Article 7 June 2011, Vol. 3, No. 1 AJHPE Introduction The measurement of research output is common practice among public institutions internationally. Although controversial and often contested, such measurement is regarded as the most important indication of re- search productivity by academic staff.1 Producing adequate research outputs is influenced by various personal and institutional factors which include finding time to write,2 lack of skills in identifying appropriate journals,3 and fear and anxiety in sharing ideas with others.4 Institutional inhibiting factors include limited research funding support and increased workload.5 Because of these inhibiting factors, various support strategies for academics have been attempted and documented in the literature. The support strategies can take various forms, ranging from providing aca- demics with time off from job responsibilities, to access to staff in senior mentoring, peer mentoring or writing support groups. In most countries, the higher education institutions produce the bulk of health research in terms of publications. A decade ago, the health re- search community in South Africa was producing approximately 3 000 publications in national and international health and related publications annually, of which about 1 500 were peer-reviewed, index-linked publi- cations.6 Less than 5 years ago it was still reported that the proportion of publications by authors in health and rehabilitation sciences was assumed to be insignificant.7 For the purpose of this article, health and rehabilita- tion sciences include all health care professions except medicine. There are currently 22 tertiary institutions in South Africa, consisting of 11 traditional universities, 6 comprehensive universities and 6 universities of technology.8 Ten of the traditional universities, 3 of the comprehen- sive universities and 1 of the universities of technology have courses in health and rehabilitation sciences. There are multiple opportunities for academic staff in these institutions to be involved in research activities. Based on the opinion of Ncayiyana,7 it seems there is little evidence of the research engagements of these academic staff in terms of publication output. In medical and nursing education, these publications are clearly documented and the dearth of information in the area of health and reha- bilitation sciences needs to be addressed. Therefore, the aim of this pa- per was to review published literature reporting on strategies designed to promote research publication among academics and clinicians in health and rehabilitation sciences programmes to inform strategies to increase the proportion of publications in health and rehabilitation sciences in the health research community in South Africa. Methods Literature search strategy A systematic search of electronic databases such as Medline, CINAHL, and Ebscohost from 2000 to 2010 was performed. The criteria for inclu- sion of articles into the study were: (i) publication in the English lan- guage; (ii) access to full text publication data between 2000 and 2010; (iii) target population included academics and/or clinicians; and (iv) pub- lication writing interventions. Search terms were constructed after some review of the relevant literature. Combinations of the following terms were used in all databases: publication, writing, intervention, support, clinicians and academics. The reference lists of all retrieved articles were examined to identify additional relevant studies. The initial search yielded titles and abstracts, which were then re- viewed by the two reviewers for: sample population (academics, clini- cians, and postgraduate students), type of intervention (e.g. courses, sup- port groups, mentoring, workshops) and outcome (improved publication rate). A total of 481 published articles were identified based on our search criteria. Abstract The health research community in South Africa annually produces a fair number of research papers in national and international health and related journals. Unfortunately, the proportion of papers produced by authors in health and rehabilitation sciences is insignificant compared with other disciplines. To identify strategies to increase the number of publications in South Africa, this article reports on a review of published papers into the effectiveness of interventions designed to promote research publications among academics and clinicians in health and rehabilitation sciences programmes. Seven of the papers reported on interventions for academics, and six reported on the inter- ventions for academics in the nursing profession. The most common interventions were ‘writing support groups’, ‘writing retreats’, and ‘writing courses’ that lasted from 3 days to 5 years. The interventions were designed to meet the needs of the participants for structured time, motivation, improved writing skills and peer support. All the interventions produced significant research output relating to submis- sion or publication of academic papers. The implementation of these interventions by South African tertiary institutions where health and rehabilitation sciences are offered may improve the number of papers published by the health research community. Identifying strategies to improve research publication output in health and rehabilitation sciences: a review of the literature J M Frantz Department of Physiotherapy, University of the Western Cape S L Amosun Division of Physiotherapy, School of Health and Rehabilitation Sciences, University of Cape Town Correspondence to: J M Frantz (jfrantz@uwc.ac.za) Article 8 June 2011, Vol. 3, No. 1 AJHPE Table I. Summary of the studies included for review No. Author(s) and titles Intervention Duration and pro- gramme components Targeted population Outcome 1 Mentoring and coaching for publication10 Writing for publication support group 10 weeks 9 physiotherapy academics in South Africa All participants submitted a paper for publication. 4 were published and 2 were asked to revise, with 1 rejected 2 Mentored residential re- treats: a leadership strategy to develop skills and gener- ate outcomes in writing for publication11 Writing retreats 3 days and 2 nights – scheduled work time from 07h00 to 21h00, with two 1-hour breaks 2005: 20 nursing par- ticipants 2007: 15 nursing participants 2007: 14 nurs- ing participants, Australia 2005: 16 papers submitted, 15 published and 1 in revision 2007: 12 papers submitted, 10 currently under review and 2 published 2007: 9 papers submitted and cur- rently under review 3 Building research capacity: through a hospital-based clinical school of nursing12 Clinical school 3-year period • joint research • development of clini- cians and academics Nursing clinicians and academics, Australia 11 articles published Additional research projects 4 Facilitating writing for publication13 Writing course 6-month course • six 3-hour meetings • programme included writing, discussion and planning time 14 health and rehabilita- tion sciences profession- als, Glasgow. 6 physiotherapists 2 occupational therapists 3 speech and language therapists 3 podiatrists 7 submitted articles, of which 6 were accepted for publication 2 had submitted and received reviewer feedback 5 Supporting academic publi- cation: evaluation of a writ- ing course combined with writers’ support group14 Writing for publication course and support group 5-day writing for publica- tion course • how to write for pub- lication • group discussions • editing guidance Writing support was provided over a 2-year period 8 academics from disci- plines such as nursing, social science, science and humanities, Australia Publication increased to 33 arti- cles in a period of 2 years 6 Conquering the publishing silences of black academic women15 Support group Monthly meetings over 1 year • 1-hour session • support and encour- agement 4 academics, in South Africa: 2 physiotherapists, 1 educationalist, 1 human ecologist 2 group articles published 7 Writing for publication: a new skill for nurses16 Writing course 4 separate half-day work- shops over a 6-month period • 2-hour sessions • strategies for success- ful writing • structuring a paper 17 nurses participated, UK 14 articles submitted 11 articles published 8 Peer mentoring for tenure- track faculty17 Support group 2 years • meetings every second week • discussions 4 nursing academics, USA 10 articles submitted and 5 ac- cepted 9 Improving faculty publica- tion output: the role of a writing coach18 Writing coach 13 months • part-time hired coach • 21 hours/month for academic support 16 nursing academics, USA 21 articles submitted, 5 rejected, 1 under review and 15 published Article 9 June 2011, Vol. 3, No. 1 AJHPE Methods of the review The search produced 481 hits and, after a review of the abstracts, we retrieved the full text of 30 articles and assessed them for information on writing for publication strategies among academics and clinicians, with specific emphasis on health and rehabilitation sciences profession- als. After further review of the 30 articles, 9 were finally selected for inclusion in the current evaluation. The articles were appraised for qual- ity using the Guidelines for Critical Review, developed by the Occupa- tional Therapy Evidence-Based Practice Research Group at McMaster University.9 Each article was given a score based on the criteria, e.g. aim of the study, literature, study design, methods. A maximum score of 15 could be achieved. Given the paucity of work in this area, papers were not excluded on the grounds of methodological weakness. Authors also followed up outputs with original authors if outputs were not indicated. Articles were excluded mainly based on the population addressed in the article and when the focus of the research capacity development initiative was not on publications. A data sheet was then designed (Table I) to cap- ture the relevant information, such as author, date, type of intervention, population and outcomes. Major themes were identified in each paper by the authors, a consensus approach was used to identify the relevant quotes, and an analytical framework was developed. Results Several interventions were being used to support academics and clini- cians within the health and rehabilitation sciences discipline to improve their publication writing. In addition, most of the articles included in the review highlighted academics as participants involved in writing for pub- lication interventions (7/9 studies). Various terminologies are used to describe interventions with similar goals and outcomes. The most common terminologies used are ‘writ- ing support groups’, ‘writing retreats’, and ‘writing courses’. Most of the studies were conducted in developed countries such as the USA and Australia. The reasons given by the participants for attending included the need for structured time, to improve writing skills, for motivation, and for peer support. All the interventions produced significant output relating to submission or publication of academic papers. The duration of the interventions ranged from 3 days to 5 years. The duration did not seem to affect the outcomes as all interventions had positive outcomes. The experiences of the participants in different interventions are sim- ilar. They reported that the group format intervention enhanced positive interpersonal relationships and mentoring: ● ‘The shared sense of achievement amongst the group was an extremely positive aspect.’14 ● ‘I found it useful to be part of a group in which all members submitted themselves to the process of reading, writing and be- ing read.’10 The participants also reported that they improved their knowledge and skills relating to writing and submitting articles: ● ‘I have never before had this sort of attention and I feel privileged and have a real sense of achievement.’11 ● ‘It’s less scary, now I believe I can write.’13 The