Title: Process of developing a cervical cancer education program for female university students
in a Health and Physical Education teacher training course: an action research
Version: 3 Date: 05 Jan 2023
Reviewer's report:
Process of developing a cervical cancer education program for female university students in a
health and physical education teacher training course: an action research
Reviewer Feedback
Thank you for the opportunity to read your manuscript which I found interesting to read. I
thought your topic was one which is important to teach and for school pupils to learn about. That
said, I am afraid your manuscript lacked depth and academic rigour in all areas and will need
significant re-writing and re-working in that regard before it would be publishable. Much of
what you wrote needed a lot more unpacking and a lot of claims you made throughout the paper
were not self-evident. The purpose, justification, methods, results, discussion and conclusion
were all lacking. Because of the limitations in the front end of the paper, the latter end was really
difficult for me to make sense of.  I hope that my comments are useful and wish you well with
developing the paper if that is what you choose to do.
Abstract
I think your abstract could be punchier and more efficient. For example, in terms of efficiency the
mention of the university twice should be addressed – see my comment about this below. Also,
your findings seem somewhat underwhelming. What did you find that is compelling and could
add to the academy about why HPE pre-service teachers should know about cervical cancer?
Think about your abstract as an opportunity to ‘sell’ your article to the readership. I think you
could also provide a deeper sense at this stage of what the articles is about, why it is important
and what new insights it provides.
Page 2 line 22 – suggest you write in the past sense as much as possible, so ‘was to develop…’
rather than ‘is to develop’.
Page 2 line 24 - health and physical education teachers – revise to ‘Health and Physical Education
teachers’.
Page 2 line 25 – delete ‘the’.
Page 2 lines 26-27 - Not sure what ‘the content of the report as a process evaluation’ means?
Check expression and keep your language clear and not over-complicated.
Page 2 line 27 space between Thirty and five.
Page 2 lines 28-29 – suggest not naming the university to de-identify it and to describe it as
something other than a Sports Science University again to de-identify. Could it be described as
an HPE teacher education university?
Page 2 lines 31-32 – suggest deleting as I am not sure this information is necessary/required.
Page 2 line 40 – not sure ‘visualized’ is the right word here. Do you mean ‘reported’?
Main manuscript
Page 2 line 46 – suggest ‘Introduction’ rather than ‘Background’.
Page 2 line 48 ‘are’ rather than ‘is’.
Page 2 line 52 – more on ‘the curriculum’ – is it a national curriculum for example? What is it
and who is it for? Also, it should be referenced.
Page 3 line54 – what students? Do you mean children or university students/pre-service
teachers?
Page 3 line 56 – more on the education model and what did the evaluations find?
Page 3 lines 58 to 64 – more detail about where in the curriculum cancer education would
typically be taught. What exactly are ‘are homeroom teachers in elementary schools?’ How old
are the students these teachers teach? To me this sounds like a really young age to be teaching
this topic. Should it not be taught in upper primary school? Also, what are the disadvantages of
using ‘instructors’ to teach curriculum? For example in ensuring curriculum alignment?
Page 3 line 59 ‘although the effectiveness of using external instructors has been shown’ ref
required.
Page 3 lines 62-64 – what you suggest is one approach for addressing the gap you highlight.
What are other ways this gap could be addressed?
Page 3 lines 65-66 – explain what you mean by ‘primary and secondary prevention measures’.
Page 3 line 68 ‘Health Promotion Act’ – which one?
Page 3 line 72 – ‘appropriate teaching material model’ for who? Pre-service teachers to use as
future teachers in schools or for the university students as part of their own learning?
Page 3 line 81 – not sure that you have explained ‘political controversy’ in enough depth in the
previous sentences. In what way/s controversial?
Page 3 line 81 – what is the authors’ understanding of the term ‘health literacy’? Might be useful
to provide a defn here. Also, is health literacy something that is taught in your curriculum?
Where does teaching about cervical cancer fit into the curriculum?
Page 3 line 82 ‘who do not fluctuate their knowledge of cancer.’ – check expression – ‘fluctuate’
is not the right word here.
Page 3-4 lines 83 to 85 – much stronger justification for your study needs to be provided. Also to
me your study or article should really be about the evaluation part and not about the development
of a program?
Methods
I felt this section lacked depth. What was your research design? Why did you choose to use
AR? More detail on what the AR process involved exactly. It would be useful to include your
research questions at the end of the previous section if you have any. Your research questions
would also inform your research design/methods.
