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ABSTRACT
Given their potential for engaging audiences, there has been 

increasing interest recently in the use of digital enhancements, 

such as video abstracts and infographics, for primary publica-

tions in peer-reviewed medical journals. However, their uptake 

by authors and sponsors of medical publications has been 

mixed, with few top journals offering the possibility of  

publishing digital enhancements beyond supporting slides and 

lay summaries.

 Digital enhancements for primary manuscripts may pro-

vide new opportunities for medical writers to expand their 

skills and services, but it is unclear whether medical writers 

receive and accept requests to develop digital enhancements 

regularly and what training they need to generate high-quality 

deliverables for their clients. Understanding the perspectives 

of medical publication professionals and their clients on digi-

tal enhancements for peer-reviewed journals may help address 

misconceptions and concerns and identify more effective ways 

to create auxiliary digital content to support the dissemination 

of research findings. Here, a survey was conducted to gauge the 

overall interest in accompanying digital enhancements among 

medical publication professionals and their perception of their 

clients’ needs, determine the perceived value of these features, 

and identify barriers in development.

 The survey was created and posted on AMWA Engage, AMWA 

New England Chapter E-News, LinkedIn, and the MedComms 

Networking webpage. A total of 116 respondents completed 

the survey. About half had developed digital enhancements for 

primary publications, mostly for pharmaceutical companies, 

medical communication agencies, and other nonacademic 

organizations. Infographics and visual abstracts were the most 

frequently requested type of enhanced content. Although the 

respondents recognized the importance of digital enhancements 

to facilitate data visualization, approximately half reported not 

having specific training or experience to enable them to accept 

such assignments. For their clients, the main reasons given for 

not developing digital enhancements were cost and time con-

straints, lack of interest, and author unavailability.

The medical literature is essential to the communication of sci-

entific evidence. In the past few decades, traditional print jour-

nals have predominantly assumed electronic formats, allowing 

for wider access and outreach, and social media and digital 

tools are now important vehicles in content dissemination.1

 A digital enhancement in the context of scientific 

publications is an online feature that is developed to aid in the 

visualization and interpretation of data. Infographics have been 

used for quite some time, particularly in patient education 

materials, and are effective channels for the communication 

of complex concepts. Infographics typically combine text with 

graphics, illustrations, and/or charts in a logical sequence to 

tell a story.2,3 Examples of infographics can be found here in 

https://www.fda.gov/media/82381/download and https://

www.who.int/reproductivehealth/publications/violence/VAW_

infographic.pdf?ua=1.

 Visual or graphical abstracts are schematic or animated 

representations of the content of an article, require less 

time and effort to create than infographics, and can be 

easily shared on social media.4,5 For examples of visual 

abstracts, see https://www.nejm.org/doi/full/10.1056/

NEJMoa2026845?query=featured_home and https://www.cell.

com/cancer-cell/fulltext/S1535-6108(21)00339-1. Video formats 

have become very popular with the widespread availability 

of mobile and relatively inexpensive filming/recording 

devices.6 Different types of video abstracts can be viewed here: 

https://www.youtube.com/watch?v=vNIg0pah3wE, https://

players.brightcove.net/656326989001/default_default/index.

html?videoId=5824269862001, and https://player.vimeo.

com/video/301841421. In addition, “Twitter abstracts” (visual 

abstracts that are disseminated via Twitter) are gaining traction 

Patricia Fonseca, PhD, CMPP / Medical Writer/Translator, Cambridge, MA

Digital Enhancements for Primary Medical 
Manuscripts: A Survey on Perceptions, Challenges, 
and Needs of Medical Publication Professionals

R
E

S
E

A
R

C
H

https://www.fda.gov/media/82381/download
https://www.who.int/reproductivehealth/publications/violence/VAW_
https://www.who.int/reproductivehealth/publications/violence/VAW_infographic.pdf?ua=1
https://www.nejm.org/doi/full/10.1056/NEJMoa2026845?query=featured_home
https://www.cell.com/cancer-cell/fulltext/S1535-6108(21)00339-1
https://www.youtube.com/watch?v=vNIg0pah3wE
https://players.brightcove.net/656326989001/default_default/index
https://players.brightcove.net/656326989001/default_default/index.html?videoId=5824269862001
https://player.vimeo.com/video/301841421
https://player.vimeo.com/video/301841421


