Review Reports

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The article written by Siqi Li et al., entitled "HPV Vaccination Knowledge and Awareness Among Male University Students in Malaysia: A Cross-Sectional Study" is a very modest study regarding the awareness for the vaccination against HPV vaccines. The study is based on a cross sectional study conducted among male university students in Malaysia. The data were collected just using a structured 335 questionnaire assessing sociodemographic characteristics, sexual intercourse, HPV-related knowledge, and awareness of the HPV vaccine.

Despite the importance of the medical and scientific information, that could be published as a short communication or brief report, but some issues should be corrected to be well presented:

• The Materials and Methods section should be shorten and just focolized on the questionnaire and population.
• In Results section, authors can change some table to histograms figures presenting the essential of information that have effects on the degrees of the awareness regarding the HPV vaccine.
• Discussion and conclusion sections are too long. They should be shorten and authors should highlighted the essential results.
• An important question: Why authors don't included females in this study?

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Cross sectional students on the knowledge of male university students regarding HPV vaccination.

The study is based on a questionnaire, and response was analysed based on demographic and socio-economic and other variables.

The study could be augmented provided the prevalence of HPV infection among the students was attempted.

studies based on one sex (males) and using internet based questionnaires are usually of limited benefit, yet, this might be suitable for public health journals.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

This study investigated HPV vaccination knowledge and awareness among male university students in Malaysia. The topic falls within the scope of the journal, and the ethical approval and basic methodological requirements have been met. However, the scientific contribution is limited, and several interpretative and methodological issues must be addressed through substantial revisions before the manuscript can be reconsidered.

Major Comments

1. Lines 68–71, 207–227: The main findings largely reiterate previously reported associations between HPV related knowledge, sociodemographic factors, and vaccination awareness. While the focus on male university students in Malaysia is relevant, the manuscript does not sufficiently articulate how this study advances the existing literature beyond prior regional or international studies. The Introduction and Discussion should be substantially revised to clearly position this study in relation to previous HPV awareness research and to justify its scientific value beyond confirming established patterns.

2. Lines 78–83: The study relies on convenience sampling from only two universities. Although the logistical rationale is described, the manuscript does not sufficiently acknowledge that this approach limits the representativeness of the broader male university student population. The methodological limitations associated with this sampling strategy should be explicitly stated.

3. Lines 289–295: While sampling limitations are briefly mentioned, their impact on interpretation and external validity is understated. The Discussion does not adequately address how restricted recruitment may influence awareness estimates or observed associations. This section should be revised to critically reflect how the sampling design constrains interpretation and generalizability.

4. Lines 303–315: Several statements in the conclusion extend beyond what can be supported by a cross-sectional design with convenience sampling. References to broad intervention strategies and policy-level implications are not sufficiently justified by the data presented. The Conclusions should be revised to align more closely with the exploratory nature and methodological limitations of the study.

5. Lines 173–177, 253–271: Associations related to religion, race, and relationship status are discussed in a manner that risks implying causal or culturally deterministic explanations for the findings. Given the cross-sectional design, such interpretations are not supported. The Discussion should adopt a more cautious tone and clearly indicate that these associations may reflect contextual factors such as information exposure or access, rather than intrinsic characteristics.

6. Lines 103–109, 190–204: The rationale for dichotomizing knowledge and awareness scores using median cutoffs is not adequately justified. The manuscript does not explain why this approach was selected over other analytical strategies. Additionally, the inclusion of same-sex intercourse as an explanatory variable, despite the very small number of respondents, raises concerns regarding statistical power and interpretability. These analytical choices require a clearer justification.

Minor Comments

1. Grammatical and stylistic issues are present throughout the manuscript and should be addressed through careful editing.

2. Lines 338–343: Duplicate references are present in the reference list and should be corrected.

3. Abbreviations should be defined at first use and applied consistently throughout the manuscript. Tables should be reviewed to ensure clarity and consistent format.

Comments on the Quality of English Language

The English language is generally understandable, but grammatical and stylistic issues are present throughout the manuscript. Careful language editing is required to improve clarity and readability.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

Thanks for authors for their positive interactions....

Author Response

We are grateful to the reviewers for their careful reading of the original manuscript and for providing detailed and constructive suggestions. All revisions have been incorporated into the revised manuscript.

Reviewer 2 Report

Comments and Suggestions for Authors

This revised version is much bettet

Author Response

We are grateful to the reviewers for their careful reading of the original manuscript and for providing detailed and constructive suggestions. 

Reviewer 3 Report

Comments and Suggestions for Authors

The authors have made visible efforts to address the previous round of comments, particularly by revising the tone of the Introduction, Discussion, and Conclusion sections and by more explicitly acknowledging several methodological limitations. However, while these revisions improve the clarity and caution of the narrative, they do not resolve the major conceptual and analytical concerns raised in the initial review. Substantial issues remain regarding the novelty of the study, justification of key analytical choices, and interpretability of several findings. Therefore, I recommend major revisions.

