Title: HPV Self-Collection for Cervical Cancer Screening among Survivors of Sexual Trauma:
A Qualitative Study
Version: 0 Date: 01 Jul 2024
Reviewer's report:
I want to thank the authors for their important work investigating a topic that substantially affects
the acceptability and uptake of cervical cancer screening for many people with a cervix.  The
article is generally well-written and the analysis and reporting are thorough and exacting. In
places, the authors might shorten sentences and avoid conflating sources by splitting sentences.
Revisions for clarity are advised.
The most notable revisions are required for the discussion, which while thoroughly addressing
literature in the subject area, does not always establish how the present study contributes and
expands on existing research.
I provide the following substantive comments:
Introduction:
The introduction provides a thorough review of the literature, but might be edited and
streamlined for clarity.
Line 82-83: It might be worth specifically stating that the "72.4%" screening statistic is U.S.
specific as to not confuse readers when the previous sentence focuses on the "worldwide."
Line 85-87: I think this sentence (starting with "Most cervical cancer cases...") could be rewritten
for clarity. I think it conflates two facts: underscreened and never-screened individuals are more
likely to develop cervical cancer and undocumented citizens, minorities, etc. are typically more
likely to be under/never screened.
Line 93-96: Are there any existing studies that might be able to support this cognitive reaction
to screening by IPV survivors? A reference would be advisable.
Line 107-108: I think this sentence might be overstated and should be framed more as a research
gap than a total unknown.
Methods:
The description of participant recruitment, interview guide development, and data collection
are excellent and clear. If possible, it would be interesting to know how the questions in the
interview guide were decided upon by the research team. Was this an iterative process? Was
there a process to revise questions? How did the team ensure questions would be well understood
by participants? This would be a welcome addition after the sentence in Line 146.
The qualitative analysis methodology is well described.
Results:
The themes are well-reported and the quotations in Table 2 are highly illustrative. I would be
curious if the results of the qualitative coding could be provided in some form, either within the
results or in a figure? The results provided would be more verifiable with further disclosure of
the results of qualitative coding.
The authors should provide an interrater reliability statistic for thematic coding, if possible.
I would be curious to know if hrHPV positive status was related to specific themes in interviews.
In general, I think a cross-examination of sociodemographic and health factors with themes
would be interesting, but is likely beyond the scope of this study.
Discussion:
Lines 254-262: Could authors more explicitly connect the recital of existing research to some
of the specific quotations or ideas that arose in the study interviews?
Line 263-276: This appears to be about Theme 2, but that connection is not explicated. The
authors should revise to specifically explain how their study contributes to research and supports
trauma-informed practice.
Lines 316-320: The authors invoke "several strengths" to the study but only discuss thematic
saturation and novelty. This section could be expanded to include their use of a socio-ecological
model to guide interview guide development, grounded theory approach, and concurrent coding
of transcripts by two team members.
Lines 319-320: The authors should better explicate what they mean with the limitation regarding
recall bias here. It is not currently clear what this sentence achieves.