Putting plain language summaries into perspective

Abstract

Publication-associated plain language summaries are brief, jargon-free summaries of scientific publications. They are intended for a broad, non-expert audience to help maximize the accessibility of the publication. Plain language summaries are typically found alongside peer-reviewed publications or in supplementary materials and can be indexed in PubMed. In this narrative commentary, we present the perspectives of five day-to-day users of plain language summaries from different stakeholder groups, gained through semi-structured qualitative interviews about the users’ experiences with and opinions of plain language summaries.

PLAIN LANGUAGE SUMMARY

Plain language summaries such as this one are an increasingly popular tool for helping readers cut though jargon and understand the key points of a research article faster. To get a better idea of how plain language summaries are being used, we spoke to five people from different backgrounds who read, write and review plain language summaries in their personal and professional lives.

Keywords:

• Plain language summary
• accessibility
• discoverability
• inclusivity
• medical research
• public engagement

Introduction

Thanks to the open science movement, and especially open access publishing, it is becoming easier for readers outside of large research institutions to access research articles for free. The proportion of research articles that are openly available has been increasing year over year¹. This increase in open access has removed one important barrier to accessing research information. However, another key barrier to access is understanding. After all, what is the point of research information being openly available if only a tiny proportion of the people who have access to it can understand the technical language it’s written in?

Despite the benefits of clear and understandable language to readers, studies have suggested that research articles are actually becoming more difficult to read^2,3. Many modern research articles are full of obscure acronyms, jargon, and long words and sentences – all of which can make reading harder.

Publication-associated plain language summaries are an increasingly popular tool for helping readers cut though the jargon and understand the key points and potential impact of a research article⁴. These short summaries of peer-reviewed research articles are written in everyday, non-technical language and can come in a variety of formats – from written summaries to infographics, podcasts and videos. It is important to note that a plain language summary is not the same as an EU-mandated regulatory lay summary, which is a distinct and non-interchangeable type of document and is not the topic of this commentary. Plain language summaries are designed to be readily understood by anyone who is interested in the content of peer-reviewed research articles, be they specialists or non-specialists^5,6. The intended readership of plain language summaries can include patients, patient advocates, caregivers, members of the media, busy healthcare professionals, policymakers and even researchers themselves, for whom staying on top of the scientific literature can be a full-time job.

Interview methods

Interviewees were screened and recruited via personal correspondence and professional networking forums. Semi-structured interviews about experiences with and opinions on publication-associated plain language summaries were designed and conducted by CE and AR. Individual interviews took place in January 2022. All interviewees provided informed consent to participate and for their views to be included in this publication. No interviewees were compensated.

Who uses plain language summaries?

David Schley is Deputy Director of Sense about Science, London, UK and was previously Head of Science Communications at the Marine Stewardship Council, London, UK, and the Research Communications Manager for the Multiple Sclerosis Society, London, UK. He used plain language summaries in these roles to help communicate clinical trial results to patient groups and to explain complex sustainability standards to industry and environmental stakeholders. ‘You have to communicate rapidly to patient groups to manage expectations and explain the outcomes’, he said, ‘and if there's a [plain language summary] that does that, that you know has been peer-reviewed and approved by the authors, that's a million times better than the university office press release’. ‘Plain language summaries’, he said, are ‘a plain but authoritative source’.

Emma Georgiou is Executive Director of the Oxford Health Policy Forum, Oxford, UK. Emma’s team produces plain language summaries both for grant proposals and for policy reports. She previously also worked in medical communications. Emma believes that policy is about being inclusive and breaking down the barriers to information and that communicating research in an understandable way is vital in the health policy field. ‘The way that you do that’, she said, ‘is by writing things or producing documents in a way that everybody can access them and learn from them’. She added, ‘You never know whose desk your [report is] going to land on. You can't take for granted that their background is academia and science’.

James Piercy is a Science Communicator and Public Engagement Consultant, and Communication and Engagement Officer at the John Innes Centre, Norwich, UK. After experiencing a severe brain injury 11 years ago, James used plain language summaries to help learn more about his condition and to write a science show about his journey. James then became a patient partner in a brain injury research group and has since been involved in writing plain language summaries of their research. James is also a public reviewer for the UK’s National Institute for Health Research (NIHR) and regularly reviews plain language summaries submitted with grant proposals.

