Publication Extenders: Yes, They Are Worth the Effort

Apr 8, 2025 | News and Trends

Kelly Soldavin, Taylor & Francis Group, USA; Caroline Halford, Springer Healthcare, UK*; Adeline Rosenberg, Oxford PharmaGenesis, UK and Centre for Pharmaceutical Medicine Research, King’s College London, UK; Joanne Walker, Becaris Publishing, UK; Hamish McDougall, Sage Publishing, London, UK

*Since this article was written, CH has moved to a role within Springer Healthcare IME, the independent education division of Springer Healthcare.

Email your questions and comments on this article to TheMAP@ismpp.org.

Over the past several years, publication extenders, also known as enhanced publication content or digital features, have become a gold-standard enhancement to peer-reviewed journal articles. As interest has steadily increased, so has the research looking into publication extender impact, discoverability and readability. However, the evidence supporting the benefits and value of publication extenders, which can include infographics, video abstracts, podcasts and plain language summaries (PLS), has not been readily available nor easily found.

In response to this need, the ISMPP Digital/Visual Communications Committee (DVCC) developed the Publication Extenders Evidence Resource, which was launched in November 2024 and is freely accessible on the ISMPP website. This resource was built upon previous work by the authors—an initial literature search that identified peer-reviewed evidence focused on extenders. DVCC updated and expanded the selection, categorizing it by extender and highlighting key findings and data that demonstrate their efficacy and return on investment.

Some of the most compelling evidence was presented by the authors in the June 2023 ISMPP University webinar, Digital Features – Are They Really Worth the Effort? This article shares those findings in a question-and-answer format to aid publication planning professionals in securing support for publication extenders.

ARTICLE METRICS

How do publication extenders impact article metrics?

One of the most common questions asked about publication extenders is: Do publication extenders increase the impact of the articles they accompany? The short answer is “Yes.” But the longer answer is more nuanced.  

First, you need to define what you mean by ”impact.” Do you measure impact by increased downloads? A higher Altmetric score? More citations than similar articles? Several studies have demonstrated that adding publication extenders to publications can improve all these metrics. For example:

  • Zong and colleagues compared 315 articles with video abstracts against 630 matched articles without them. The authors found that articles with videos were expected to have a 1.206 higher citation rate1. 
  • In 2023, Bonnevie and colleagues analyzed the metrics of 500 research articles published in New England Journal of Medicine (NEJM) (152 with a video abstract) and, over a 3-year period, articles with videos had a “worthwhile increase in views”2.
  • When studying phase 3 lung cancer publications, Arndt and colleagues found that publications with enhanced content were associated with higher Altmetric scores3.
  • At the 2022 ISMPP European Meeting, Hammad and colleagues looked at nine NEJM oncology articles with either video abstracts, graphical abstracts or both. Both types of features were associated with greater average monthly page views, citations and Altmetric scores. However, there was no extra benefit for articles that had both4.

Articles with PLS have also been shown to benefit from increased views. In a 2022 pilot study, Adis compared 50 articles with text-based PLS against matched articles without PLS, across all article types and 8 therapeutic areas. The authors (Winter et al) found that 62% of articles with PLS were accessed significantly more than those without (i.e., >25% more downloads)5.

UPTAKE & DISCOVERABILITY

What is the uptake of publication extenders?

Despite significant interest and discussion around publication extenders, their uptake by authors and journals remains low. Several studies illustrate this trend:

  • A study presented at the ISMPP Annual Meeting in 2023 examined the availability of graphical abstracts in type 2 diabetes and multiple sclerosis by searching Google Images6. Out of 450 images identified, only 14 (3%) were graphical abstracts. The authors attributed this low proportion to limited adoption of graphical abstracts.
  • Another study focused on clinical trial publications for Parkinson’s disease, a condition with strong patient engagement7. Among 103 articles analyzed, only one included a graphical abstract, and six articles featured a PLS.