      AMWA Journal / V36 N3 / 2021 / amwa.org    111

as a rapid means of disseminating research findings to a wider 

audience.7

 Written lay summaries are digestible forms of presenting 

data to patients, nonspecialist health care providers, or 

the public. Lay summaries require no expertise in terms of 

graphic design and have been embraced by several publishers 

as important elements of research articles.8-10 Examples of 

different formats of lay summaries can be found in https://

www.acpjournals.org/doi/10.7326/P21-0006 and https://link.

springer.com/article/10.1007/s13300-018-0531-0#Sec1. Other 

digital enhancements accepted by biomedical journals include 

audio abstracts, which are voice recordings summarizing an 

article, and interviews with the authors, in either video or 

audio format, in which the authors have a conversation with 

an interviewer about their research findings. For audio and 

video interviews, see https://jamanetwork.com/journals/

jamaophthalmology/pages/jama-ophthalmology-author-

interviews and https://www.mayoclinicproceedings.org/

video-archive-2021.

 Given their ease of access and potential for engaging audi-

ences,11-13 there has been increasing interest in recent years in 

the use of digital tools for data dissemination, and this inter-

est was greatly amplified by the COVID-19 pandemic and the 

increase in virtual congresses. Regarding primary publica-

tions in peer-reviewed medical journals, the uptake of digital 

enhancements by authors and/or pharmaceutical companies 

sponsoring the development of scientific publications has 

been mixed.

 Digital enhancements for primary manuscripts may pro-

vide new opportunities for medical writers to expand their skills 

and services. Understanding the main advantages and limita-

tions of digital features may help address misconceptions or 

concerns about the development of auxiliary digital content 

to enhance the communication of research findings. The main 

objective of this survey was to gauge the overall interest and 

demand for accompanying digital enhancements among medi-

cal writers and other publication professionals. The second-

ary objective was to determine the perceived value of digital 

enhancements and identify barriers to their development.

METHODS
A survey targeting medical writers and other professionals 

involved in the development of primary manuscripts for peer-

reviewed journals was developed using Google Forms. The 

25-question survey, which took no longer than 10 minutes 

to complete, was shared on AMWA Engage, the AMWA New 

England Chapter E-News, and the LinkedIn pages of AMWA, 

the AMWA New England Chapter, MedComms Networking, 

the Publication Plan, and the Medical Writers Corner. In addi-

tion, the survey was disseminated directly in the MedComms 

Networking online newsletter. Permissions to advertise the 

survey were requested as needed. Responses were accepted 

from August 25, 2020, to June 1, 2021.

 The survey included 24 multiple-choice questions and a 

comment box (question 25) to collect feedback from respon-

dents. Some questions allowed for more than one answer to 

be selected. All questions allowed respondents to add in their 

answers, if different from the choices provided; there were 

no mandatory questions. Information captured in the survey 

included demographic data (ie, region, role, therapeutic areas, 

and years of experience), the number and type of enhance-

ments developed, the perceived benefits and main obstacles 

encountered before and during the development of digital 

enhancements, and metrics deemed relevant to evaluate their 

impact. Awareness, interest, and determining factors in the 

decision-making process were assessed for academic com-

pared with nonacademic sponsors and/or authors. The com-

plete survey is included as a supplement.

RESULTS
As of June 8, 2021, a total of 116 responses had been received; 

the majority of the respondents were based in Europe (59%) 

and North America (35%). The top 3 roles (n = 114) were medi-

cal writers (66%), publications planners (29%), and editors/

proofreaders (25%) (more than one option could be selected). 

The vast majority of respondents (97%) were employed or 

worked as freelancers, and most worked full-time (72%); 

62% had more than 10 years of work experience, and only 3% 

reported having less than 2 years of experience in the field. The 

most common therapeutic areas (n = 114) in order of preva-

lence were oncology (52%), neurology (28%), respiratory dis-

eases (26%), and cardiology and endocrinology (approximately 

24% each) (more than one option was allowed).

 The majority of the respondents were employed by medi-

cal communication agencies or contract research organiza-

tions (37%) or worked as freelancers (35%); a small portion of 

respondents were affiliated with academic institutions and 

other medical and educational organizations (10%) (Figure 1).

