Factors Influencing USA Women to Receive the Human Papillomavirus Vaccine: A Systematic Literature Review
Round 1
Reviewer 1 Report
Comments and Suggestions for Authors
The manuscript aimed to review and synthetise results of qualitative studies pubblished in the USA about factors influencing women to receive the HPV vaccine. Although this is quite relevant theme, there are some major methodological issues that need to be addressed before the manuscript can be considered for pubblication.
First of all, narrative and systematic reviews are two distinct types of reviews that follow different methodologies. A narrative review is by definition non-systematic as it addresses one or more questions with a much broader scope, without research question and rigorous search or review methodology. A systematic review attempts to distillate empirical evidence from a relatively smaller number of studies relative to a focused research question by using a robust methodology including study protocol, research question, PICO, search strategy, predefined analysis and presentation of results, assessing study quality, tabullation and graphical presentation of results. Authors should decide which type of review they want to conduct. If they decide to go in the direction of the systematic review, the methodology needs to be improved following corresponding guidelines and recommendations for qualitative research. In this case results should be divided in themes in a more more meaningful way than just in barriers, facilitaits or both. There are numerous sources that can be usefull:
- Cohrane's chapter 5 on Extracting Qualitative Evidence (Noyes J & Lewin S. Chapter 5: Extracting qualitative evidence. In: Noyes J, Booth A, Hannes K, Harden A, Harris J, Lewin S, Lockwood C (editors), Supplementary Guidance for Inclusion of Qualitative Research in Cochrane Systematic Reviews of Interventions. Version 1 (updated August 2011). Cochrane Collaboration Qualitative Methods Group, 2011. Available from URL http://cqrmg.cochrane.org/supplemental-handbook-guidance)
- The University of North Carolina published a list of resources such as scientific articles, books, tools, etc that can be usefull when conducting a systematic review of qualitative research. https://guides.lib.unc.edu/qual/integrate-SR
Othervise a simple narrative review should be performed following the recomandations for such type of review.
Another important methodological issue are themes. Division in barriers, facilitators and both doesn’t seem as a result. Givent that methods are scarce I would suggest to use this as a priori classification of results and then try to group the themes within each cathegory, for example in the barriers the themes could be ‘tabbo discussion’, ‘insufficient knowledge’, etc. This source can be usefull to understand how to classify results of qualitative research in systematic reviews:
- Thomas, J., Harden, A. Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Med Res Methodol 8, 45 (2008).
Minor issues:
Abstract- it would be better to focus more on the results of the review in terms of barriers and facilitators percieved, rather than to describe methods and conclusions in detail.
Line 21-23: this phrase is not clear
Line 29: replace ‘results’ with ‘records’
Line 34- this is the second time that the aim is repeated
Line 37-38- this is the third time the aim is repeated
Line 42: delete ‘the prevent’
Introduction
Line 57: are caused?
Line 68: There is no an 8-valent vaccine, there is a 9-valent vaccine ‘Gardasil 9’ (Human papillomavirus 9-valent Vaccine, Recombinant) approved by the FDA on 10 December, 2014.
Line 81: Provide a reference for this statement, please.
Line 92-94: redundant description of the cited study
Line 101-107: This entire part is confusing, starting from the font, meaning and purpose
Methods:
Line 124: If the objective was to identify, select, analyze, and summarize qualitative studies than systematic review is adequate but methodology needs a major improvement. Otervise, correct the objective.
Line 158-159: There is no PRISMA flowchart in the text or in the supplementary matherial.
Results
Table 1:
- add age of the sample
- it would be better to use only one column to summarize the principal themes of the included study as you did for study design and then in the subsequent column to enlist main results, for example cost, taboo, etc in ‘barriers’, or marketing, communication style, etc in ‘facilitators’.
Line 178-179: to be moved with previous paragraph
Line 184-186: as explained above, this division is strange for results, it suits better the results
Discussion
Line 324-325: with all the respect of the time and effort invested in this relevant work, it is an overstatement that this is “in-depth and detailed understanding of the facilitators and barriers”. Please see previous comments on the methodology.
Line 327-329: themes identified are repeating unneccessarly throughout abstract, methods and discussion
Line 403: There might be no reviews focused only on the USA studies but there are numerous studies that report all studies including the USA.
Line 414: no trends were identified, maybe themes
Author Response
The manuscript aimed to review and synthetise results of qualitative studies pubblished in the USA about factors influencing women to receive the HPV vaccine. Although this is quite relevant theme, there are some major methodological issues that need to be addressed before the manuscript can be considered for pubblication.
