Bridging Gaps in Cancer Screening Research: A Call for Methodological Precision

Dear Editor

We have read the article “From Insights to Impact: Understanding Cancer Screening Choices through Mixed-Methods” published in Asian Pacific Journal of Cancer Prevention, June 2024, Volume 25, Issue 8, Page no. 2655-2660, with interest [1]. We would like to appreciate the important topic the authors have chosen to conduct their research. The objective of the study was to investigate cancer screening utilization and its influencing factors among men in Amman and to explore and understand men’s engagement in cancer screening. However, there are certain observations, comments and queries which we would like to highlight.

For instance, in methodology section, it is not clear what specific type of mixed-methods design was used (e.g., convergent parallel, sequential explanatory or exploratory) [2]. This would have helped gain clarity on the triangulation of quantitative and qualitative data. It would be helpful if authors can clarify the study setting i.e, from where and how participants were selected in the phase 1 (hospital, community, type of sampling, etc.). It is not clear whether any sample size calculation was done prior to conducting the study and if not, whether any post hoc power calculation was done. Moreover, clarity is required on whether quantitative survey was self-administered or an interview schedule was conducted. Such details are would be helpful for understanding any sources of potential biases during the data collection. Also, it would be good to know the inclusion and exclusion criteria used to recruit the participants, such as, whether the cut off for age was kept at 40 years (eligibility criteria) or there were no participants below 40 years of age. It would also be helpful to clarify in quantitative survey that whether questions related to cancer screening uptake and screening modalities were based on any previously available validated scale or the scale was developed and validated by the authors itself. Further, it would be helpful to know the rationale of conducting focus group interviews as compared to other commonly used qualitative methods, such as FGDs and IDIs. It would be good if authors can clarify regarding the details of academic credentials and training of researchers who conducted the focus group interviews, any software used for qualitative analysis, number of sessions of focus group interviews conducted to recruit 30 participants, and their average duration [3].

In the results section, the mean age of participants of focus group interviews and among them, how many had undergone and not undergone screening is not provided, which the authors can provide. It would be good if authors can clarify if any standard reporting checklist was used for reporting this mixed method study or qualitative findings. Since only themes are stated, it would be interesting to know if any sub themes were also generated along with one or two quotes from participants in verbatim. Overall screening rate is mentioned as less than 37%, but it would have been good to know the age-specific screening rates. Similarly, it would be helpful to know the cancer screening rates, category-wise under demographic variables given in table 1. Result section does not seem to capture the key findings of cancer screening uptake scale and screening modalities in quantitative part. Thus, it would be interesting to know the other findings apart from those mentioned in cancer screening sub head. This is also important for triangulation of qualitative and quantitative findings in a mixed-methods research design. We would like to point out that there is a minor error in table no. 1, which reports 98.2% participants with family history of cancer, although in text on page no. 2656, paragraph 3 under results section, the same is mentioned as 1.8%. We would also like to know the limitations of current study, if any.

Although the study highlights an important public health issue, addressing the above observations could provide additional critical insights.