Reviewer ’s report  
 
Title:  Effect of structured training programme on the knowledge and behaviors of breast and 
cervical cancer screening among the female tea chers in Turkey  
 
Version: 2 Date: 10 Feb 2017 
 
Reviewer:  Cameron  Hurst  
 
Reviewer’s report:  
 
In all cases except one, the authors seemed  to have address my comment.  
 
However, the issue the authors have not adequately addressed means (in my opinion) that the 
paper is not acceptable for publication. The authors have failed to provide sufficient evidence (or 
even partial evidence) of the cont ract validity of the scales that represent their outcomes.  
 
I acknowledge that the authors have found a reference to state that expert opinion and a thorough 
literature review is sufficient for validity, but anyone with even a passing familiarity with the 
psychometric workup of measurement instruments knows this not to be true. Expert and 
literature input are only used for the content validation process, a necessary part of instrument 
deveoplment, but far from suffcient to claim 'validity'.  Expert input in to the instrument 
development phase only provides support for what sort of items should be used (i.e. questions 
ask), and partially, how these items might hang together to form instrument subscales. Content 
validation does not, nor sets out to, ensure that  the combined scores obtained from the items 
associate with the construct of interest. This is the role of construct validity. This is something 
the authors did not do, and nor did they convince me that others have done this on other similar 
populations. I nstead, they point out that difference in the scales between the groups (teachers and 
students) was further evidence of validity. I do not agree. I imagine the students and teachers 
differed in many ways. For example, a difference between the teachers and students in terms of 
age does not suggest age can be used as a surrogate measure of breast cancer knowledge -
attitude -practice. Why did the authors not go back and conduct a confirmatory factor analysis 
(the minimal step required to provide evidence of cons truct validity). For me this is omission is a 
major limitation, and moreover, it is one the authors could solve.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
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.  
 
No 
 
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 edito rs. 
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
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 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, eithe r 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 relati ng 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 relating 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 have no competing interests.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included 
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to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal