Reviewer ’s report  
 
Title: Using the health belief model to assess beliefs and behaviors r egarding cervical cancer 
screening among Saudi women: A cross -sectional observational study  
 
Version: 0 Date: 09 Oct 2018  
 
Reviewer: Theresa Byrd  
 
Reviewer's report:  
 
This was an interesting manuscript.  I believe you answered your question.  I do think you need a 
little more explanation of the theory (HBM).  You are using a construct (General Health 
Motivation) which is not used in general anymore, so you might d iscuss that and how the theory 
ought to work.  You over -interpreted in your discussion of the scales, for example: 237:A high 
score defined a belief of increased likelihood of developing cervical cancer and a serious attitude 
towards having a Pap smear tes t.  Although a high perceived susceptibility ought to increase the 
intention to be tested, we can't say that is true without the data!  You might also discuss self -
efficacy and why you chose not to include it.  I think generally the survey items come from some 
qualitative work with the population.  Your experts who reviewed the survey were not (I don't 
think) behavioral scientists, and that would have been helpful.   
 
Please explain how the instrument was changed after pilot testing.   
In these data, I didn 't understand the difference between unmarried and single:  
 
 Married  
Unmarried  
Single  
Divorced  
Widow  
 
The rate of screening in this group is very low, while the number of cases seems low as well.  I 
am surprised at this because of the percentage of people  reported to have HPV.  I also wonder 
about the other women in Saudi --I understand that there are many workers from other countries --
you might discuss their status as well.  I am also surprised at the late age for HPV vaccination, 
especially with the high rate of HPV!  In most countries the vaccine is recommended at age 11 or 
12.  Please comment on that.   
Are the methods appropriate and well described?  
If not, please specify what is req uired 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, pleas e 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 the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
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