18%

37%

3%

35%

7%

Pharmaceutical/biotechnology
and medical devices company

Medical communications agency/
Contract Research Organization

Academia

Freelancer

Other*

Figure 1. Survey population per professional setting (N = 116). 
*Includes medical societies, journal publishers, and nonprofit 
research and/or educational organizations.

https://www.acpjournals.org/doi/10.7326/P21-0006
https://www.acpjournals.org/doi/10.7326/P21-0006
https://link.springer.com/article/10.1007/s13300-018-0531-0#Sec1
https://jamanetwork.com/journals/jamaophthalmology/pages/jama-ophthalmology-author-interviews
https://www.mayoclinicproceedings.org/video-archive-2021
https://link.springer.com/article/10.1007/s13300-018-0531-0#Sec1
https://www.mayoclinicproceedings.org/video-archive-2021


112    AMWA Journal / V36 N3 / 2021 / amwa.org        

 More than half of the respondents (53%) had developed 

digital enhancements professionally (ie, created the concept, 

produced content, or reviewed the deliverables). Of these  

(n = 62), the majority provided these services for clients in the 

life sciences or medical communication industry (92%). Among 

respondents who had not developed enhancements for primary 

manuscripts (n = 55), only a small proportion (7%) reported 

not having an interest in doing so. For respondents with digital 

enhancements in their professional portfolios, 37% typically  

worked on 1-2 of these types of projects per year, with 28% 

indicating working on more than 5 enhancements in 1 year. A 

total of 49% reported receiving more requests for developing 

enhancements during the COVID-19 pandemic, and 49% saw 

no change in these requests (n = 63).

 The most frequently developed enhancements (n = 62)  

were infographics/illustrations (76%) and visual/video abstracts 

(74%) (more than one option was allowed) (Figure 2).  

The perceived benefit of digital enhancements by medical com-

munication professionals (n = 115) was improved data visu-

alization and comprehension (60%), followed by increased 

interest in primary publication (21%) and increased access 

(13%). For the clients, as reported by the respondents (n = 102), 

the value of digital enhancements was to stimulate interest 

in the primary publication (36%), to increase data access to a 

wider audience (29%), and to improve data visualization and 

comprehension (22%). Approximately 5% of the respondents 

did not see a benefit but noted that their clients inquired about 

these enhancements because they were a requirement provided 

by the target journals of the primary publications.

 Although respondents working for nonacademic clients  

(n = 66) reported that their clients mostly rejected proposals 

to develop digital enhancements because of cost (73%) and 

time (49%) constraints, concerns about enhancements being 

perceived as promotional (34%) were also reported. Clients in 

the academic or nonprofit sector (n = 26) mostly reported to 

the respondents about concerns related to the unavailability 

of authors (69%), concerns about the time needed to develop 

enhancements (50%), and concerns about the associated costs 

of development and publication (42%). The unavailability  

of peer review or specific metrics for enhancements were  

only deemed relevant for clients in the nonacademic  

setting (Table).

 Approximately 63% of the respondents (n = 114) reported 

proposing the development of digital enhancements to clients; 

of those who suggested (n = 70) enhancements depending on 

the type of project or whenever applicable to the manuscript, 

the majority (79%) suggested these features to nonacademic 

clients only. The main barriers for medical communication 

professionals (n = 109) in the development of accompanying 

digital features were a lack of specific training and/or expe-

rience (45%), a lack of time or insufficient pay (21%), and 

unclear/absent instructions from the journal 

(20%) (Figure 3). Not surprisingly, 46% claimed 

they would accept this type of assignment if 

they had adequate training, with 26% mention-

ing better guidance from journals regarding 

the requirements for submission of enhance-

ments and 16% noting the importance of spe-

cial pay rates to accept these services (n = 110).

 Respondents (n = 108) thought that ade-

quate dissemination of the enhancement with 

the manuscript (eg, visible link next to the man-

uscript) would be the determining factor in the 

Figure 2. Most frequently developed digital enhancements (n = 62). More  
than one option could be selected. *Summary slides with audio commentary. 
**Video or animated abstract with/without voice-over and/or images/charts.

