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In this Q&A, we ask Mohamad Saab, University College Cork, about his systematic review published on HRB Open Research (Version 2 now available), discussing the rise of testicular disorders in Ireland, interventions to help promote awareness and he shares his thoughts on open peer review.  

Why did you carry out a systematic review on men’s knowledge and awareness of testicular disorders?

Testicular cancer is the most common solid tumour among men aged between 18 and 50 years. The incidence of this disease in Europe doubled over the past four decades and is increasing by 2.4% in Ireland every year. Fortunately, testicular cancer is one of the most treatable and curable diseases.

While testicular cancer is well researched and is well known to the public, other disorders such as testicular torsion (i.e. twisting of the testis) and epididymo-orchitis (i.e. infection in the epididymis and/or testes) get short shrift in the scientific literature and in men’s health promotion campaigns. For instance, testicular torsion can cause testicular necrosis and epididymo-orchitis, often transmitted sexually among men younger than 50, can lead to sepsis and irreversible infertility if not detected and treated early.

Early detection of testicular cancer is linked to reduced tumour size at diagnosis and cost of health care. However, there is very little evidence that monthly testicular self-exams help detect testicular disorders early. As a result, we created the concept of “testicular awareness” which enables men to: (i) become familiar with the look and feel of their own testes; (ii) know what is normal versus abnormal; (iii) be able to detect an abnormality; and (iv) know their own risk factors, without necessarily performing monthly self-exams.

We reviewed the latest literature in order to explore the concept of “testicular awareness” further, update reviews that we have conducted in the past, and provide the evidence base for a HRB-DIFA (Definitive Interventions and Feasibility Awards) grant application.

What interventions do you think should be used to promote men’s awareness of testicular disorders?

The reviewed studies used “conventional” strategies in order to promote men’s awareness of testicular cancer. Examples include: shower gel sachets with information on how to perform self-exams, demonstrations using models of testes, PowerPoint presentations, and brochures.

None of the reviewed studies aimed to promote men’s awareness of disorders other than testicular cancer and none reported on involving men in the design and delivery of the interventions. This is crucial since tailoring interventions that appeal to at-risk age groups and actively involving the public in intervention design are key in health promotion.

Therefore, in 2017, we conducted and published a qualitative study whereby we explored men’s preferred strategies for learning about testicular disorders. Men recommended steering clear of conventional methods (i.e. print media). Alternatively, they were interested in interventions that are novel, visually appealing, interactive, snappy, and light-hearted.

As a result, we developed a 3-level virtual reality experience (E-MAT; Enhancing Men’s Awareness of Testicular Disorders) in order to raise men’s testicular awareness, intentions to seek help for testicular symptoms, and their intentions and behaviours in relation to feeling their own testes and advising other men to do the same. We then tested the feasibility and usability of E-MAT and conducted a pilot study to test its effectiveness. Results from the pilot study were very promising (manuscript accepted in the journal Nursing Research); therefore, we applied for the HRB-DIFA grant in order to develop and test E-MAT further.

Why did you decide to publish on HRB Open Research?

We first learned about HRB Open Research in one of the HRB workshops. After reading more about the platform and reviewing a sample of papers submitted to and published in HRB Open Research, we realised the high standard of the published articles, the rigorous peer review process, and the speed of publication. Moreover, our review served as the evidence base for the HRB-DIFA application. Therefore, there was a unanimous decision to share our review findings with other researchers and the public using HRB Open Research.

What do you think are the benefits of open peer review and how did you find the process?

This was my first time engaging with an open peer review process. At first, I was full of anticipation and was not sure what to expect. However, the editorial team was able to address my queries fairly quickly. Below is a summary of the benefits of open peer review based on my own experience publishing with HRB Open Research:

• Professionalism and timeliness of the editorial team
• Short time between submission, receiving editorial comments, and publication
• “Built-in” referee recommendations based on their areas of expertise
• Quick eligibility screening of referees
• Rigorous peer review process
• Opportunity to engage with referees and replying to their comments
• Option to nominate more referees if one of the referees did not approve/ approved with reservations
• Publication will be indexed upon passing peer review (once the platform has been formally approved by bibliographic databases)
• Publication is free for authors with/ applying for a HRB grant
• Publication is freely available and accessible to the public
• Option to trace views and downloads and provide and/ or receive comments from other authors