Major comments

1. Although the authors have expanded the Introduction and Discussion sections to better position the study within the existing literature, the manuscript still does not clearly demonstrate a substantive conceptual or empirical advance beyond prior HPV knowledge–attitude–practice type studies. The main findings largely reiterate well-established associations between HPV-related knowledge, selected sociodemographic factors, and awareness of vaccination, which have been extensively documented across diverse populations in the literature. The authors emphasize that focusing on male university students in Malaysia represents a key novelty of this study. While this population is indeed understudied and contextually relevant, population specificity alone is not sufficient to establish a strong scientific contribution unless it is accompanied by deeper theoretical framing, novel analytical insights, or meaningful methodological innovation. Currently, the manuscript primarily confirms previously reported patterns rather than extending, challenging, or refining existing knowledge. To strengthen the manuscript, the authors should more explicitly articulate the new conceptual insights this study offers to the field of vaccine awareness and uptake research. This could include clearer hypothesis-driven framing, more explicit engagement with existing theoretical models of vaccine decision-making, or a stronger justification of why the observed patterns in this specific population meaningfully advance the current understanding rather than simply reproducing known associations in a new setting.
2. The authors have now acknowledged the use of convenience sampling and restricted recruitment from two universities as limitations. However, the implications of this sampling strategy for the interpretation of both prevalence estimates and observed associations remain underdeveloped. Specifically, the manuscript should critically discuss how selection bias may have influenced the observed levels of awareness, knowledge, and willingness. For example, participants who voluntarily responded to the survey may have been more health-conscious or more exposed to health-related information than the general male student population. This could lead to a systematic overestimation of awareness and positive attitudes. Currently, these concerns are mentioned but not fully integrated into the interpretation of the results. The authors are encouraged to connect the sampling strategy to the uncertainty surrounding the generalizability of their findings more explicitly.
3. The justification for dichotomizing the knowledge and awareness scores using median cutoffs remains weak. Although the authors state that this approach was adopted for interpretability and consistency with prior KAP studies, this rationale does not sufficiently address the well-known statistical limitations of dichotomization, including information loss, reduced statistical power, and potential distortion of effect sizes. The authors should either provide a stronger theoretical and methodological justification for this approach or consider alternative analytical strategies, such as treating these measures as continuous variables or using ordinal models, where appropriate. Sensitivity analyses using alternative modeling strategies would substantially strengthen the robustness of the conclusions and increase confidence in reported associations.
4. The inclusion of same-sex sexual experience as an explanatory variable remains problematic because of the extremely small number of respondents in this category. Although the authors now describe these findings as exploratory, the variable is still included in the main multivariable regression framework, which risks over-interpretation and statistical instability. The authors should reconsider whether this variable should be retained in the main inferential model. At a minimum, its inclusion must be more carefully justified, and its results should be clearly separated from the primary analytical narrative. One possible solution would be to move this variable to a supplementary or purely descriptive section rather than treating it as a core predictor.
5. The authors adopted a more cautious tone when discussing associations related to religion, race, and relationship status, which is appreciated. However, some parts of the Discussion still risk implying group-based explanatory narratives without sufficient empirical grounding. These associations should be consistently framed as context-dependent correlates, rather than group-intrinsic effects. The authors should further emphasize the likely roles of information access, social networks, institutional exposure, and health communication pathways as alternative explanations for the findings. This would help avoid culturally deterministic interpretations that are not supported by a cross-sectional design.
6. Given the scope of Vaccines, this manuscript would benefit from a stronger conceptual framing that links the descriptive findings to broader debates in vaccination science, the behavioral mechanisms of vaccine uptake, or implementation challenges. Currently, the study remains largely descriptive. The authors are encouraged to connect their findings to existing theoretical frameworks or policy-relevant discussions, thereby clarifying why this work is particularly suitable for this journal rather than for a more general public health or regional outlet.

Minor comment

While the main concerns are conceptual and analytical, some minor issues remain, including occasional grammatical inconsistencies and formatting inconsistencies in tables. These should be carefully reviewed in the next revision of the manuscript.

Comments on the Quality of English Language

The English language is generally understandable, but grammatical and stylistic issues are present throughout the manuscript. Careful language editing is required to improve clarity and readability.

Author Response

We are grateful to the reviewers for their careful reading of the original manuscript and for providing detailed and constructive suggestions. All revisions have been incorporated into the revised manuscript, as indicated in the attached highlight version.

Author Response File: Author Response.pdf

Round 3

Reviewer 3 Report

Comments and Suggestions for Authors

The authors have addressed the main concerns raised in the previous review, and the revised manuscript shows clear improvements in conceptual framing, analytical rigor, and interpretative caution.

In particular, the revised Introduction and Discussion now more clearly position HPV vaccine awareness as an intermediate cognitive construct within male-excluded vaccination systems, which strengthens the manuscript’s relevance to vaccination science and implementation. The discussion of the Malaysian policy context and its implications for male vaccine awareness is more explicit and better integrated with the study’s findings.

The authors have appropriately addressed the methodological concerns. The implications of convenience sampling and potential selection bias are now more clearly discussed, and the limitations regarding generalizability have been adequately acknowledged. The justification for dichotomizing the knowledge and awareness scores was strengthened by the sensitivity analyses using continuous measures, which supported the robustness of the reported associations. In addition, the removal of same-sex sexual experience from the main multivariable model was appropriate, given the small subgroup size, and reduced the risk of overinterpretation.

The remaining issues are minor and relate primarily to editorial refinement. The authors are encouraged to carefully review the manuscript for minor grammatical inconsistencies, wording clarity, and formatting issues in tables and figures to ensure consistency and readability of the text.

Overall, the manuscript is suitable for publication in Vaccines after minor revisions focused on methodological clarification and text editing.

Comments on the Quality of English Language

The English language is generally clear and understandable. Minor editing is recommended to improve clarity and consistency.

Author Response

We sincerely thank the reviewer for the positive and thoughtful evaluation of our revised manuscript. We greatly appreciate the reviewer’s recognition of the substantial improvements made.