Title: The Effectiveness of Educational Intervention based on the Health Action Model )HAM)
in Improving Breast Cancer Screening Behaviors
Version: 4 Date: 09 Feb 2023
Reviewer:  Ayat Mahmoud Tawfik
Reviewer's report:
1. Replace the term statistical population by the word (study) population.
2. It is 162 women not woman, correct.
3. What is (easy) sampling in research?? It seems to be non-scientific word. Replace it.
4. Quasi-experimental design attempts to establish a cause-and-effect relationship by using
criteria other than randomization. How this was met in your study to consider it as quasi.
5. Who are those authors? “ designed by mahboobi ghazaani and et al[32]” are they the same
authors or different and why it is so important to mention their authorship of the questionnaire
design? Is it a validated questionnaire by these authors? Clarify as it was so ambiguous statement.
6. Which technique to design the questionnaire is right? “the items of this section were obtained
through literature review” or ““ designed by mahboobi ghazaani and et al[32]”? It is so
confusing.
7. What are these mentioned 85 items: “semi-structured interviews, expert panel opinions, and
studies in this field and then were investigated with 85 items.”?
8. This sentence is not organized and can not be understood: ‘The structure of health action
(or breast cancer screening behaviors including: monthly breast self-examination, clinical
examination by a midwife/doctor and mammography) with 6 items and scoring it as a Likert
scale for item 2 and as yes and no for items 1 and 3. 4,5 and 6 were done.”
9. The estimate 0.9 represents what statistical indicator? “The values of content validity ratio
and content validity index for knowledge items, constructs of health action model and behavior
higher than 0.9 were obtained.”
All the data collection scores are vey disorganized. If it is to be re-written in a logic, organized,
and understandable way or it means that the tool was not good enough to accept the results.
10. You mentioned that “-The questionnaire was completed in three periods. Before the
intervention to check the status of performing screening behaviors in women and also the
primary data analysis to prepare educational content, in the period of 3 and 6 months to check
whether the educational intervention can be effective in performing screening behaviors or not.”
However, this was not written in the manuscript. Why?
11. “One person from the control group dropped out of the study due to pregnancy during the
training of the intervention group, because pregnancy was one of the criteria for dropping out
of the study. One person from the intervention group dropped out of the study at the end of the
training course and refused to complete the second and third stage questionnaires according to
multiple follow-ups.” Again not written in the manuscript.
Please, these comments to be corrected in the manuscript and on replying to the reviewer’s
comments, you have to clarify in what part and line of text we can find these corrections in the
manuscript.
12. The comment (Remove “before, three and six months after the intervention” from table 2
title.) you replied that it was corrected while it is not.
13. How this major confounder (job) was treated statistically? ‘In this study, demographic
variables such as educational level, marital status, insurance status, menopause, and income
levels were not significantly different in the two groups, but the intervention and control groups
were significantly different in terms of the job.”
14. You can not start the recommendation by therefore “Therefore, health workers and
stakeholders in comprehensive health service centers are”.
15. The conclusion is too long, please make it to the focus.
16. Where is the following was done ‘Explanations were provided in the Data collection tool
section. The number of sample people in this part is 300 people, which is wrongly stated here
as 210 people (printing error).”?
17. All tables not indicating what P-value is significant.