Research specifically investigating PLS has revealed the following:

  • A 2020 study of 30 hematology journals found that only 11 journals permitted PLS. Of these 11 journals8:
    • Two allowed PLS submissions.
    • Seven permitted PLS as supplementary materials.
    • One allowed PLS solely for article promotion.
    • One allowed PLS during the review process.
  • Another study analyzed 534 journals across 10 disease areas and 11 journal categories9:
    • Only 27 journals provided text-based instructions for PLS.
    • Of these 27 journals, 70% did not require PLS.
  • More recent research looking at inclusion of PLS among the top 50 journals in neurology, psychiatry/mental health, respiratory disease, cardiology and infectious disease found that only 26% (64/247) of the journals require or accept PLS10.

Can publication extenders be discovered?

Accessibility and discoverability are key when publishing publication extenders. Publication extenders should also be easily accessible on the journal platform and should be accompanied by clear signposting indicating a publication extender is available. Unfortunately, many journals do not consider the reader’s journey to locate and access such content. As a result, publication extenders are often published on platforms where they are difficult to find. Furthermore, many publishers are constrained by the technological limitations of their online journal platforms.

Nonetheless, strides are being taken to improve accessibility and discoverability, particularly for PLS, which are intended to be used by diverse audiences, including different groups of readers than those of the original article and time-poor individuals. Journals can now use a specific tag within the article metadata that enables PubMed to tag PLS accordingly, which increases the likelihood of these summaries being discovered on this platform. However, this tag is currently limited to text-based PLS and is utilized by only a small number of publishers.

  • A study looking at the prevalence of articles on PubMed with this PLS tag found only 61 articles per million used it11.
  • Rosenberg and colleagues also reported that while 3,127 articles were tagged on PubMed, 470 of these used the tag incorrectly12.

What does this mean?

It is clear that improved education is needed—for publication planning professionals, authors and, most importantly, publishers. A recent survey of publishers and journals highlighted a strong interest in publication extenders, especially regarding their potential to boost article visibility and impact. However, challenges remain, including the inability to effectively host publication extenders on journal platforms13. Could publication tagging be expanded to include other types of extenders, such as infographics? Doing so would make these features discoverable on platforms like PubMed, further enhancing their accessibility and utility.

Authors and publication planning professionals should also explore resources to aid discoverability beyond those provided by journals and publishers. For example, a case study about use of the Figshare portal to host PLS and other publication extenders showed that within just 10 months of its launch, the portal had garnered over 1,800 views, indicating the value of third-party platforms in enhancing the reach and discoverability of digital content14. Research by Jenkins and colleagues has also suggested an independent, dedicated website or database aggregating PLS would be beneficial to aid in the discoverability of this type of publication extender15.

AUDIENCE PREFERENCES & READER COMPREHENSION

Do audiences prefer certain types of publication extenders?

Recent studies have created a solid foundation of evidence that removes a lot of the guesswork when it comes to selecting the most suitable publication extender for an article, as well as choosing the best format. Table 1 shares data from several studies that evaluated audience preferences for publication extenders and their format.

Table 1. Publication extenders: audience type and preferences

Beyond audience preferences, several studies contributed further important findings.

The studies by Lobban and colleagues and Gadiot and colleagues demonstrate that digital extenders, particularly PLS, may be shared with those outside the target audience, expanding their reach:

  • Of 66 healthcare professionals (HCPs), 43% went on to share the PLS with their patients, and one in six referred patients and their families to the online PLS18.
  • The rare disease clinicians indicated that the availability of a PLS increased the likelihood that they would share the study information with patients19.

The van den Broek and colleagues study identified some of the reasons why patients consider PLS “essential” and “highly valuable,” reporting that patients24:

  • Spent “a lot of time looking for relevant information.”
  • Were “frustrated or confused by irrelevant information.”
  • Did not “understand how the information [they found] related to them.”

Finally, the recommendation to include both text and graphical PLS within an article20 echoes industry guidance on best practices for PLS. An ISMPP-led peer-reviewed journal article investigating publication stakeholders’ perspectives on PLS states, “a good option [for research publications] would be to have a short text-only PLS (indexed on the PubMed database) along with a more visual detailed summary”29.

How do publication extenders impact comprehension and readability?

