Reviewer ’s report  
 
Title: Cervical cancer screening service utilization and associated factors among age -eligible 
women in Jimma Town using health belief model, so uth west Ethiopia  
 
Version: 0 Date: 22 May 2019  
 
Reviewer: Megan Huchko  
 
Reviewer's report:  
 
The title is somewhat misleading: the authors are looking at factors that include the health belief 
model that impact screening. There is also no introduction to the health belief model in the 
introduction and applicability to this situati on. The authors should either focus more on their use 
of the health belief model or change the title.  
 
Abstract:  
Second sentence: cervical cancer causes over 300,000 deaths annually —this is more than 
thousands, so rephrase.  
Last sentence of the backgroun d repeats "low" twice —would rephrase (can replace first low with 
poor or limited).  
Is background —clarify that cervical cancer screening is consistently available so readers know 
that this is a study of women's decision -making around uptake, not a combinat ion of service 
availabi lity and acceptability.  
The methods sentence beginning with "data were entered…" can be removed and replaced with 
more information about the types of data collected in the questionnaire or type of sampling done.  
Multiple type -os in  the last sentence of the results section (advise=advice; should be history OF 
gynecologic exam, Knowledge should not be capitalized).  
Instead of repeating the findings from the results in the conclusion, authors should present some 
sort of summary or co nclusion (second sentence of conclusion).  
 
Intro:  
Last sentence of second paragraph: the cause of disparity is not just utilization of appropriate 
mechanism —there are gaps in funding, policy and protocols that lead to significant gaps in 
service availabil ity. 
Overall intro should be streamlined to focus on screening availability and uptake (paragraph 
starting "the study from Addis…" can be summarized into one sentence.). It is also crucial to 
understand the quality and consistency of cervical cancer scree ning service availability.  
 
Methods:  
What is the overall population of screen -eligible women in Jimma? I ask because it seems like a 
very small number of facilities offer screening. How were you assessing whether women 
sampled had been offered screening within facilities or referred for scree ning?  
Study design: this is a sentence fragment.  
Inclusion and Exclusion Criteria —first sentence repeats the last sentence in population.  
Please define Kebele.  
Under operational definition and measurements: Once you have defined the five -point Likert 
scale, you do not need to repeat it for each measure.  
 
Results:  
Suggest combining first two paragraphs, and tables 1 and 2. As data is presented in the tables, 
can summarize more and stick with referral to table.  
Knowledge about cervical cancer: The last sentence in that paragraph, starting with "almost all of 
health extension workers.." is unclear. Are women sampled health workers?  Please clarify this 
sentence.  
Constructs of Health Belief Model: From reading the methods, it appears that you have the mea n 
levels of each construct —why not present these? It would be more informative. Also, would not 
use sub -headings for each construct —just include in the narrative.  
Recommend moving "magnitude of cervical cancer screening" to the first paragraph, as this i s a 
key outcomes.  
Reason for not [being] screened for cervical cancer: does this mean reason for declining 
screening?  
 
There i  
Table 3: This seems to be among women who had ever heard of cancer. Please clarify the title.  
Also, is there more informatio n on the gender preference? Are participants desiring female 
providers? Male? Can you present the data on this?  Finally —did you also ask if ever screened, 
or only if screened in past five years?  
Table 4/Factors Associated with cervical cancer screening: women who had a history of 
gynecologic exam —this seems like it would be collinear with history of screening. Did you 
inquire as to whether this is a separate exam?  
 
Discussion:  
The discussion can be streamlined to outline and synthesize the main findings. Try to avoid 
repeating results, but rather use this to interpret.  
In limitations: there is no assessment of women's exposure to screening or their last visit to a 
health care p rovider.  
Overall, the writing needs editing for clarity. There are type -os and errors in language.  
Are the methods appropriate and well described?  
If not, please specify what is required 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.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please 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 t he manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisatio n that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relati ng to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
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