Title: HPV Self-Collection for Cervical Cancer Screening among Survivors of Sexual Trauma:
A Qualitative Study
Version: 0 Date: 17 Jun 2024
Reviewer's report:
Thank you to the authors for conducting such an important and impactful study. It is obvious that
the authors toke care with the subject matter. I do have several comments about the manuscript
and study.
Introduction
Second paragraph in the introduction- Can you explain the linkage between cervical cancer and
your listed negative social determinants of health? Are you linking these SDOHs to screening,
or cervical cancer in general? Are there barriers to cervical cancer screening for women who
have experienced IPV? Also just curious, African American women are often diagnosed at later
stages of cervical cancer, is the same to be said for women experiencing IPV?
Methods
Participants- Was there any recruitment with women's shelters or with healthcare clinics that
are tied to shelter networks?
Is the sexual abuse or trauma only related to adulthood, or did you include women who had
experience abuse in childhood?
Line 144- Was this the only theoretical framework that was involved with the interview guide
development? Did the authors use any other theories that more closely align with IPV research
to inform their interview guide and analysis?
Line 148- Looking at your interview guide, I don't see much in the questions listed that would
be able to inform this. Did you ask follow-up questions that specifically referenced the level of
support felt, or was this something that you found later on in the data when you were coding?
Line 149- Organizational level factors we sought to understand involved provider knowledge
and sensitivity providing cervical cancer screening to individuals who have experienced sexual
trauma and perceptions and preferences for the clinic versus home environment for cervical
cancer screening.  This sentence is difficult to read.
You mentioned in line 140 that you did not do any repeat interviews, and in line 160 that you did
use member checking. How did you use member checking? Were the participants compensated
again? Was there a second meeting?
Which grounded theory methodology did you use? Constructivist? Classical? Please, include
a citation.
I just want to double check that I understand, you are talking about thematic saturation and not
theoretical or code?
Can you describe your system to ‘develop, check and refine theoretical categories ’ more in-
depth?
Line- 172 In developing your codebook, did you mean to say that you used an inductive
approach?
Line 175- Did you use any other additional memo-writing? Were memos or field notes written
after each interview? How did the team establish rigor with the results and methods? Was their
triangulation? Was there peer debriefing?
Line 175- Presented the results where and to who in thematic analysis memo?
Line 182- Was there any education from the research team for the women on how to collect a
successful sample?
Results
Line 208- Did the participants say that the care was trauma informed, or did the researchers infer
that from prior knowledge of what classifies as trauma informed care?
Line 218- How did the participants frame their history of IPV as a barrier? Where there
discussions from the participants on how IPV has impacted their relationship with health in
general, and willingness to be screened?
Line 231- Which barriers in particular?
This may be due to word count restrictions, however not having quotes embedded within the
manuscript itself felt limiting. If it is possible to include more direct quotes within the manuscript
itself, rather than shuttled off into a table, that would help reinforce importance and value of
the participants perspectives.
Discussion
Line 267- Citation?
Line 280- I'd recommend including examples from US-based studies. While the exam may be
the same in Swedish and English populations, the healthcare system is different enough from
scheduling, to attendance, and insurance etc.
284- This is an excellent point, however a citation would be appreciated. Also, how reflective
of this statement is your participant population. Most women who have delays in screening or
timely diagnosis are from historically marginalized groups.
290- Citation?
Line 330- Culturally tailored to who? To women who have experienced IPV?