In addition to what formats different audiences prefer, we also need to consider which formats aid comprehension, to ensure scientific information and messages are conveyed clearly and accurately. How does your target audience consume content, what are their learning styles, what are their access needs? These are all important questions to ask when planning and deciding on publication extenders, but ultimately, it’s not going to be a one-size-fits-all approach, and multiple options for accessing content should be provided.

In terms of what the data say on content comprehension by format, several posters presented at ISMPP meetings have shown that patient audiences report that the inclusion of publication extenders as a whole improves understanding, and more specifically, PLS are easy to understand and are benefitted by both plain text and infographics24,30,31.

HCP audiences also report that supplemental digital information aids overall understanding and that, for some, plain-text PLS may be easier to read than graphical formats20,32. However, looking at specific elements within publication extenders, graphics and color tend to make content easier to comprehend, whereas lengthy titles, columns and icons may reduce engagement32. As mentioned earlier, Halford and colleagues recommended publishing both text and graphical PLS to accommodate different learning styles and preferences20.

When considering the readability of text within publication extenders and, in particular PLS, the findings are mixed. Of two studies presented at the 2023 ISMPP Annual Meeting, one found no significant differences in readability between PLS and technical abstracts in hematology papers, while another determined that a high level of oncology PLS (95!) were written at university-level readability and used persistent and unexplained medical jargon33,34. On the other hand, findings in Autism Research and the Journal of Cystic Fibrosis found PLS to be more readable, with significantly improved readability, compared with technical abstracts35,36.

What’s the take-home?

The selection of studies highlighted in this article is just a small representation of the increasing amount of evidence available on publication extenders. While some of the research cited is a few years’ old, as new evidence is published and presented, the conclusions remain the same: publication extenders play an important role in increasing the impact and reach of scientific articles, communicating research more effectively and making it more accessible to all audiences and, as a result, combatting the mis- and disinformation that is so readily available online.

Transparency

Disclaimer

Opinions expressed in this article are those of the authors and do not necessarily represent those of their employers.

Declaration of funding

There is no funding to declare for this article.

Declaration of financial/other relationships

KS is an employee of the publishing company Taylor & Francis. CH is an employee of Springer Healthcare IME, the independent education division of Springer Healthcare. JW is a co-owner of Becaris Publishing. AR is an employee of Oxford PharmaGenesis; she receives departmental funding from the Centre for Pharmaceutical Medicine Research, King’s College London, for doctoral research on patient involvement in publications.

KS is the secretary for the ISMPP Board of Trustees. KS (co-chair) and JW are members of the ISMPP Social Media & Web-based Metrics Committee. CH, AR, and HM (co-chair) are members of the ISMPP Digital/Visual Communications Committee.

Acknowledgements

The authors wish to thank Anna Geraci, ISMPP’s Senior Director, Communications and Strategic Programs, for her assistance in providing feedback as this article was developed.


