Title: Social influences on Moroccan and Pakistani immigrant women’s access and use of
cervical cancer screening in Catalonia, Spain: a social network analysis
Version: 3 Date: 13 Jun 2024
Reviewer:  Iratxe Pérez-Urdiales
Reviewer's report:
Background
- Although population-based screening programs are intended to reduce health inequities,
numerous studies report lower cervical cancer (CC) screening uptake among immigrant women
compared to native women [1-3].
In the abstract you say that this happens “in many high-income countries”, is it also the same
here?
- The concept of social influence forms part of many models of health-related behavior and has
been used to guide preventive interventions, including CC screening
Why not to cite those models?
- I think that I see better the paragraph “Intention among women to adhere…” after the sentence
“One such alternative is the use of social influence methods to change individuals’ thoughts,
feelings or actions through people or groups important to them [9].” And then the theoretical
explanation.
- For instance, Luque et al. (2016) [22] found that Peruvian Andean women with a higher
proportion of weak ties, such as with neighbors, in their immediate network were significantly
more likely to get screened for CC than those with a higher proportion of family and friends.
So… do you mean that there are exceptions that unconfirm that a higher social influence does
promote a higher screening for CC? any other cases? Could it be because of a highly different
context?
- In conclusion, individuals’ health-seeking behaviors are likely to be influenced both by
strong ties (e.g. family members) through injunctive and descriptive norms and weak ties (e.g.
neighbors) or external information sources.
The introduction is very well centered in CC but it lacks a bit of a broader perspective (health-
seeking behaviors).
Methods
- Both methods match perfect. Congratulations for having been able to manage such a big amount
of data so efficiently.
- “thus not exposed to Spanish public education” was this an exclusion criteria, or is it an
assumption from the authors?
- “Many of them, especially first-generation immigrants, do not work outside the home; those
who do work, often occupy precarious jobs (e.g., domestic work and hospitality industry).”
The cite for this?
- The recruitment process is reported in greater detail elsewhere [32].
I found it strange that the recruitment process was cited… then I consulted the reference and I
understood. Could you include here a brief explanation like: recruitment process and collected
data were part of a broader project, that included….
Social Networks’ Elicitation and Alters’ Attributes
Thanks for the very well explained section!
Data Analysis
Which approach did you use for performing content analysis? I miss a little broader expalanation
of the process
Results
If you would need to reduce word number, I would shorten the Moroccan and Pakistani
Immigrants’ Social Networks section
One Pakistani woman explained that they always avoid causing worry to their families
(especially, mothers) back home
Is this somehow related to heal-seeking behaviours? How?
Very interesting quotes!
Discussion
- In the introduction, the authors make a big effort to explain the differences between social
norms “types” and strong and weak ties. However, in the results and discussion, those differences
are not clearly represented.
- The most salient strength is the combination of multiple research methods and the triangulation
of data: egocentric network measures, graphs, and narrative accounts.
I totally agree! The triangulation of data coming from different approaches has been done very
efficiently.