Review Reports

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Summary

This paper centers on the disproportionate rates of liver cancer in Hispanic, Asian, and African American communities as a result of viral infection. Noted barriers for these communities include access to “liver cancer prevention information, prevention resources, and healthcare services concerning viral hepatitis and liver cancer.”

I see that the aims of this paper are to 1) document a CBPR approach via partnership with existing outreach initiatives and 2) assess if/how the specific strategies created through these partnerships impacted planning and implementation of cancer-themed public engagement in specific minority communities. 

Specific Critiques

Section 2. Materials and Methods

As a reader, I was distracted by the various bits of data (results?) and suggestions that were incorporated into some areas of materials and methods. Additionally, I think this section would benefit from some additional detail to reveal the process, particularly if the aim is to document a CPBR approach. 

Line 76 onward: you describe coc as having (3) 12 month community outreach initiatives. Are these happening in parallel? Do they happen sequentially? How many cycles have there been? What are the years? I know there is specific information about them in each of the individual sections, but it might be helpful to add some context here as well. Perhaps allude to more detail is coming.

Line 81: I feel I want to know more here; perhaps add that the audiences described will be invited to participate on the Community Advisory Board (which I think can help create a better segue to the next paragraph where you reference CAB)

Generally, I am left wanting to know a little more about the CAB -- how many times were they engaged, and to what extent? How had their input been specifically incorporated, and to what extent? How long did one serve on this CAB? How were they selected? Who facilitated these meetings?

Line 139: I appreciate the description of this effort as being bi-directional. I would like to learn a little more about the process -- was there any specific infrastructure offered to support effective knowledge sharing?

Line 220: I wonder if people who have been screened are more likely to see the poster because it showcases something familiar? There is no clarity on cause v effect here. 

3. Results

Line 303: typo -- insertion?? “These efforts further such support was critical…”

Line 287: how do you know that these communities experienced enhanced capacity for event org, program management, etc? How do you know it was this initiative that led to these other things? I would like more clarity here. 

4. Discussion

I would like to see the discussion incorporate how the aims were met in addition to the ultimate impact of change in behavior.

Overall, I think this paper can be strengthened to meet the first aim, which is to document an approach. I think for the second aim of assessing how these initiatives impacted planning and implementation can be clarified. I am unclear on what the specific evidence is to support this aim and would suggest reworking for clarity. 

Author Response

Reviewer 1:

Thanks for the comments! Please see our responses below in purple

Comment 1: As a reader, I was distracted by the various bits of data (results?) and suggestions that were incorporated into some areas of materials and methods. Additionally, I think this section would benefit from some additional detail to reveal the process, particularly if the aim is to document a CPBR approach. 

Response 1:

More details about the HBV/HCV initiative were added.

Comment 2: Line 76 onward: you describe coc as having (3) 12 month community outreach initiatives. Are these happening in parallel? Do they happen sequentially? How many cycles have there been? What are the years? I know there is specific information about them in each of the individual sections, but it might be helpful to add some context here as well. Perhaps allude to more detail is coming.

Response 2:

Addressed.

Comment 3: Line 81: I feel I want to know more here; perhaps add that the audiences described will be invited to participate on the Community Advisory Board (which I think can help create a better segue to the next paragraph where you reference CAB)

Response 3:

Addressed.

Comment 4: Generally, I am left wanting to know a little more about the CAB -- how many times were they engaged, and to what extent? How had their input been specifically incorporated, and to what extent? How long did one serve on this CAB? How were they selected? Who facilitated these meetings?

Response 4:

Addressed.

Comment 5: Line 139: I appreciate the description of this effort as being bi-directional. I would like to learn a little more about the process -- was there any specific infrastructure offered to support effective knowledge sharing?

Response 5:

Yes, we had an established a multi-level infrastructure that supported continuous communication and learning between community and academic partners. This included co-learning workshops and a shared digital workspace for resource exchange. CAB and the quarterly meetings further ensured that community perspectives shaped the initiative.