References

  1. Zong Q, Huang Z, Deng Z. Do graphical abstracts on a publisher’s official website have an effect on articles’ usage and citations? A propensity score matching analysis. Learned Publishing. 2023;36:266-274. https://doi.org/10.1002/leap.1523
  2. Bonnevie T, Repel A, Gravier FE, et al. Video abstracts are associated with an increase in research reports citations, views and social attention: a cross-sectional study. Scientometrics. 2023;128:3001–301. https://doi.org/10.1007/s11192-023-04675-9
  3. Arndt S, Tyree Sk, Estes K, et al. Assessing the impact of enhanced content: a review of its use in lung cancer publications. 2024 ISMPP AM. Curr Med Res Opin. 2024;40(sup2):S9. https://doi.org/10.1080/03007995.2024.2328445
  4. Hammad M, O’Meara R, Acheson KI. The effect of accompanying publication extenders on publication metrics in sets of similar oncology papers. 2022 ISMPP EU. Curr Med Res Opin. 2022;38(sup1):S33. https://doi.org/10.1080/03007995.2022.2044117
  5. Winter S, Halford C, West M, et al. Do plain language summaries encourage readers to access your publication? A pilot study. 2022 ISMPP EU. Curr Med Res Opin. 2022;38(sup1):S33. https://doi.org/10.1080/03007995.2022.2044117
  6. Phipps P, Leavy K, Lusk S, et al. Access to graphical abstracts via Google Images search: a pathway to connect patients with research? 2023 ISMPP AM. Curr Med Res Opin. 2023;39(sup1):S7. https://doi.org/10.1080/03007995.2023.2194075
  7. Vreeland AC, Litvana J, Lambe K et al. Ease of reading: evaluating clinical data accessibility through the use of graphical abstracts and plain language summaries, a case study of Parkinson’s disease publications. 2023 ISMPP AM. Curr Med Res Opin. 2023;39(sup1):S18. https://doi.org/10.1080/03007995.2023.2194075
  8. Marcheva G, Rane S. Are hematology journals open to publishing plain-language summaries?  2020 ISMPP AM. Curr Med Res Opin. 2020;36(sup1):S10. https://doi.org/10.1080/03007995.2020.1732581
  9. Gainey KM, Smith J, McCaffery KJ, et al. What Author Instructions Do Health Journals Provide for Writing Plain Language Summaries? A Scoping Review. The Patient. 2023;16:31-42. https://doi.org/10.1007/s40271-022-00606-7
  10. Ruzich E, Antolin-Fontes B, Pattanaik S, et al. Plain language summaries in medical journals: how accessible is scientific research to the general public? Value in Health 2024 27; 6: S292.
  11. Gattrell W, Wagner K, Sheikh N, Chisholm A. Prevalence and characteristics of plain language summaries indexed in PubMed. 2022 ISMPP EU. Curr Med Res Opin. 2022;38(sup1):S41–S42. https://doi.org/10.1080/03007995.2022.2044117
  12. Rosenberg A, Baróniková S, Gattrell W, et al. Assessing PubMed Metatag Usage for Plain Language Summary Discoverability. Presented at the Ninth International Congress on Peer Review and Scientific Publication, September 8-10, 2022. https://peerreviewcongress.org/abstract/assessing-pubmed-metatag-usage-for-plain-language-summary-discoverability/
  13. Skillen R, Whann E, Patel R et al. Insights on enhanced publication content in journals: a survey of editors/publishers. 2022 ISMPP AM. Curr Med Res Opin. 2022;38(sup1):S13. https://doi.org/10.1080/03007995.2022.2055262
  14. Sykes, Angela; Figshare, Team (2022). Pfizer enhances discoverability and impact of research with Figshare. Figshare. Online resource. https://doi.org/10.6084/m9.figshare.19898827.v1
  15. Jenkins R, Cavana S, Soldavin KA, et al. Cracking the code: how discoverable are plain language summaries. 2024 ISMPP AM. Curr Med Res Opin. 2024;40(sup2):S40. https://doi.org/10.1080/03007995.2024.2328445
  16. Bredbenner K, Simon S. Video abstracts and plain language summaries are more effective than graphical abstracts and published abstracts. PLoS ONE 2019;14(11):e0224697. https://doi.org/10.1371/journal.pone.0224697
  17. Clarke N, Lai C, Payne H, Halford C. Which types of digital features have the most impact on article accesses? A pilot study. 2022 ISMPP AM. Curr Med Res Opin. 2022;38(sup1):S23. https://doi.org/10.1080/03007995.2022.2055262
  18. Lobban D, Oliver J, Buttaro M, et al. Do healthcare professionals really value plain language summaries? 2022 ISMPP EU. Curr Med Res Opin. 2022;38(sup1):S32–S33. https://doi.org/10.1080/03007995.2022.2044117
