Title: Narratives of Resilience: Understanding Iranian Breast Cancer Survivors through Health
Belief Model and Stress-Coping Theory for Enhanced Interventions
Version: 2 Date: 04 Jul 2024
Reviewer's report:
I would like to offer a few suggestions to further enhance the manuscript's contribution to the
field.
1- While the abstract mentions the development of culturally sensitive interventions, it could
be more specific about the practical implications of the study's findings. For example, it could
suggest concrete strategies for healthcare providers to address the identified barriers and enhance
support systems for Iranian breast cancer survivors.
2- The introduction of the manuscript establishes the importance of understanding the
experiences of Iranian breast cancer survivors and the need for culturally relevant interventions.
However, it does not explicitly state a specific research gap that this study aims to fill. To
enhance the introduction, the authors could consider adding a statement that highlights the lack
of research on the combined application of the Health Belief Model (HBM) and Stress-Coping
Theory (SCT) in understanding the adaptation process of Iranian breast cancer survivors. This
would clarify the unique contribution of this study and its potential to inform the development
of tailored interventions for this population.
3- The authors mention that questions were derived from a literature review and validated by
an expert panel. It would be helpful to specify the specific sources of the literature review and
the composition of the expert panel.
4- The methods section would be strengthened if the authors elaborated on how the existing
literature and theoretical frameworks (HBM and SCT) were specifically used to inform the
development of the interview guide and the data analysis process. This would provide a clearer
understanding of how the grounded theory approach was integrated with these pre-existing
theories.
5- In the result section, while participant quotes are valuable, consider paraphrasing some or
selecting the most impactful ones to avoid overwhelming the reader. This will help maintain the
flow of the narrative and highlight key points more effectively. Also, use a numbered list format
for all subthemes to maintain consistency and improve readability.
6- The authors state, "Our results are consistent with the hypothesis that people with high levels
of social support have better health outcomes than those with low social support, irrespective
of stress [53]." However, reference 53 (Strom & Egede, 2012) is a systematic review focused
on the impact of social support on outcomes in adult patients with type 2 diabetes, not a
general statement about the relationship between social support and health outcomes across all
conditions.
7- The discussion mentions the influence of religious beliefs on coping strategies but does
not delve into the specific ways in which religion might shape health behaviors and outcomes
among Iranian breast cancer survivors. A more in-depth exploration of this aspect could provide
valuable insights for developing culturally sensitive interventions.
8- Incorporating the findings of "Patients’ Experiences of Cancer Pain: A Descriptive
Qualitative Study" [DOI: 10.1177/08258597221149545] (2023) and "Enhancing cancer pain
self-management: a Holistic supporting model [DOI: 10.1177/23779608231197581]" (2022)
into the discussion section of your manuscript would significantly enrich the understanding of
the Iranian context. The qualitative study's exploration of cancer pain experiences and coping
mechanisms among Iranian patients aligns with your study's focus on resilience in breast cancer
survivors. By comparing and contrasting your findings on coping strategies with those identified
in the 2023 study, you could offer a more nuanced understanding of how Iranian women navigate
the challenges of breast cancer and its associated pain. Additionally, the holistic model for pain
self-management proposed in the 2022 study could serve as a valuable framework for developing
culturally sensitive interventions tailored to the unique needs of Iranian breast cancer survivors.
This would not only strengthen your discussion but also contribute to the development of more
effective and culturally relevant support systems for this population.