45%

20%

21%

14%

23%

47%

74%

76%

Interview with author(s)

Audio slides*

Visual abstracts**

Infographics/illustrations

Table. Reasons for Rejecting Digital Enhancements

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  
(eg, Link Not Easily Visible)

14% 8%

Hosted Externally to Journal  
(eg, Commercial Video Platform)

12% 4%

Journal Does Not Collect Specific Metrics 6% 0%

Cost (eg, Production Costs, Journal Fees) 73% 42%

Time and Resources Needed for  
Development

49% 50%

Authors Unavailable 27% 69%

A maximum of 3 options could be selected. 

Industry clients: pharmaceutical, biotechnology, or medical device companies, 
contract research organizations, or medical communications agencies. 

Nonindustry: academia, medical societies, or individual authors.



      AMWA Journal / V36 N3 / 2021 / amwa.org    113

decision to develop digital enhancements for nonacademic 

clients (64%), which was followed in importance by the avail-

ability of useful metrics specific to the enhancement (50%). 

However, for those providing services to clients in academia 

and nonprofit entities (n = 60), journal assistance (60%),  

adequate dissemination (48%), and no or reduced fees for 

hosting the enhancement (47%) were referred to as factors that 

could influence a decision to develop enhancements. The  

most relevant enhancement-specific metrics for medical  

publication professionals (n = 113) were the total number 

of views/downloads (56%) and the time spent viewing the 

enhancement (30%); 55% of the respondents reported they 

would use the total number of views/downloads as a measure 

of the impact of digital enhancements to promote this type of 

service to clients.

 In the open-ended responses, the respondents recognized 

that demand for digital features will continue to grow and spe-

cifically mentioned the difficulties in demonstrating the over-

all benefit compared with the cost to clients as well as issues 

related to open access and copyright.

DISCUSSION
This survey was conducted to learn about the impact of digi-

tal enhancements on the practices of professionals involved in 

the development of primary publications, and the responses 

obtained provided a glimpse of the challenges encountered 

in the field of biomedical publications. Despite the current 

interest in digital formats, which has been intensified by the 

COVID-19 pandemic, and increasing research attempting to 

measure their value, digital enhancements for peer-reviewed 

primary publications do not seem to have a significant  

presence outside the context of medical communication  

agencies and sponsors of scientific publications in the life  

sciences industry.

 Although sponsors seem to recognize digital features as 

effective means of disseminating scientific data, there are 

oftentimes issues to address that do not relate to content or the 

choice of the most adequate format for the data in question, 

namely the journal’s capacity for hosting enhancements and 

requirements, the timing of submission of the enhancements, 

the availability of peer review, the visibility of the enhance-

ments, and copyright licensing.

 For medical publication professionals, accepting requests 

to develop these features may involve advising hesitant clients 

or authors, discussing benefits and concerns, and integrating 

the development process for digital features into the timeline 

for the core manuscript. Some journals may request the sub-

mission of an enhanced content piece with a manuscript, but 

if the manuscript is rejected, the enhancement developed may 

not be in the correct format for another journal. For these rea-

sons, clients and authors may see enhanced features as a poor 

use of their time and budgets.

 In addition, different practices by journals in terms of how 

digital enhancements are displayed on their websites (eg, 

as supplementary materials, as links to external websites, or 

prominently displayed with the article) may hinder access. 

Authors also face barriers to sharing digital content online, 

as the copyright license for the enhancement may be owned 

by the journal. Moreover, nonacademic sponsors may have 

restrictive policies on sharing content online, which may par-

tially explain the low level of engagement of academic co-

authors in the development of enhanced digital content in 

these industry-sponsored publications. Authors, sponsors, and 

medical communicators alike would certainly benefit from 

having detailed guidance, assistance, and quantitative data 

from journals hosting digital enhancements.

 Finally, there is currently a lack of evidence regarding the 

best strategies to effectively disseminate data and engage  

the target audience through digital channels. In the future, 

digital enhancements may be as standard as traditional writ-

ten abstracts in journal articles, ultimately benefiting their 

audiences.

Limitations
This study had some limitations. First, there was selection bias 

owing to how the survey was advertised to medical publica-

tion professionals. Most respondents were experienced profes-

sionals who may have had a distinct exposure to this type of 

publications compared with less “seasoned” professionals. In 

addition, the survey may have captured the responses of those 

already developing or with an interest in developing digital 

features.

 Second, biomedical publication professionals from other 

geographic regions other than Europe and North America as 

well as professionals working in nonprofit, academic, and edu-

cational backgrounds were poorly represented, which may be 

45%

20%

21%

14%

No specific training experience

No clear or absent instructions 
from journal

Lack of time or insufficient pay

Other

Figure 3. Main barriers for medical communications 
professionals (n = 109). A maximum of 3 options could 
be selected.



114 AMWA Journal / V36 N3 / 2021 / amwa.org 

explained by the only relatively recent rise in medical writing 

services in Asia14 and the traditionally low presence of these  

professionals at research centers and universities.

 Finally, the open-text format of some of the questions 

added a level of complexity to the analysis of the responses,  

as some of the answers added were the same as the ones  

provided, but with different wording, and others did not fit  

into the context of the questionnaire (eg, interactive posters  

for congresses).

CONCLUSION
Digital enhancements may add value to primary publications, 

but many barriers persist and hinder a wider uptake by medi-

cal communication professionals and their clients. Although 

nonacademic clients may be particularly concerned about the 

return on investment, the cost and time invested in the devel-

opment of these features pose challenges to both academic 

and nonacademic clients.

 Medical communication professionals are uniquely posi-

tioned to provide clients and authors with much needed 

support in creating visual and digital enhancements for pub-

lications, but confidence in their own expertise to guide the 

development process falls below expectations. Professional 

societies such as AMWA could potentially contribute to meet 

the needs for specific training in the development of digital 

enhancements in the form of continuing education activities.

Acknowledgment

The author thanks all the respondents for their valuable feedback 

and comments and thanks Pete Llewellyn for disseminating the 

survey in the MedComms Networking online newsletter.

Author declaration and disclosures: Patricia Fonseca is an employee 
of Excerpta Medica. This survey was conducted independently. The 
opinions expressed in this article are those of the author. The author 
received no honorarium, fee, or other form of financial support related 
to the development of this article. Preliminary data collected from this 
survey were presented as a poster at the AMWA 2020 Medical Writing & 
Communication Conference held in October 2020 and as part of a webi-
nar titled “Extending the Reach of Medical Publications: Working on 
Digital Enhancements in Practice,” which was organized by MedComms 
Networking and held on May 26, 2021.

Author contact: pfonsecamedical@gmail.com

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recent-developments-and-trends

LEARN MORE

ISMPP University, “Visual Medical Communications,” 
Webinar presented on January 29, 2020: https://www.
ismpp.org/complimentary-ismpp-u-webinars

Boston University, Certificate in Visual and Digital Health 
Communications: https://www.bu.edu/academics/met/
programs/graduate-certificate-in-visual-digital-health-
communication/

Graphical abstracts: https://www.cell.com/pb/assets/raw/
shared/figureguidelines/GA_guide.pdf

Twitter posters:  
https://www.youtube.com/watch?v=fQDL8r3r_d4

Plain language summaries:  
https://www.envisionthepatient.com/plstoolkit/

Tools: Canva Infographic (https://www.canva.com/), 
PiktoChart (https://www.piktochart.com/),  
Motifolio (https://www.motifolio.com/),  
Mind The GRAPH (https://mindthegraph.com/)

mailto:pfonsecamedical@gmail.com
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https://www.ismpp.org/complimentary-ismpp-u-webinars
https://www.bu.edu/academics/met/programs/graduate-certificate-in-visual-digital-health-communication/
https://www.cell.com/pb/assets/raw/shared/figureguidelines/GA_guide.pdf
https://www.youtube.com/watch?v=fQDL8r3r_d4
https://www.envisionthepatient.com/plstoolkit/
https://www.canva.com/
https://www.piktochart.com/
https://www.motifolio.com/
https://mindthegraph.com/
https://doi.org/10.1097/SLA.0000000000002277
https://static1.squarespace.com/static/5854aaa044024321a353bb0d/t/5a527aa89140b76bbfb2028a/1515354827682/VisualAbstract_Primer_v4_1.pdf
https://www.audiovisualresearch.org/science-film/validity-of-video-abstracts/
https://doi.org/10.3163/1536-5050.104.3.011
https://doi.org/10.7554/eLife.25410
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