  19. Gadiot R, Hanekamp E, Diamond M, et al. Medical information consumption and sharing practices in rare diseases–a clinician perspective. 2022 ISMPP EU. Curr Med Res Opin. 2022;38(sup1):S16. https://doi.org/10.1080/03007995.2022.2055262
  20. Halford C, Evans M, Alborn L, Winter S. Plain language summary formats: opinions and preferences of healthcare professionals. 2023 ISMPP AM. Curr Med Res Opin. 2023;39(sup1):S29. https://doi.org/10.1080/03007995.2023.2194075
  21. Palma R, Rametta M, Toscani M. The effect of digital enhancements on publication impact in the cardiovascular space. 2023 ISMPP AM. Curr Med Res Opin. 2023;39(sup1):S34–S35. https://doi.org/10.1080/03007995.2023.2194075
  22. Burd G, Strangman N, Schoensiegel C, et al. What do doctors really do on the internet? 2023 ISMPP AM. Curr Med Res Opin. 2023;39(1):S37. https://doi.org/10.1080/03007995.2023.2194075
  23. Georgieva A, Nuottamo N, McNamara M, Bijvank S. Patient information needs and relevant channels. 2018 ISMPP AM. Curr Med Res Opin. 2018;34(sup1):S23. https://doi.org/10.1080/03007995.2018.1440994
  24. van den Broek R, Crowley P, Ellenberger C, et al. Key insights from patient organizations for developing effective plain language summaries of medical publications. 2022 ISMPP EU. Curr Med Res Opin. 2022;38(sup1):S14. https://doi.org/10.1080/03007995.2022.2055262
  25. Silvagnoli LM, Shepherd C, Pritchett J, Gardner J. Optimizing readability and format of plain language summaries for medical research articles: cross-sectional survey study. J Med Internet Res 2022;24(1):e22122. https://doi.org/10.2196/22122
  26. Fazzone W, Bessler J, Darby C, et al. Trends in the use of omnichannel approaches to transform publication planning: results of a cross-sectional survey of medical publications professionals. 2021 ISMPP AM. Curr Med Res Opin. 2021;37(sup1):S18–S19. https://doi.org/10.1080/03007995.2021.1899492
  27. Soldavin KA, Patience J, Nagda N. Understanding appetite and opportunities for plain language summaries. 2024 ISMPP EU. Curr Med Res Opin. 2024;40(sup2):S56. https://doi.org/10.1080/03007995.2024.2314805
  28. Hanekamp E, Drake T, Buisson S, et al. Value of enhanced content in health-economic outcomes and real-world evidence publications. 2024 ISMPP AM. Curr Med Res Opin. 2024;40(sup2):S40. https://doi.org/10.1080/03007995.2024.2328445
  29. Lobban D, Gardner J, Matheis R. Plain language summaries of publications of company-sponsored medical research: what key questions do we need to address? Curr Med Res Opin. 2022;38(2):189–200. https://doi.org/10.1080/03007995.2021.1997221
  30. Iqbal TR, Kruempel J, Kruempel J, Carrera A, Neuman KM. Patient awareness of and perspectives on plain language summaries. 2023 ISMPP AM.Curr Med Res Opin. 2023;39(sup1):S28. https://doi.org/10.1080/03007995.2023.2194075
  31. Issa N, Shaw E, Marshall A, et al. Understanding the benefits of publication enhancements from the patient perspective. 2023 ISMPP EU. Curr Med Res Opin. 2023;39(1):S57. https://doi.org/10.1080/03007995.2023.2184562
  32. Subramanian RP, Bessler JB, Fazzone W, et al. Plain language summaries – how can we improve patient understanding? 2023 ISMPP AM. Curr Med Res Opin. 2023;39(sup1):S29. https://doi.org/10.1080/03007995.2023.2194075
  33. Wissing MD, Porter AC, Tanikella SA, et al. Evaluation of use of medical terminology and interpretation of results in oncology plain language summaries. 2023 ISMPP AM. Curr Med Res Opin. 2023;39(sup1):S19. https://doi.org/10.1080/03007995.2023.2194075
  34. Samara R, Hodge J, Steele A. Review of use and characteristics of plain language summaries (PLS) in hematology. 2023 ISMPP AM. Curr Med Res Opin. 2023;39(sup1):S32. https://doi.org/10.1080/03007995.2023.2194075
  35. Wen J, Yi L. Are plain language summaries more readable than scientific abstracts? Evidence from six biomedical and life sciences journals. Autism Res. 2023;16(5):935-940. https://doi.org/10.1177/09636625241252565
  36. Anderson HL, Moore JE, Millar BC. Comparison of the readability of lay summaries and scientific abstracts published in CF Research News and the Journal of Cystic Fibrosis: Recommendations for writing lay summaries. J Cystic Fibrosis. 2022;21(1):e11-14. https://doi.org/10.1016/j.jcf.2021.09.009