Reviewer's report
Title:Validation of a Susceptibility, Benefits, and Barrier Scale for Mammography
Screening among Peruvian Women: a cross-sectional study
Version: 1Date:28 June 2011
Reviewer: Tytti Sarkeala
Reviewer's report:
The study ’Validation of susceptibility, benefits, and barrier scale for
mammography screening among Peruvian women: a cross-sectional study’
examines a Champion’s scale measuring perceived susceptibility to breast
cancer and perceived benefits and barriers to mammography utilization among
women attending outpatient gynaecology clinic in a public hospital in Lima, Peru.
The authors adapted a Spanish version of the Champion’s scale to a local
dialect, piloted the new version among 20 women, and thereafter administered
the piloted version to 294 women aged 40-65 years to assess construct validity
and reliability of the scale. The authors also evaluated concurrent validity of the
scale by comparing various scores of the Champion’s scale between those who
had received and those who had not received a mammogram within the last 15
months.
The results revealed high construct validity and reliability. Since perceived
barriers was the only sub-score associated to mammography screening, the
authors concluded that the Champion’s scale showed limitations in concurrent
validity and therefore should not as such to be used to explore perceived beliefs
about breast cancer and mammography screening in Peru.
Major comments:
1. More information on the Champion’s scale, e.g. on the scale items and the
previous study populations should be given. Is the Champion’s scale currently
utilized somewhere?
2. Accordingly, more information on mammography screening utilization in Peru
should be given, e.g. do the women need to seek mammograms by themselves,
or is mammography screening based on invitation? Is it expensive to have a
mammogram in Peru? Is mammography screening generally available, and is it
available simultaneously with cervical cancer screening?
3. The study group consisted of women attending a gynaecology clinic in the
capital city of Peru. Did the women come to the clinic due to cervical cancer
screening, due to mammography screening, or due to both of these (see above)?
In any case, the study group has already ‘bypassed the accessibility barrier’, and
therefore does not necessarily form a representative sample of Peruvian women
aged 40-65 years. This should be discussed in the manuscript.
4. In the Champion paper (1999), the study group consisted of women aged 50+
(mean age 61) with a fairly high mean educational level (12.5 years). Those not
being able to read or write were excluded. Could the differences between the
Champion and the current study group affect e.g. on the level and distribution of
perceived susceptibility to breast cancer or perceived benefits of mammography
screening?
5. The authors conclude that the Champion’s scale should not be used among
Peruvian women until the content of the scale is revised. Considering the low
mammography rates in Peru, there could also be other means to be developed,
e.g. accessibility to screening and information systems. If there is a lack of
information and services, there probably won’t be large differences in perceived
beliefs about breast cancer and mammography screening among the screening
target population?
Minor comments:
6. Out of the 285 women in the study group, approximately 37% had received a
screening mammogram within 15 months, 20% had received at least one
mammogram prior to 15 months, and 43% had never received a mammogram.
Which groups did the authors compare when assessing the concurrent validity of
the scale?
7. How the independent analyses on age, prior Pap test, and knowledge about
breast cancer are connected to validation of the Champion’s scale?
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests.