Digital enhancements to a publication
Digital enhancements accompany a publication with additional ways to present and interpret its findings. Their development involves choosing a suitable format, coordinating with the journal and authors, and addressing costs, access and evidence of value.
Formats and uptake
A digital enhancement is an online feature intended to aid visualisation and interpretation of a publication’s data. Formats accepted by biomedical journals include infographics, visual or video abstracts, lay summaries, audio abstracts and audio or video interviews with authors. Enhancements can attract views, strengthen social-media presence and extend the geographic reach of scientific publications. By 2021, interest had been amplified by COVID-19 and virtual congresses, but uptake by authors and sponsoring companies was mixed, and few top journals offered enhancements beyond supporting slides and lay summaries.
A survey of medical publication professionals collected responses from 25 August 2020 to 1 June 2021 through professional networks, newsletters and LinkedIn. Questions were optional and some allowed multiple answers. Of 116 respondents, 59% were in Europe and 35% in North America; among 114 answering about roles, 66% were medical writers, 29% publication planners and 25% editors or proofreaders, with multiple roles allowed. Most worked full time (72%), 62% had more than ten years’ experience and 3% had less than two; 37% worked in agencies or contract research organisations, 35% freelanced and 10% worked in academic, medical or educational organisations. The sample was mostly experienced professionals and may have favoured those already developing or interested in enhancements; regions outside Europe and North America, and nonprofit, academic and educational settings, were poorly represented.
Among respondents, 97% were employed or freelanced. The most common therapeutic areas among 114 respondents were oncology (52%), neurology (28%), respiratory disease (26%), and cardiology and endocrinology (about 24% each), with multiple answers allowed.
Just over half (53%) had professionally developed enhancements, including concept development, content production or deliverable review. Of these 62 respondents, 92% provided the services to life-science or medical-communications industry clients; among 55 who had not developed enhancements, only 7% were uninterested. Among those with enhancements in their portfolios, 37% worked on one or two projects a year and 28% on more than five. Of 63 answering about pandemic demand, 49% reported more requests and 49% no change. Infographics or illustrations (76%) and visual or video abstracts (74%) were the most frequently developed formats among 62 respondents, with more than one answer allowed.
In a survey circulated by email, LinkedIn and WhatsApp from 6 August to 16 September 2022, 256 people responded: 68 academics, 73 clinicians, 41 industry professionals, 66 medical writers, 3 pharmacists and 5 who did not specify a role. About 49% had more than five years’ experience. Among respondents, 74% agreed that enhancements could improve visualisation, publication reach and reader engagement; 59% knew about different enhancements, 40% had used them and 84% were interested. Infographics were the most-used format, reported at 51%.
Perceived value and client objections
In the 2020–2021 survey, professionals valued improved data visualisation and comprehension most (60%, n = 115), followed by interest in the primary publication (21%) and increased access (13%). Respondents reported different priorities for clients: stimulating interest in the publication (36%, n = 102), widening access (29%) and improving visualisation and comprehension (22%). About 5% of respondents saw no benefit but said clients requested enhancements because the target journal required them.
The same survey compared clients’ reasons for rejecting enhancements, as reported by publication professionals who could select up to three reasons. Industry clients comprised pharmaceutical, biotechnology and medical-device companies, contract research organisations and medical-communications agencies; nonindustry clients comprised academia, medical societies and individual authors.
| Reason | Industry clients (n = 66) | Nonindustry clients (n = 26) |
|---|---|---|
| No perceived value | 12% | 15% |
| May be perceived as promotional | 34% | 4% |
| Journal does not offer peer review | 9% | 0% |
| Copyright issues related to enhancement | 21% | 4% |
| Insufficient dissemination by journal, such as a poorly visible link | 14% | 8% |
| Hosted externally to journal, such as on a commercial video platform | 12% | 4% |
| Journal does not collect specific metrics | 6% | 0% |
| Cost, including production and journal fees | 73% | 42% |
| Time and resources needed for development | 49% | 50% |
| Authors unavailable | 27% | 69% |
In the 2022 survey, reported constraints were inadequate budgets (66.4%), lack of knowledge about choosing an enhancement (51.5%) and inadequate access to tools and platforms (36%). Cost and time challenge academic and nonacademic clients alike, while nonacademic clients may be particularly concerned about return on investment. Open comments in the 2020–2021 survey anticipated growing demand but identified difficulty demonstrating benefits against costs, alongside open-access and copyright concerns.
Journal requirements and dissemination
Obstacles can concern the journal’s hosting capacity, submission timing, peer review, visibility and copyright licensing rather than the enhancement’s content or format. Developing an enhancement can involve advising hesitant clients and authors, discussing benefits and concerns, and fitting the work into the core manuscript’s timeline. If an enhancement must accompany the initial submission and the manuscript is rejected, it may need a different format for the next journal, contributing to concerns about wasted time and budget.
Journals may display enhancements as supplementary material, external links or prominent content beside the article, and these differences can hinder access. Journal ownership of the enhancement’s copyright licence can restrict authors’ sharing; sponsors’ restrictions on online sharing may also partly explain limited academic-coauthor involvement in industry-sponsored enhancements. Authors, sponsors and medical communicators would benefit from detailed journal guidance, assistance and quantitative data. In 2021, evidence on the best digital dissemination and audience-engagement strategies remained lacking, while enhancements were proposed as a possible future standard alongside written abstracts.
Among 108 respondents to the 2020–2021 survey, adequate dissemination beside the manuscript would influence development for nonacademic clients (64%), followed by enhancement-specific metrics (50%). Among 60 answering about academic or nonprofit clients, factors influencing development were journal assistance (60%), adequate dissemination (48%) and no or reduced hosting fees (47%). Total views or downloads (56%, n = 113) and time spent viewing (30%) were the most valued metrics, and 55% would use views or downloads to promote enhancement services to clients.
Skills, guidance and training
In the 2020–2021 survey, about 63% of respondents (n = 114) had proposed enhancements to clients; of 70 suggesting them by project or whenever applicable, 79% proposed them only to nonacademic clients. Professionals’ main barriers were insufficient training or experience (45%, n = 109), lack of time or insufficient pay (21%), and unclear or absent journal instructions (20%), with up to three answers allowed. Among 110 answering about accepting assignments, 46% cited adequate training, 26% better journal submission guidance and 16% special pay rates.
In 2022, respondents favoured specific publication guidelines (74%), clear company policies (85%), more awareness programmes (91%) and relevant training (90%); about 79% wanted publications organisations, including ISMPP, EMWA, AMWA and MAPS, involved in increasing use. The findings suggested growing popularity and that association-led awareness and training would encourage more authors to use enhancements. Medical communicators can expand their services through enhancements and support clients and authors, but the 2021 findings indicated less confidence in guiding development than expected; professional societies such as AMWA could help through continuing education.