Title: Effectiveness of motivational interview on psychological distress of women with human
papilloma virus: A randomized clinical trial
Version: 2 Date: 05 Dec 2024
Reviewer's report:
Dear Authors
“Effectiveness of motivational interview on anxiety, stress, depression of women with human
papilloma virus: A Randomized Clinical Trial Study”
This randomized controlled trial, investigating the impact of motivational interviewing on
anxiety, stress, and depression levels among HPV-positive women in Iran, addresses a highly
significant issue and highlights notable findings.
I deeply appreciate the effort and time the authors have dedicated to this study. However, I
believe some improvements are necessary before the manuscript is ready for publication. To
enhance the clarity and impact of the study, I kindly request the authors to consider the comments
and suggestions outlined below.
Wishing you continued success in your work.
Abstract
Introduction:
It would be more fluent if the first two sentences started with what HPV is. Revise the sentences.
Methods
Align like other sections.
There is no need to mention the ethical trail in the Abstract, please delete it. You have already
mentioned it in other sections.
Line 47—“ Correct ‘Dass-21’ to DASS-21. Correct in the whole article.
Line 51—“ Use DASS-21 total score instead of ‘average score’.
Lines 51-53— It would be more understandable if you give the decrease in points instead of
the effect size.
Line 58— Do not write keywords in bold.
Introduction
Lines 65-67 --- Instead of first listing the causes of cervical cancer, you can say that HPV causes
cervical cancer (the emphasis should be on HPV).
Line 70-- Instead of 55.4-10.5%, write 10.5-55.4%.
Lines 81-83 -- “Kahn et al. in their study that HPV positive women are afraid of their partner's
possible reactions such as anger, rejection and questions, so this issue can be challenging and
stressful for them, which motivates them. ”
What do you mean in this sentence, what motivates them?
Line 83-- “It reduces them for testing”
Do you mean to say that it would reduce their need for testing? Please correct the sentence.
Line 86—STI ?? Write clearly where first used, give the abbreviation in brackets.
Another situation related to HPV that impairs women's psychological health is related to
the reactions they develop against their sexual partners. It is known that more than blaming
themselves, women also blame their partners because they think that they have contracted the
virus from them. This should also be addressed in this chapter.
Methods
Line 122 ----‘socio-demographic information form’ instead of ’socio-demographic checklist’
DASS-21 instead of Dass-21
Lines 127-128- - “Exclusion criteria encompassed unwillingness to continue cooperation and
acute physical or mental conditions.”
“acute physical or mental conditions.” What is it? How did you determine that?
Lines 135-136 ----“The control group received routine education on the HPV virus.”
What kind of programme was the routine training? Could you tell us about it.
Was there a special reason why you chose 5 weeks after the intervention for the final tests?
Lines 139 – “socio-demographic Checklist and Dass-21”
Correct as previously stated.
Lines 139-155— Describe the DASS scale in more detail.
Has the scale been adapted to the Iranian language? Which scale form did you use?
What was the internal consistency of the scale? What was the c. alpha in your study?
Line 154-155 – “As per the guidelines, the resulting scores are then categorized as: “normal,
mild, moderate, severe, or extremely severe.”
What do the scores on the scale mean?
Please explain all of them.
Line 57—“SPSS version 23” indicate the open form in brackets.
Results
Table 2— Under the table, indicate what the abbreviations ASCUS, CIN mean.
Line 209-212--- It would be more understandable if you compare the scale total scores instead
of comparing the impact magnitudes.
Line 217-- * Adjusted based on the average score of the base (before the intervention)
What does this statement point to in the table?
Did you also implement such a programme for the women in the control group later on, were
they deprived of this programme?
Lines 229-232 – “In addition, the two important treatment processes of acceptance and
commitment under the title of contact with the present and self as a background cause the client's
awareness of himself and current needs to increase, and this awareness helps to continue self-
care behaviors in patients (17).”
This paragraph is irrelevant. I suggest it be deleted.
Lines 232-237 “White and Miller believe that in motivational interviewing, it is assumed that
the client is hesitant to change and the therapist supports him in the challenge of changing
his behavior. Therefore, motivational interviewing allows the client to openly express his
ambivalence and identify and satisfactorily resolve his conflicting motivations, in this case,
the psychological pressures that a person experiences can lead to physical and psychological
disorders lead to control (18).”
You should move these statements to the introduction, where you mention motivational
interviewing.
Lines 238-242 --“One of the most important points that doubles the importance of informing
and educating HPV positive women is the introduction of factors or cofactors that cause cervical
lesions to progress to aggressive and malignant lesions. Introducing these factors (smoking, birth
control pills, not using condoms, contracting other sexually transmitted diseases, etc.) to HPV
positive women is vital.”
It is enough to say that it only increases its importance, do we know that it doubles its
importance?
Lines 244-246--- “In the present study, it was shown that women infected with HPV virus suffer
from many psychological problems, so counseling with them was able to reduce their anxiety,
stress and depression.”
“many psychological problems”.  Can we say that? You questioned depression, anxiety and
stress. We don't know about the others. Please correct the statement.
Lines 255-256---However, there was no significant difference between the interventions using
the educational booklet at any time after the intervention.
Rewrite this sentence without however. The previous sentence also started with however.
Lines 256-261—“Therefore, according to the results of this study, if the educational needs of
HPV positive patients are addressed, even though the educational booklet within 6 months of
the intervention, the effect of the intervention on anxiety and depression will not disappear. So it
seems that the main factor is not to improve people's information and knowledge, psychological
and emotional counseling will probably not have much effect on improving the mental condition
of patients.”
You should make this sentence clearer. It causes confusion.
Lines 275-277--- “Based on the findings of this study, it is suggested that motivational
interviewing be used as a low-cost and effective treatment intervention in the treatment and care
line.”
“low-cost and effective treatment” For what? Cure HPV, cure depression, anxiety, stress? Can
we call it a cure? Please review
Dear authors, finally, I think that the following points should be reconsidered throughout the
article.
• The language and fluency of the article should be revised. It is seen that the language used
makes it difficult to understand in some sections. Adopting a simpler and more fluent style of
expression will contribute to the readers to follow the text more easily.
• The scale name is written differently throughout the article (DASS-21 and dass-21). It is
recommended to standardise the terminology and use ‘DASS-21’ throughout the text.
• The study results show that motivational interviewing makes a significant difference.
Therefore, it would be useful to provide more detailed information in the introduction about the
definition, application and proven benefits of motivational interviewing. This will allow readers
to better understand the basis of the method.
• Although the motivational interviewing programme is mentioned in Table 1 in the
methodology section, it is recommended that this programme is also explained in detail.
Giving concrete examples of the content of the programme, the implementation process and
the materials used will contribute to a clearer understanding of the study intervention and its
replicability.
• Please structure the text, citations and references according to the journal's spelling rules.
I wish you success.