clarify the results saying « …
significantly higher than… ». example; « In the three-month (p<0.05) and six-month (p<0.05)
phases, the mean scores of the HAM constructs in the intervention group were significantly
higher than in the control group. »
Write  « NCSS » in full.  In the methods, please, you can say « Power and Sample Size (PAS) »
In sampling, please, write «women aged 30 to 69years »
Regarding data collection tools, in the measurements, paraphrase the first sentence.
On page 9, the last sentence. Please, write the value of the validity after you write « validity
coefficient writen as r=). For example; (r=.93 & r=.94). the readers need to know if your validity
is beneficial or not! Please, add the interpretations of the validity.
On page 10, please, write « Cronbach’s Alpha » instead of « Cornbrash’s alpha ». On the same
page, you have to check well the cut-off of Alpha of Cronbach and paraphrase the paragraph.
On page 12, what is Whets App?
On page 15, please write well SPSS. Start with the full words and then abbreviation. Check the
comments above.
Although you have improved the manuscript, I am not convinced that you can conclude that you
assessed the effect of the intervention because the methods do not clarify statistical parameters to
assess the effect of an interview. Please, mean difference cannot indicate that there is an impact
of the intervension. On my views, I accept that you found significant differences mean scores on
certain behaviors, but you did not find the effect of the intervension. In addition to that, you need
to control the confounders before you conclude that there is an effect of the intervension. Please,
check well your methods and results sections. If you do not clarify that I cannot endorse this
manuscript on my side. I think that you need to compute statistical analysis using Chi-square,
independent t-test, or paired t-test in the data analysis for responding to your hyportheses.
On page 10, you said that you computed factor analysis to assess the construct validity. How
did you perform it? Why do you think that this kind of factor analysis is essential in this study?
Please, revise well the strengths and limitations sections. I think you have to srenegthen them.
I think that using the HAM can be mentioned as a strength because this standardised model
can be used as framework for promoting behavior change. This indicates that using the HAM
can help healthcare profesionals in health and treatent sectors to use it as an prominent model
forrequirment assessment at all levels and plan and implement effect intervention for promoting
screening behaviors based on this model.