PONE-D-19-24843

Implementation of Australia’s Renewed Cervical Screening Program: Preparedness of General Practitioners and Nurses

PLOS ONE

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JMLB and MS are chief investigators of the NHMRC Centre for Research Excellence in Cervical Cancer Control (APP1135172) from which FS (formerly) & TM receive salary support. JB, MS and LR are investigators of a trial of primary HPV screening in Australia (Compass) that has received a part funding contribution from Roche Molecular Systems, Ventana Inc. USA.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: This is an important paper that provides a great breadth of detailed and subtle information that contributes valuable information about key self-collect HPV deployment. There has clearly been great effort made to collect and analyze the data, with overall strong methods employed, but there is key missing methodological information hindering fully interpreting the findings.

1. Please briefly provide an overview or more detail provider education and outreach in support of the NCSP, especially pre- and post-"renewal". E.g., how were materials developed, at what frequency were they deployed, were they uniformly deployed and accessed (rural vs. urban)? All deployments have differences that do not translate to other settings and populations, but in the quickly evolving and important area of self-collect sampling for cervical cancer screening, greater detail in education and outreach would provide greater possibility for potential cross-setting sharing of generalizable tools.

2. Since you emphasize delays and barriers due to laboratory validation delays, it might be useful to include comments/analysis accounting for regions with unanticipated delays in laboratory validation.

3. Please provide more recruitment/sampling details at pre AND post surveys to allow better understanding of why this is an acceptable/representative sample. For example, you mention differences in pre-post participant characteristics, but do not comment in detail on why they are adequate for pre/post-comparison.

4. Page 6, line 117

What was "routine baseline evaluation"? Were these materials that may have primed subjects for your survey?

5. Page 7, lines 134-135

If applicable, please comment on any qualitative frameworks used and/or a bit more on what "refined it based on feedback received" entailed". A key missing component hindering many biomedical intervention behavioral survey comparisons and cross population analysis and implementation is lack of detail regarding instrument development and validation methods.

6. Page 9, lines 180-183

Please provide a bit more detail in open-ended response methods. For example, coding manual developed, independently coded by each reviewer, and discordant coding was adjudicated via... I appreciate your use of good methods for open-ended response coding, but think inserting the usual detail found in psychology studies would both encourage non-psych. researchers to learn of best practices and also provide clarity on the process.

7. Pages 19-23

When not using a validated instrument or established instrument framework, open-ended responses are an often critical area of information. There is tremendous valuable information in the responses, and more detail is needed to interpret open-ended responses, for example, total responders providing open-ended, reporting based on coded themes/subthemes, more compact reporting of frequencies, how it ties to other results, etc. As written and reported, it provides anecdotal findings. Tied with more detail in the coding methods, there appears to be potentially valuable information to justify an additional analysis, table, or supplemental table.

Reviewer #2: Dear authors,

This is a well written and clearly presented paper describing the qualitative and quantitative findings of a survey related to preparedness of health practitioners regarding the change in the Australian cervical screening program. Understanding practitioners’ perceptions, including their level of comfort and confidence in the change in screening recommendations, is important to ensure the success of the new program.

The design and the statistical analyses conducted were appropriate and well described. The interpretations and discussion of the findings were well supported by the findings. The conclusions highlight the usefulness of this work. I only have four very minor comments for the authors’ consideration.

Minor

• Introduction, Line 95: RACGP it is spelled out in the Methods, but should be spelled out first here.

• Method, Study procedures, Line 117+: It is not entirely clear if GPs and nurse cervical screening providers could only attend the education sessions if attending one of the included conferences or they were part of a new practice in the Compass trial, or whether other GP/nurse providers had other opportunity to attend the education sessions (and thus have the opportunity to be involved in the survey). How representative were the include GP/nurses likely to be of all GP/nurses at relevant health services? I know you are address this in the strengths and limitations, but I think the method could be clearer about exactly who was in the study and who had the opportunity to be in the study.

• Results: Given how different the pre- and post- sample are, I wonder if it would more appropriate to only report the adjusted estimates. Please consider presenting the unadjusted and adjusted estimates in the table, but only highlighting adjusted estimated in text.

• The structure of the report was a little confusing. I think the ‘results and discussion’ section is really a results section (with quant and qual findings), and then you could have the sections that are currently after the conclusion in a ‘discussion’ section, and then the conclusion last.

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Reviewer #1: No

Reviewer #2: No

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Implementation of Australia’s Renewed Cervical Screening Program: Preparedness of General Practitioners and Nurses

PONE-D-19-24843R1

Dear Dr. Brotherton,

We are pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it complies with all outstanding technical requirements.

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Erin Bowles

Academic Editor

PLOS ONE

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