Title: Insufficient Knowledge of Human Papilloma Virus among Reproductive-Aged Women
from Arak, Iran
Version: 3 Date: 15 Oct 2023
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research
question(s) (brief or other article types: is there a clear objective)?
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
Yes - the approach is appropriate
EXECUTION - Are the experiments and analyses performed with technical rigor to allow
confidence in the results?
No - there are minor issues
STATISTICS - Is the use of statistics in the manuscript appropriate?
No - there are issues with the statistics in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
No - there are minor issues
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically
sound? If not, can revisions be made to make the work technically sound?
Maybe - with major revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: This is an interesting study about knowledge on HPV among Iranian
women in Arak. This is an important isssue for women's health and this study shed a light onto
the lack of knowledge about HPV. I have some comments to make this manuscript stronger.
Abstract - the authors should provide the Background part that is consistent with the study topic.
The last two sentences of results within the Abstract do not seem to provide study results, but are
better fitted for a discussion or a conclusion. I suggest removing these sentences and providing
more results.
Introduction - the introduction focused on describing the problem of HPV infection globally
and that is, no doubt, important. However, thr Introduction did not touch upon the HPV issue in
Iran. I suggest that the authors shorten the part about the burden of HPV in the US and instead
provide a literature review about previous studies on HPV in Iran (and Iranian women).
Methods - the authors need to provide a detailed explanation about the recruitment strategy.
How many health centers there are in Arak? How was this particular center selected? What is
the turnover of women in this health center to illustrate whether the sample is representative?
How was the sample size calculated? All these pieces of information should be added in the
manuscript.
Data collection - Based on what prior literature was the questionnaire developed? Why did the
authors used a Likert scale responses instead of binary (correct/false)? Based on what rationale
was level of knowledge categorized? These data should be added in the manuscript.
Scoring of points - The Liker type scale is not precise to measure knowledge. Instead, the
authors should recode the responses on the Likert scale into binary result (positive/negative).
The affirmative responses should be categorized as positive. The negatove responses and unsure/
neutral responses should be categorized as negative.
Statistical analysis - the analytical strategy to analyze data appears suboptimal. Only basic
tests to identify the difference between groups were used and these results cannot provide
robust conclusions. To better understand the predictors of a higher knowledge level, I suggest
that the authors develop a linear regression model in which the outcome (dependent variable)
is the knowledge score (calculated as the sum of binary responses as described above). The
independent variables (predictors) in the model should be all other participant data (age,
education level etc.)
The Discussion should be adapted based on the regression results.
The Discussion section is lacking a paragraph regarding study limitations which should be added
in the manuscript.
There are some grammatical errors in the text (e.g. in Abstract the first sentence in results reads
- Women were married, diploma, etc...and should read - Women were married, had university
(?) diploma etc... or in Results of the manuscript "202 were moderate" when referring to their
socio-economic status). The manuscript should be proofread by a native English speaker.
REQUESTED REVISIONS:
This is an interesting study about knowledge on HPV among Iranian women in Arak. This is
an important isssue for women's health and this study shed a light onto the lack of knowledge
about HPV. I have some comments to make this manuscript stronger.
Abstract - the authors should provide the Background part that is consistent with the study topic.
The last two sentences of results within the Abstract do not seem to provide study results, but are
better fitted for a discussion or a conclusion. I suggest removing these sentences and providing
more results.
Introduction - the introduction focused on describing the problem of HPV infection globally
and that is, no doubt, important. However, the Introduction did not touch upon the HPV issue in
Iran. I suggest that the authors shorten the part about the burden of HPV in the US and instead
provide a literature review about previous studies on HPV in Iran (and Iranian women).
Methods - the authors need to provide a detailed explanation about the recruitment strategy.
How many health centers there are in Arak? How was this particular center selected? What is
the turnover of women in this health center to illustrate whether the sample is representative?
How was the sample size calculated? All these pieces of information should be added in the
manuscript.
Data collection - Based on what prior literature was the questionnaire developed? Why did the
authors used a Likert scale responses instead of binary (correct/false)? Based on what rationale
was level of knowledge categorized? These data should be added in the manuscript.
Scoring of points - The Likert type scale is not precise tool to measure knowledge. Instead, the
authors should recode the responses on the Likert scale into binary result (positive/negative).
The affirmative responses should be categorized as positive. The negative responses and unsure/
neutral responses should be categorized as negative.
Statistical analysis - the analytical strategy to analyze data appears suboptimal. Only basic
tests to identify the difference between groups were used and these results cannot provide
robust conclusions. To better understand the predictors of a higher knowledge level, I suggest
that the authors develop a linear regression model in which the outcome (dependent variable)
is the knowledge score (calculated as the sum of binary responses as described above). The
independent variables (predictors) in the model should be all other participant data (age,
education level etc.)
The Discussion should be adapted based on the regression results.
The Discussion section is lacking a paragraph regarding study limitations which should be added
in the manuscript.
There are some grammatical errors in the text (e.g. in Abstract the first sentence in results reads
- Women were married, diploma, etc...and should read - Women were married, had university
(?) diploma etc... or in Results of the manuscript "202 were moderate" when referring to their
socio-economic status). The manuscript should be proofread by a native English speaker.
ADDITIONAL REQUESTS/SUGGESTIONS:
This is an interesting study about knowledge on HPV among Iranian women in Arak. This is
an important isssue for women's health and this study shed a light onto the lack of knowledge
about HPV. I have some comments to make this manuscript stronger.
Abstract - the authors should provide the Background part that is consistent with the study topic.
The last two sentences of results within the Abstract do not seem to provide study results, but are
better fitted for a discussion or a conclusion. I suggest removing these sentences and providing
more results.
Introduction - the introduction focused on describing the problem of HPV infection globally
and that is, no doubt, important. However, thr Introduction did not touch upon the HPV issue in
Iran. I suggest that the authors shorten the part about the burden of HPV in the US and instead
provide a literature review about previous studies on HPV in Iran (and Iranian women).
Methods - the authors need to provide a detailed explanation about the recruitment strategy.
How many health centers there are in Arak? How was this particular center selected? What is
the turnover of women in this health center to illustrate whether the sample is representative?
How was the sample size calculated? All these pieces of information should be added in the
manuscript.
Data collection - Based on what prior literature was the questionnaire developed? Why did the
authors used a Likert scale responses instead of binary (correct/false)? Based on what rationale
was level of knowledge categorized? These data should be added in the manuscript.
Scoring of points - The Likert type scale is not precise to measure knowledge. Instead, the
authors should recode the responses on the Likert scale into binary result (positive/negative).
The affirmative responses should be categorized as positive. The negatove responses and unsure/
neutral responses should be categorized as negative.
Statistical analysis - the analytical strategy to analyze data appears suboptimal. Only basic
tests to identify the difference between groups were used and these results cannot provide
robust conclusions. To better understand the predictors of a higher knowledge level, I suggest
that the authors develop a linear regression model in which the outcome (dependent variable)
is the knowledge score (calculated as the sum of binary responses as described above). The
independent variables (predictors) in the model should be all other participant data (age,
education level etc.)
The Discussion should be adapted based on the regression results.
The Discussion section is lacking a paragraph regarding study limitations which should be added
in the manuscript.
There are some grammatical errors in the text (e.g. in Abstract the first sentence in results reads
- Women were married, diploma, etc...and should read - Women were married, had university
(?) diploma etc... or in Results of the manuscript "202 were moderate" when referring to their
socio-economic status). The manuscript should be proofread by a native English speaker.