Comment 6: Line 220: I wonder if people who have been screened are more likely to see the poster because it showcases something familiar? There is no clarity on cause v effect here. 

Response 6:

We didn’t include this question in the bus campaign survey.

Comment 7: Line 303: typo -- insertion?? “These efforts further such support was critical…”

Response 7:

Addressed. Thanks.

Comment 8: Line 287: how do you know that these communities experienced enhanced capacity for event org, program management, etc? How do you know it was this initiative that led to these other things? I would like more clarity here. 

Response 8:

Clarified

Comment 9: I would like to see the discussion incorporate how the aims were met in addition to the ultimate impact of change in behavior.

Response 9:

Addressed.

 

Reviewer 2 Report

Comments and Suggestions for Authors

Thank you for the opportunity to review the manuscript and provide a more detailed review.

The manuscript presents a relevant and timely study that applies community-based participatory research (CBPR) to liver cancer prevention among underserved groups. The topic is crucial given the burden of liver cancer in the studied communities. The paper is well written, and their community engagement approach is commendable, presenting important template for applied research scholarship.

Although the author(s) presented a commendable piece of work, here are some specific critiques the study may benefit from to further guide the improvement of the(ir) manuscript.

1. The study sought to evaluate the effectiveness of CBPR-guided community initiatives in raising awareness and promoting liver cancer prevention. These are clear and relevant questions aligned with existing gaps in health disparities research.
2. The study’s focus on underserved Hispanic, Asian and African American populations make it relevant, Author(s) use of multicomponent CBPR initiatives is significant, (although not entirely new), integrates diverse outreach strategies and highlights sustainability. I would suggest the author(s) come up more strongly on the relevance of their approach. In other words, think along these guided questions: What exactly is novel here? Is it the multilevel approach or the integration of community advisory boards simultaneously? Does the simultaneity confer any advantage? Simply argue to build up knowledge for scholars on this sort of engagement – just like doing quantitative research before qualitative research or vice versa or doing both at the same time. You may know that such has its own strengths. Lean on this idea and argue your simultaneous engagement of advisory boards across the different communities. This is for the purposes of building knowledge and expanding arguments in the Literature for other scholars that may want to replicate your methods. Find supporting evidence to support your argument credibly.
3. In terms of contributions to the field, the study adds value by documenting community empowerment, capacity building, co-creation of solutions and data co-ownerships. It also demonstrates adaptation during the COVID-19 which strengthens its contemporary relevance.
4. Relative to methodological rigor, the study acknowledged its limitation by stating that it relied on descriptive evaluation without a control group. This limited causal inference. Also, beyond descriptive percentages, was there any inferential tests such as chi square? Why or why not? Make a statement on this. The study may consider adding more details on survey tools such as how knowledge scores was developed, validated and analysed. How were the dietary behaviour changes measured? Was it measured through validated scales or self-reported recall?
5. On your conclusion, consider clarifying the extent or degree to which the changes may be attributed to the CBPR interventions versus any external influences. While the conclusion is good, you may consider moderating the presented data so as not to overstate the impact given the lack of comparison groups.
6. The manuscript is heavy with text. Consider using Tables and Figures where necessary or appropriate. This can help enhance clarity and summarize participants demographics, pre/post knowledge changes, and the campaigns reach. Also, a Figure that outlines the three initiatives and their outcomes would make the results more accessible.
7. Deepen/expand the Discussion and substantiate with relevant CBPR and prevention literature.
8. Separate Discussion, Conclusion and Recommendations, and Policy/Practice Implications into different sections. In other words, explicitly show how findings can inform screening programs or sustainable health initiatives.
9. References are generally appropriate.

Overall, I consider the manuscript a commendable piece using applied research and community engagement approach. With deeper methodological rigor and making revisions based on the issues raised, the paper stands out as a valuable contribution to the field.

Author Response

Response attached.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

Thank you for incorporating review points. This looks good!