various formats also allowed the participants to appreciate the value of feedback. ● ‘It was an opportunity to “try” your writing on others.’14 ● ‘I was able to take on board comments from peer review with more understanding.’13 Discussion Much has been said about the need, purpose and benefits of research publication,19,20 and about it being the natural conclusion in the research and discovery journey, allowing new findings and ideas to be shared, challenged and verified before adoption. Research and publication are essential factors in the survival of the education of health care profes- sionals. Publications are a major element in the transfer of knowledge from clinicians and academics to potential users that could ultimately assist in saving lives and improve health care and delivery. This review therefore focuses on intervention strategies aimed at improving research publication outcomes. Although there are only a few studies focusing on strategies for health and rehabilitation sciences professionals, the lit- erature suggests positive outcomes relating to publication. The strategies are recommended to improve research publication output in health and rehabilitation sciences in South Africa. From the review, interventions would obviously vary according to target groups (academics v. clinicians), but the basic framework of in- terventions should comprise interactive sessions where participants are allowed opportunities to write and receive feedback from others. The sharing and critiquing process in writing for publication interventions allows for participants to bring forward the realisation that there can be many ways of presenting a finding or expressing an idea. It also prepares writers for the process of reviewing, but some are more effective than others. In addition, as in interdisciplinary clinical goal, interdisciplinary research goals and groups can positively impact on health care and deliv- ery among health and rehabilitation sciences professionals. In addition, it seemed that the outcomes for clinicians14 and academ- ics10 can be the same with a structured intervention. Thus we can create synergy between clinicians and academics using structured writing for publication workshops. Conclusion The review is encouraging in that the strategies identified in the 9 re- viewed articles have resulted in improvement in publication counts among health and rehabilitation sciences professionals. However, studies tended not to report on the status of the participants before the interven- tion so as to be able to measure whether there had been an increase in publication. If implemented, these strategies may contribute to increasing the research publication output among health and rehabilitation profes- sionals in South Africa. References 1. Pouris A. Assessing scientific strengths of academic institutions: the example of the University of Pretoria. South African Journal of Science 2006;102:23-28. 2. Emden C. Establishing a ‘track record’: Research productivity and nursing aca- deme. Australian Journal of Advanced Nursing 1998;16(1):29-33. 3. Keen A. Writing for publication: pressures, barriers and support strategies. Nurse Education Today 2007;27:382-388. Article 10 June 2011, Vol. 3, No. 1 AJHPE 4. Lee A, Boud D. Writing groups, change and academic identity: research develop- ment as local practice. Studies in Higher Education 2003;28(2): 87-200. 5. Wheeler E, Hardie T, Schell K, Plowfield L. Symbiosis – undergraduate research mentoring and faculty scholarship in nursing. Nursing Outlook 2008;56:9-15. 6. Mbewu A, Mngomezulu K. Health research in South Africa. In: The South African Health Review. Durban: Health Systems Trust, 1999. 7. Ncayiyana D. Academy of Science survey of research publishing in SA - the SAMJ streaks ahead. SAMJ 2006;96(8):659. 8. Fourie M, Hay D. Preparing the way for mergers in South African higher and further education institutions: An investigation into staff perceptions. Higher Education 2002;44:115-131. 9. Law M, Stewart D, Pollock N, Letts L, Bosch J, Westmorland M. Critical guidelines for critical review form – quantitative studies. McMaster University Occupational Therapy Evidence-Based Practice Research Group, 1998. 10. Frantz J, Rhoda A, Rowe M, et al. Mentoring and coaching in promoting publica- tions in the Department of Physiotherapy at a local university in South Africa. South African Journal of Physiotherapy 2010;66(2):33-36. 11. Jackson D. Mentored residential writing retreats: A leadership strategy to develop skills and generate outcomes in writing for publication. Nurse Education Today 2009;29:9-15. 12. Lee G, Metcalf S. Building research capacity: Through a hospital based clinical school of nursing. Nurse Education Today 2009;29:350-356. 13. Murray R, Newton M. Facilitating writing for publication. Physiotherapy 2008;94:29-34. 14. Rickard C, McGrail M, Jones R, et al. Supporting academic publication: Evalua- tion of a writing course combined with a writers’ support group. Nurse Education Today 2008 Doi:10.1016/j.nedt.2008.11.005 15. Rhoda A, Maurtin-Cairncross A, Phillips J, Witbooi S. Conquering the publishing silences of black academic women. Journal of Community and Health Sciences 2006;1(2):70-77. 16. Taylor J, Lyon P, Harris J. Writing for publication: a new skill for nurses? Nurse Education in Practice 2005;5:91-96. 17. Jacelon C, Zucker D, Staccarini J, Henneman E. Peer mentoring for tenure-track faculty. Journal of Professional Nursing 2003;19(6):335-338. 18. Baldwin C, Chandler G. Improving faculty publication output: the role of a writing coach. Journal of Professional Nursing 2002;18(1):8-15. 19. Pololi L, Knight S, Dunn K. Facilitating scholarly writing in academic medicine. Journal of General Internal Medicine 2004;19:64-68. 20. McGrail M, Rickard C, Jones R. Publish or perish: a systematic review of inter- vention to increase academic publication rates. Higher Education Research and Development 2006;25(1):19-35.