Reviewer ’s report  
 
Title: Using the Heath Belief Model to explore why women decide for or against the removal of 
their ovaries to reduce their risk of developing cancer  
 
Version: 0 Date: 09 Jul 2018  
 
Reviewer: Melissa Clark  
 
Reviewer's report:  
 
This manuscript describes the findings from a qualitative study of 18 women about  deciding for 
or against having an oophorectomy for cancer risk reduction. It is a timely, well -written 
manuscript that adds to the relatively limited literature about the difficult decision for women 
about surgical removal of healthy ovaries to reduce can cer risk. Areas in which the manuscript 
could be strengthened are listed below:  
 
Background  
1. It would be helpful if the authors provide more explanation about why the Health Belief 
Model (HBM) was chosen over other potential theoretical models such as th e Theory of Planned 
Behavior or others, particularly given the limitations of the HBM including some identified by 
the authors themselves.  
Methods  
2. Page, 10, lines 46 -53: Who was involved in the data analysis is not clear. Was all the 
coding only done by  one person? The authors say that the conclusions drawn from the data were 
discussed amongst all members of the research team but how many team members actually 
reviewed and coded the data?  
 
Results  
3. Page 11: Do the authors have any data bout reasons for  refusal, given the low response 
rate? How did those who participate compare to those who did not? While qualitative research is 
not necessarily intended to be generalizable, in this context, understanding who participated 
versus who did not would provide valuable context to the results and conclusions.  
4. Table 1, De Facto should be defined for those unfamiliar with the term.  
5. The authors have done a good job providing quotes to support the interpretation of the 
findings. However, the paragraphs are a bit hard to follow because all of the quotes are generally 
at the end of the paragraph rather than directly after a statement is made that is supported by the 
quote(s). For instance, quotes inserted throughout the paragraph on Page 15 would be easier to 
follow as below:  
Women identified a number of barriers which they felt increased the cost of having the surgery. 
For instance, s everal women feared the sudden onset of menopause and relating symptoms. They 
reflected on the potential intensity of symptoms, how long it would take them to physically, 
emotionally and mentally adjust to having early menopause and for how many years they  may 
have to cope with menopausal symptoms.  
I don't want to be this scarred cranky bitch, dry old woman in the body of a 40 -yearold. And not 
just that, I've then got another 15 years on top of the normal woman who does that [= having 
menopause]. […] But I  just want you to understand that I'm not a 67 -year-old woman, I'm a 40 -
odd-year-old woman, so I've got to think of my long term. I'm fighting this to be here for a 
longer period of time, but I've got to think about these things so that I can manage in tho se years 
ahead. (patient, 47 years)  
 
Some women were concerned about the side -effects of hormone replacement therapy and that 
having this treatment could increase their risk of getting breast cancer. All women made their 
treatment decision based on what th ey thought would be the best long -term option for them.  
The risk factors of osteoporosis and that sort of thing that was relevant to me. I thought, oh, well 
maybe it's better if there's something else that we can do, as opposed to then needing to take 
horm one replacement and all that sort of stuff, which puts you at higher risk of breast cancer 
once again anyway. (patient, 34 years)  
 
6. Page 13: Some of the text on this page seems to be better placed in the conclusions rather 
than results. For example, This  highlights that decision making in the context of oophorectomy is 
very personal.  
7. Page 14: The first and second quotes do not seem to support the themes identified in the 
text regarding perceived benefits.  
8. Page 17: The Sentence beginning, "A number of women reported" seems to be a very 
different than the rest of the paragraph and likely warrants a separate paragraph.  
 
 
 
Discussion  
9. Depending on results of the proposed analysis comparing participants to non -participants, 
additional comments in the Dis cussion regarding limitations/context are warranted.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
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.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
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  
organisation 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 relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial com peting 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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