First of all, narrative and systematic reviews are two distinct types of reviews that follow different methodologies. A narrative review is by definition non-systematic as it addresses one or more questions with a much broader scope, without research question and rigorous search or review methodology. A systematic review attempts to distillate empirical evidence from a relatively smaller number of studies relative to a focused research question by using a robust methodology including study protocol, research question, PICO, search strategy, predefined analysis and presentation of results, assessing study quality, tabullation and graphical presentation of results. Authors should decide which type of review they want to conduct. If they decide to go in the direction of the systematic review, the methodology needs to be improved following corresponding guidelines and recommendations for qualitative research. In this case results should be divided in themes in a more more meaningful way than just in barriers, facilitaits or both. There are numerous sources that can be usefull:
- Cohrane's chapter 5 on Extracting Qualitative Evidence (Noyes J & Lewin S. Chapter 5: Extracting qualitative evidence. In: Noyes J, Booth A, Hannes K, Harden A, Harris J, Lewin S, Lockwood C (editors), Supplementary Guidance for Inclusion of Qualitative Research in Cochrane Systematic Reviews of Interventions. Version 1 (updated August 2011). Cochrane Collaboration Qualitative Methods Group, 2011. Available from URL http://cqrmg.cochrane.org/supplemental-handbook-guidance)
- The University of North Carolina published a list of resources such as scientific articles, books, tools, etc that can be usefull when conducting a systematic review of qualitative research. https://guides.lib.unc.edu/qual/integrate-SR
Othervise a simple narrative review should be performed following the recomandations for such type of review.
Another important methodological issue are themes. Division in barriers, facilitators and both doesn’t seem as a result. Givent that methods are scarce I would suggest to use this as a priori classification of results and then try to group the themes within each cathegory, for example in the barriers the themes could be ‘tabbo discussion’, ‘insufficient knowledge’, etc. This source can be usefull to understand how to classify results of qualitative research in systematic reviews:
- Thomas, J., Harden, A. Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Med Res Methodol 8, 45 (2008).
Response: Thank you for this feedback. We agree that narrative and systematic reviews are two different objects and have removed the word "narrative" from the title. We followed PRISMA methodologies with a systematic search across four databases, assessed qualities of included studies, and followed qualitative thematic methods; therefore, we feel we have followed the protocols associated with a systematic review. Thank you for your review of our article!
Minor issues:
Abstract- it would be better to focus more on the results of the review in terms of barriers and facilitators percieved, rather than to describe methods and conclusions in detail.
Line 21-23: this phrase is not clear
Response: Thank you for this clarification. The text has been amended.
Line 29: replace ‘results’ with ‘records’
Response: Thank you for this clarification. The text has been amended and it uses records.
Line 34- this is the second time that the aim is repeated
Response: Thank you for this clarification. The text has been amended.
Line 37-38- this is the third time the aim is repeated
Response: Thank you for this clarification. The text has been amended
Line 42: delete ‘the prevent’
Response: Thank you for this observation. The text has been deleted.
Introduction
Line 57: are caused?
Response: Thank you for this clarification. The text has been amended and it is reads caused.
Line 68: There is no an 8-valent vaccine, there is a 9-valent vaccine ‘Gardasil 9’ (Human papillomavirus 9-valent Vaccine, Recombinant) approved by the FDA on 10 December, 2014.
Response: Thank you for this suggestion. Gardasil 9 is the only vaccine available in the USA. We amended the text.
Line 81: Provide a reference for this statement, please.
Response: Thank you for this recommendation. The reference was added.
Line 92-94: redundant description of the cited study
Response: Thank you for this clarification. The text has been amended and it flows better.
Line 101-107: This entire part is confusing, starting from the font, meaning and purpose
Response: Thank you for this clarification. The text has been amended.
Reviewer 2 Report
Comments and Suggestions for Authors
Dear authors,
thank you for this paper It is an interesting review of HPV vaccine hesitancy, and it is well written. Methdology is correct and results are consistent with the evidences.
Results are supported by evidences.
I would only correct some minor errors:
- line 68: please modify, nine types (6, 11, 16, 18 , 31, 33, 45, 52, 58)
Thank you for letting me revise your paper.
Author Response
thank you for this paper It is an interesting review of HPV vaccine hesitancy, and it is well written. Methdology is correct and results are consistent with the evidences.
Results are supported by evidences.
I would only correct some minor errors:
- line 68: please modify, nine types (6, 11, 16, 18 , 31, 33, 45, 52, 58)
Response: Thank you for this suggestion. We amended the text.
Reviewer 3 Report
Comments and Suggestions for Authors
Congratulations to the authors of the work. As we can see, we have tools for primary and secondary prevention that we do not fully use.
Abstract: Because the work concerns the American population, in the abstract I would write where cervical cancer ranks in terms of morbidity and mortality.
