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The authors addressed the reviewers' concerns and substantially improved the content of MS. So, based on my own assessment as an academic editor, no further revisions are required and the MS can be accepted in its current form.
[# PeerJ Staff Note - this decision was reviewed and approved by Bob Patton, a PeerJ Section Editor covering this Section #]
The manuscript has been re-assessed by the two reviewers, and both of them agree on the fact that there are still a few points that need to be addressed. We would be glad to consider a revision of your work, where the reviewers' comments will be carefully addressed one by one.
Well reported
Well designed
Seems valid, the authors may try to handle better some confounders
To the Editor
PeerJ
Re: Colorectal cancer screening behaviors by Selda Tekiner Corresp et al.
Dear Editor, I would like to thank you for the opportunity to evaluate the revised manuscript.
Here are my detailed comments:
Abstract
Results section:
Please the total number of participants, and if you have data on the participation compliance rate
In general and in the abstract – Age can be presented with only one digit after the point (ie. 35.4 instead of 35.42)
Conclusion section:
Please “affected by” to “associate with” as in such a descriptive study we cannot establish cause and result effect and can only point association between two phenomena.
Introduction – no comments
Materials and methods
Line 94: “Based on this, we know that our patient population consists of those who are not at the screening age for colon cancer, which was the age group we wanted to study.”
Please clarify – if this is not the group you wanted to study why you choose this group. I would rephrase it in this way: “Based on this, we know that our patient population consists of those who are not at the screening age for colon cancer, but these are the years when we can intervene and change the health beliefs.”
Results
Table 1 - the legend – “Table 1: Some characteristics of participants” please change to: “Table 1: Sociodemographic characteristics of participants”
Table 2 legend – referral (page 27) is a mistake referring to the author's details, and the mistake continues to all tables headings.
Please start the results section with the number of participants, and add information (if available) on compliance rates.
Line 183:” There was a difference between work status and barrier scores (p<0.01). The barrier scores of the participants who were students were found to be significantly higher than those of working and retired participants (p=0.001, p=0.013).” – It can be a confounder – as age have a strong relation to the work status, students are usually much younger. Please discuss it
Discussion:
Line 198:” This study was conducted in a reference hospital in the capital city of Turkey, for the purpose of evaluating the health beliefs of people in relation to CRC before the age of screening for CRC.” – You have to clarify as 15.3% of your study population was older than 50 years, the age screening is recommended.
Line 286 – the conclusion: “As a conclusion, we can say that it is better to give specific messages and specific barriers according to personal characteristics instead of general messages about conducting screening tests beginning from youth.” – I would say “it may be better” instead of “it is better” as to prove this we need an intervention study and not a descriptive study like the current one.
L154 please revise Kruskal-Wallis test with right spelling.
please remove white spaces in the paper (e.g, L185 ( p )
Please use lower case p value L181
no comment
no comment
no comment
Your manuscript has been reviewed and requires modifications prior to making a decision. The comments of the reviewers are included at the bottom of this letter. Reviewers indicated that the introduction, the methods sections should be improved. They have also concerns about the experimental design of the study. Reviewers found several typos and recommended extensive English editing. I agree with the evaluation and I would, therefore, request for the manuscript to be revised accordingly. I would also like to suggest the following changes:
• Please specify the names of statistical tests used in the study in the methods section of the abstract.
• Please provide p-values for the results section of the abstract.
• Change “SPSS 21.0” to “IBM SPSS Version 21.0”
• Check the raw data.
• Please give the reliability analysis results of the HBM scale in the results section, and provide Cronbach alpha values for each factor (sub-scales) and total points?
[# PeerJ Staff Note: Please ensure that all review comments are addressed in a rebuttal letter and any edits or clarifications mentioned in the letter are also inserted into the revised manuscript where appropriate. It is a common mistake to address reviewer questions in the rebuttal letter but not in the revised manuscript. If a reviewer raised a question then your readers will probably have the same question so you should ensure that the manuscript can stand alone without the rebuttal letter. Directions on how to prepare a rebuttal letter can be found at: https://peerj.com/benefits/academic-rebuttal-letters/ #]
[# PeerJ Staff Note: The review process has identified that the English language must be improved. PeerJ can provide language editing services - please contact us at editorial.support@peerj.com for pricing (be sure to provide your manuscript number and title) #]
In general well written, some typo - in specific comments
The literature review is sufficient
I would skip most of the details of table 5
Well designed
Needs clarifications about the sample size calculation, and correction for multiple comparisons
The findings are valid
To the Editor
PeerJ
Re: Health beliefs of patients at a primary health care center in relation to attitudes to colorectal cancer screening (#48107)
General
Colorectal cancer screening is a very important measure to improve morbidity and mortality rates in the general population. We should look for any possible way to overcome obstacles and to increase compliance rates.
