Title: The Levels of Women's Awareness, Experience, Acceptability and Preference for Vaginal
Human Papillomavirus (HPV) Self-sampling in Three Provinces of China: A Cross-sectional
Study
Version: 1 Date: 15 Jan 2024
Reviewer's report:
This manuscript examines the knowledge, experience, acceptability, and preference for vaginal
HPV self-sampling among a sample of women residing in three China cities (Jiangsu, Zhejiang,
and Shanghai). Strengths of the study include a large sample size and firsthand experiences
of HPV self-sampling among survey respondents. In this review, I highlight major and minor
suggestions.
GENERAL COMMENTS:
1. Major suggestion:  To ensure optimal reading comprehension and professional scholarly
communications, I recommend the assistance or service of a copy editor. I saw several uses of
derogatory language (e.g., mental retardation) in certain sections of the manuscript. It is crucial
to maintain a professional and respectful tone in scientific writing. I kindly request that you
review and revise the language to ensure it aligns with the standards of scholarly communication.
INTRODUCTION:
2. Minor suggestion:  The authors state that their research objective is to examine the association
of various sociodemographic variables with specific outcomes related to HPV self-sampling
(e.g., knowledge, acceptability, etc.). There should be additional literature cited about which
sociodemographic variables are of interest and why they would warrant further investigation in
this study.
METHODS:
3. Major suggestion:  Please complete and report how the cross-sectional study meets or does
not meet reporting guidelines for observational studies using the STROBE guidelines.
4. Minor suggestion:  The authors should report a response rate.
5. Major suggestion:  The authors state that participants were recruited from a previous HPV
self-sampling study, but failed to provide a citation for this prior work. The authors should either
describe in details the study procedures in this text or cite the previous research.
6. Minor suggestion:  The authors should also provide details on procedures of whether
participants were contacted multiple times, in the event of no response.
7. Major suggestion:  Please provide the name(s) of the HPV self-sampling test kit(s) and the
HPV assay(s) used to test self-collected samples within the study. Also elaborate on whether
self-sampling kit instructions were made available in respective Chinese languages. Further,
there is insufficient details to truly identify whether participants who purchased an HPV self-
sampling kit did complete the test themselves (i.e., the test kit may have been purchased for
someone else). These limitations should be discussed in the discussion.
8. Major suggestion:  The authors stated that they removed participants with more than 20% of
missing survey items from the analysis. There is no clear rationale for why the authors handled
the missing data in this way. What is the rationale for the 20% cutoff? Did the authors attempt
to assess any of the missingness?
9. Major suggestion:  The authors used a scale to assess participants’ knowledge of HPV self-
sampling and cervical cancer. However, the items within the scale itself does not actually
measure knowledge. Many of the items ask participants to respond either yes or no. As a matter
of fact, many of the items in the scale do not actually test knowledge, but a level of awareness.
The authors should state or cite any previous literature that developed, tested, and validated this
scale, and how scores were assessed for such a scale.
10. Major suggestion:  Furthermore, the authors stated that they created the questionnaire/survey
themselves. However, there was no discussion or description regarding whether the survey
underwent appropriate piloting or pre-testing. There is cause for concern whether the de novo
scales and items included in this questionnaire performs well on psychometric properties (e.g.,
validity and reliability).
11. Major suggestion:  The authors state that they conducted univariate analyses for all reported
predictors and outcomes, then used the statistically significant results to inform the model
building for their multivariable analyses. This is not the recommended approach for building
higher order regression models. What is the authors’ rationale for using this analytical approach?
12. Major suggestion:  The authors reported values for a Cronbach’s alpha and retest reliability.
It is unclear why these statistics were performed and what they represent. For example, is the
Cronbach’s alpha for the knowledge score? Further, the authors did mention having survey
respondents complete the survey twice, so it is unclear why they would have calculated and
reported a retest reliability.
RESULTS:
13. Minor suggestion:  The authors reported that participants were recruited from three cities
in China. They should provide a breakdown or report percentages of where participants came
from each region.