Reviewer ’s report  
 
Title: Cervical cancer screening service utilization and associated factors among age -eligible 
women in Jimma Town using health belief model, so uth west Ethiopia  
 
Version: 0 Date: 02 Jul 2019  
 
Reviewer: Paolo Giorgi Rossi  
 
Reviewer's report:  
 
The paper is presents the results of  an interesting survey on cervical screening uptake in 
Ethiopia. The questionnaire is based on  a well -done application of the Health Biliefs Model.  
 
Abstract  
Which occupational status was associated with screening? Wha t is knowledge status?  
 
Methods  
Good to report the Chrombach's alpha results, but it is more  important to see the content of the 
questionnaire and the scales.  
The methods to construct the score are all similar and it is not useful to report it several ti me, it 
would more interesting to show which items are included.  
While a threshold to build the model can be useful (but 0.05 is definitely too high, more  
meaningful 0.2 or 0.1 to see more  possible associations and to take all possible  confounders), 
significance threshold at 0.05 is an observational study like this is not meaningful: there are not  
formal test of  hypothesis to do in this case and a p -value of 0.051 can be interpreted as a p -value 
of 0.049.   
 
Results  
In the text percentages are presented  in a confusing way: if  you say "From a total of 524 heard 
about cervical only about 114(15.5%)" one would expect that the percentage was computed on 
the 524 and not on the total respondents. Actually it is more correct to present thee percentage  
on the total, but the text is misleading. In the following sentence in fact the percentage is 
computed on those who heard about cervical cancer. I do not understand this  choice, because not 
all the women have gynecological examination for oncological reasons, so  I do not expect that 
having heard about cervical cancer is a necessary condition to have a gynecological examination.  
Please presents also the results of each item for all the scales.  
Figures are not informative, the same results are already in the table s.   
With such common outcome OR cannot be  interpreted as  prevalence ratio, i.e. if the AOR is 
2.67 it does not mean that a group has 2.67 times more probability to have been screened.  
Results in the text describe exactly what is in the table in a very repetitive way, I suggest to 
report in only one paragraph the variables associated.  
 
Discussion  
The main limit of this approach is that you cannot distinguish the time sequence of the exposure 
and outcome. Some of the association may be not causal or even  causal in the opposite way: for 
example  the association with knowledge about cervical cancer could be the reverse, i.e. the 
woman is informed because she attended to screening and in that moment she got the 
information.  
Most of the discussion repeat the results without. I suggest to use the Health beliefs model in 
interpreting the results. Maybe a figure could be useful.  
The conclusions are again a summary of the results (it  is ok, but boring). The recommendation is 
very generic and not all the actions a re evidence based. The recommendation about counselling 
should be sustained by specific results that are not given: how many women had had a contact 
with health service but were not advised about cervical cancer?  
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 the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify 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 t he manuscript:  
 
Not suitable for publication unless extensively edited  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisatio n 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, either 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 relati ng 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 interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
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