Abstract
Introduction is too long and should be shortened substantially, I would leave only:
CRC screening program compliance in Turkey t is around 20-30%. Factors that may affect preventive health behaviors, mainly individuals’ values, beliefs and attitudes should be explored. To explain insufficient participation of some individuals at screening programs, a “Health Belief Model” (HBM) scale was developed in 1950. In this study we aimed to investigate attitudes toward prevention from CRC using the HBM scale.
Methods
Need more details about the research tool, scales, subscales etc. You cannot use in the result section terms that were not defined in the methods section. – Please revise
Results
It is not clear why you choose to study young patients because screening is recommended 50-75 years old and not earlier – please clarify the rationale and add to the methods section more details about the participants age and gender and refusal / compliance rates of the questionnaire filling
"Significant differences" is not enough – You should give the numbers in each group and the p Value
Conclusion
"Regardless of their area of expertise or the health system level worked those who provide healthcare should practice the idea of CRC screening for their patients especially among young people. They should talk about screening program at every meeting." – should be omitted as it is not a conclusion of the current study.
Introduction
Line 10 – usually it is either FOBT or Colonoscopy and not both, please clarify
Line 34 – "In this study we aimed to evaluate the health beliefs of people before the age of screening in relation to attitudes to colorectal cancer screening" – This should be clarified also in the abstract
Methods
Well and clear written
Line 40 – "The sample size was calculated as to be 200 and we enrolled 215 volunteer responsive participants" – please clarify for what outcome you calculated the sample size and also clarify if it was calculated to find gender or age differences in this outcome / outcomes
Results
Line 70 – "Average age of participants were.." – should be "was"
Line 84 – "“It is not pleasant to have regular controls for early diagnosis of colon cancer" – I would use tests instead of controls, here and along the text
Lines 92-114 – You did a lot of subgroup analyses – I believe that some of the statistically significant differences you found are only a result of multiple comparisons. You have one of two options – to reanalyze the finding with correction for multiple comparisons or to shorten substantially this part of the results – I would recommend option 1.
Table 2 – The content is not coherent – I would remove from the table the family history of CRC and move it to table 1 as one of the background data on participants.
Table 3 – Add the maximum points for each statement.
Discussion
Line 172 and forward, in accordance to my remark above (lines 92-114) I would recommend keeping in the discussion only the differences that are related to age.
Conclusion
The same sub analyses interpretation as above should be limited in the conclusion part
I suggest revision on title to improve readability.
Needs language editing. There are grammatical mistakes such as: “Of the participants’ 62.8%”.
L3 Comma is needed when you place three digits “862 000”
L4: Incostintent citation style for (Turkey Cancer Statistics, 2015). This is also not present in the reference list. The authors are encouraged to follow the instructions from PeerJ for styling.
L34: Please change “evaluate” to assess.
L75 space needed between “58.1%agreed”
Since the authors use HBM scale in the study, I do not see a point to give item by item results as presented in the table 3 and the section starting line 78. This overly complicates the reading of the manuscript, and makes it long.
I am confused with the participant selection. In the beginning of the methods section, the authors explain the participants as anyone who was admitted to Primary Care Clinics but on L64 they say “students.” Please clarify this. The authors also refer to the participants as patients. Please try to use consistent naming throughout the study.
For the data collection part, you mentioned 14 CRC and sociodemographics but the raw data has 15 different independent variables, as follow: “age, sex, marital status, education, business statement, occupation, height, weight, security, alcohol, exercise, nutrition, colon ca history, fec. occult blood, colonoscopi” Please provide your data collection form as a supplement to evaluate this.
There are multiple missing data in the raw data. The SPSS output and raw data do not match.
I did not see the original cronbach alpha of the scale as well as the cronbach alpha of the scale used in the current study. Authors should provide reliability results for the scale.
As data is not intact, I was not able to reproduce the analysis. I encourage the authors to give more details on the analysis, explain and justify how you handled the missing data.
What is the original source of the scale? You only mentioned that this scale is a Turkish version. You mentioned the HBM scale developed on L19, but I am confused if it is the original scale. Was it adapted from this scale developed by Hochbaum, Kegeles, Leventhal and Rosenstock? Or, is this an original scale constructed in Turkish? Please explain in the methods section.
How many negative items were there in the scale? How did you transform them and get a total score for the subscales and overall scale. More details are needed for the scale.
In the results section, you presented the statistical results but you did not write the statistics. When you compare the groups, it is not enough to present p value only, you should provide the test statistics such as t-test, anova along with their effect size such as Cohen’s d.
Dear Authors,
Thank you for your submission to PeerJ. I have read your manuscript with interest. I am a PhD scientist in the field of medical education. I know less about the topic that you covered in the study. I accepted to review this article because of the methods that you applied. I was not able to assess the content area and its importance to your field. Please consider my reviews as a method and statistical expertise.
I wanted to repeat the analysis to confirm the results but there were missing scores in the raw data, and you did not describe the analysis thoroughly. Therefore, I could not evaluate the results.
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