Line 52. 20 or 14 HR HPV.
Line 53. Instead of CIN, I suggest writing SIL or CIN/SIL.
Line 58. On first place should be CC.
Line 68. Nonavalent HPV vaccine (Gardasil 9) – 6,11,16,18,31,33,45,52,58.
Line 73 – 83 - Does the system in the United States remind you to administer subsequent doses of vaccines? If so, whether they are text messages, e-mails or telephone calls from health care workers.
Did the authors analyze the impact of religious beliefs on the decision to vaccinate?
Initially, there is no data on payment for vaccines, which age groups, whether girls and boys, whether in each state they receive the vaccine for free or it is paid.
The work confirms the necessity of education in primary and secondary schools in the field of sexually transmitted diseases, including HPV. There are large gaps in youth education. Anti-vaccination groups also have a significant negative impact.
There is also idea of vaccination affects the recurrence of the disease and persistent infections. - Effect of HPV Vaccination on Virus Disappearance in Cervical Samples of a Cohort of HPV-Positive Polish Patients. J. Clin. Med. 2023, 12, 7592.
I propose to the discussion to add some information and citations regarding other countries, e.g. European, Asian or Australia.
The conclusions confirm the need for education at school, medical facilities, reimbursement of vaccinations and family discussions on health issues.
The problem discussed in this work concerns not only the United States but also other countries, both developed and developing.
Author Response
Congratulations to the authors of the work. As we can see, we have tools for primary and secondary prevention that we do not fully use.
Abstract: Because the work concerns the American population, in the abstract I would write where cervical cancer ranks in terms of morbidity and mortality.
Response: Thank you for your recommendation. The text has been changed.
Line 68. Nonavalent HPV vaccine (Gardasil 9) – 6,11,16,18,31,33,45,52,58.
Response: Thank you for this suggestion. Gardasil 9 is the only vaccine available in the USA. We amended the text.
Line 73 – 83 - Does the system in the United States remind you to administer subsequent doses of vaccines? If so, whether they are text messages, e-mails or telephone calls from health care workers.
Response: Thank you for this recommendation. Different practice sites have different protocols and there is no standard of practice when it comes to subsequent doses. Since
Did the authors analyze the impact of religious beliefs on the decision to vaccinate?
Response: Thank you for this recommendation. However, the studies did not state the impact of religion.
Initially, there is no data on payment for vaccines, which age groups, whether girls and boys, whether in each state they receive the vaccine for free or it is paid.
The work confirms the necessity of education in primary and secondary schools in the field of sexually transmitted diseases, including HPV. There are large gaps in youth education. Anti-vaccination groups also have a significant negative impact.
There is also idea of vaccination affects the recurrence of the disease and persistent infections. - Effect of HPV Vaccination on Virus Disappearance in Cervical Samples of a Cohort of HPV-Positive Polish Patients. J. Clin. Med. 2023, 12, 7592.
I propose to the discussion to add some information and citations regarding other countries, e.g. European, Asian or Australia.
Response: Thank you for this valuable suggestions. We included several systematic literature reviews conducted in Europe and Asia that strenghtened our discussion.
Round 2
Reviewer 1 Report
Comments and Suggestions for Authors
The authors addressed most of the issues. There are still some aspects that should be improved.
A table with a quality assessment should be provided.
Please add a search period in the abstract and in the methods.
Introduction, methods and conclusions of the abstract are two long and real results are inexistent. Abstract is not useful at all if you write that objectives were to identify the facilitators and barriers to HPV uptake and as only result you write that facilitators and barriers were identified without any further summary.
Line 202: Based on a thematic analysis of the 26 studies, we identified the following themes:
Author Response
The authors addressed most of the issues. There are still some aspects that should be improved.
A table with a quality assessment should be provided.
Response: Thank you for this suggestion. We added the quality assessment to the existing table, which was the best option.
Please add a search period in the abstract and in the methods.
Response: Thank you for this valuable suggestion. We added the search period in the abstract and methods.
Introduction, methods and conclusions of the abstract are two long and real results are inexistent. Abstract is not useful at all if you write that objectives were to identify the facilitators and barriers to HPV uptake and as only result you write that facilitators and barriers were identified without any further summary.
Line 202: Based on a thematic analysis of the 26 studies, we identified the following themes:
Response: Thank you for recommendation. We revised the abstract as suggested.
Reviewer 2 Report
Comments and Suggestions for Authors
Thank you for your precious work.
Now the paper deserves publication
Author Response
Thank you for your time to review our manuscript.
Reviewer 3 Report
Comments and Suggestions for Authors
Congratulations on your work.
Thanks for the answers.
I recommend the publication.
Author Response
Thank you for your time to review our manuscript.