Page 4 line 89 ‘Action Research (AR) method’ should be referenced here. Also, why was this
method adopted over alternative methodological approaches?
Page 4 lines 90-92 ‘Together with the participants on-site, they promote democratic activities
that include academic activities and also those that influence and change society’ – your ideas
here need clearer explanation – again check your expression – not sure ‘democratic’ is the right
word here?
Page 4 line 94. Note sure what ‘the activation process’ is exactly?
Page 4 line 102 – relevance of ‘even in occupational fields’ is not self-evident to your study.
Page 4 line 105 – ‘a twelve-member editorial committee’ – the reason for creating this needs
more explaining. Also, it seems like a bit of a jump from the previous ideas to this.
Page 4 line 110 – more about the ‘review’ – what was it exactly? When and where did it occur
and what form did it take?
Page 4 line 116 ‘updated each year’ needs some defining. What years exactly do you refer to?
Page 5 line 123 – how were the students recruited exactly? How was it decided that 35 was an
appropriate number to produce compelling results?
Page 5 line 125 – your Figure (photo) could identify people on publication. Do you have
appropriate permissions from people in the photo for their image to be used?
Page 5 line 125 – how many lectures did they give and how was this decided?
Page 5 lines 128-129 – more on how they ‘were instructed to prepare and review them’ – was
this in the context of the curriculum they would teach in schools?
Page 5 line 130 – what was it exactly about ‘their impressions of the lectures and their aspirations
for future learning’ that was relevant to the researchers.
Page 5 Lines 132 to 136 this section in analysis is far too brief and lacks meaning and context.
It is not clear what the purpose of the reports were, what the researchers wished to obtain from
them. The actual analysis needs to be more detailed to provide a much more compelling account
of what you actually did. What process did you follow exactly and what part did each of the
authors play in this process and towards what outcome? Regarding the latter, in other words,
what was the actual purpose in carrying out this analysis?
Results
Table 1 is somewhat overwhelming in its current form. It reads like raw data, needs to be
simplified and its relevance explained before it could be considered for publication.
Page 5 line 140 ‘Of the nine reviewers, six approved its publication’ – similar to your Abstract, I
am not sure what the relevance is here? Who were the nine reviewers? What was their purpose?
Why did three not approve for publication and publication in what context?
Page 5 lines 140-141 ‘The remaining three, two adult women and an obstetrician-gynecologist,
were undecided’ – ‘undecided about what?
Table 2 is less overwhelming for the reader than Table 1 but again its relevance needs unpacked/
made clearer. Line
Page 6 - Table 3 – similar to my previous comments, this table also needs more explaining and
why it is important to the study. In the absence of research questions, the relevance of your
results is unclear. Also, if content analysis was used as part of your method it should have been
included earlier and its use for analysis and its relevance explained.
Discussion
In this section you make a lot of claims that need more evidence to support them. I think this
shortfall is a consequence of a lack of depth in your Results section.
Page 6 lines 166 – while the study may have been original, what is more important is the meaning
of your results and how they contribute to the scholarly literature which is what your ‘Discussion’
section should really be about.
Page 6 lines 167-168 – more evidence on how the reports can aid the training of Japanese Health
and Physical Education teachers in the way you claim.
Page 6 line 169 -  you wrote ‘difficult to provide cervical cancer education’ – it would be
useful to mention in your introduction what the literature states about some of these difficulties.
Examples?
Page 6 – line 175. How many participants did you have beyond the student teachers and how
many is enough?
Page 6 – last para – this looks like it should be in your Method section and not in your Discussion?
Page 7 – the relevance of this page was lost on me because of the issues and limitations I raised
in the previous sections.
Page 8 line 227 – be more specific and avoid expressions like ‘a certain number of’.
Page 8 line 230 – who were the ‘subjects’? Were they the same as the ‘participants’?
Page 8 lines 231-232- ‘as current students, they would like to convey the acquired knowledge
to their immediate families and friends’ – how do you know? Is this not speculation?
Page 8 line 233 - in what way ‘such a change of consciousness’? Change from what?
Page 9 – Limitations and challenges
It is not possible for me to comment here because of the limitations I have described thus far. I
am afraid I completely lost the track/thread of your manuscript from about page 5 onwards.
Page 10 – Conclusions – same comment as for page 9.