Judi Smith is a Patient Caregiver Partner with the Oxford Patient Engagement Network for Arthritis and Musculoskeletal Conditions, Oxford, UK. She previously worked as a Nurse and Health Visitor for the UK’s National Health Service (NHS) and as a teacher of children with special educational needs. As a caregiver, Judi uses plain language summaries to help find new research about her daughter’s health conditions. ‘My daughter has a nice collection of rare diseases, so trying to find relevant up-to-date information is really important’, she said. Judi also provides advice to researchers on writing effective plain language summaries.

Louise Hailey is a Research Assistant in Psoriatic Arthritis at the University of Oxford and the Patient and Public Involvement Coordinator for the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, UK. Louise also previously worked as a Clinical Specialist and Spinal Physiotherapist in the NHS and found that plain language summaries allowed her to quickly understand research so that she could discuss it with her colleagues and patients. They were also helpful for informing the language used in patient materials. While studying for a Master’s degree in Evidence-Based Healthcare, Louise found plain language summaries useful for learning about topics outside of her area of expertise and as a guide for her own writing. Today, as a Research Assistant, Louise is involved in writing plain language summaries for research articles and grant applications, and she is also involved in training doctoral students in how to write plain language summaries. She thinks it is important that researchers learn these skills early in their careers.

Our interviewees

• David Schley – Deputy Director of Sense about Science, London, UK.

• Emma Georgiou – Executive Director of the Oxford Health Policy Forum, Oxford, UK.

• James Piercy – Science Communicator and Public Engagement Consultant, and Communications and Engagement Officer at the John Innes Centre, Norwich, UK.

• Judi Smith – Patient Caregiver Partner with the Oxford Patient Engagement Network for Arthritis and Musculoskeletal Conditions, Oxford, UK.

• Louise Hailey – Research Assistant in Psoriatic Arthritis at the University of Oxford and Patient and Public Involvement Coordinator for the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, UK.

Plain language summaries save time – if you’re able to find them

Several of our interviewees noted that a key benefit of plain language summaries is that they save time for the reader. James suggested that this may be particularly useful for researchers who don’t have time to read hundreds of papers in-depth but could use, for example, infographics to decide which papers are worth focusing on. Louise also shared this sentiment and suggested that plain language summaries could help researchers decide which papers to include when conducting systematic literature reviews and which may be worth purchasing if they are behind a paywall. Emma said that she often goes straight to the plain language summary if she is trying to find information quickly. ‘If it's something I need to find the answer to in 5 minutes, which is often the case, then I'll do the quickest route possible’, she said.

David believes that plain language summaries can also speed up the sharing of science by helping science communicators feel confident that they understand the content of a research article more quickly. What’s more, because plain language summaries are often written by the researchers themselves, less time needs to be spent double-checking the facts, as is usually the case for the information in press releases. ‘You can do things quickly’, he said, ‘which means you can respond in the time frame that the media and the public and social media work in’. He added, ‘Sometimes you look at a paper and by the time you’re confident to say something about it, the moment has passed’. Our interviewees noted that they generally don’t actively seek out plain language summaries but instead tend to find them incidentally when looking for research articles. As David put it, ‘They’re a very welcome bonus’.

Several of the interviewees said that they use PubMed to find medical research. Emma thought readers of policy reports who are interested in finding more information on a topic or research area might also use PubMed. To increase the discoverability of plain language summaries in PubMed, both James and Emma suggested that a toggle switch that filters for research articles with plain language summaries might help users to find them. James also thought that a separate search tool for plain language summaries that links out to the research paper could be useful because PubMed may be daunting to some audiences. ‘Searching through something like PubMed, it's scary, isn't it?’ he said. He suggested that a tool like this might also improve the discoverability of research by allowing users to search using common plain language words for medical terms.

Putting your trust in plain language summaries

Our interviewees also shared various methods they use for deciding whether a plain language summary is trustworthy. A key consideration is who wrote the plain language summary. For David, it’s important that plain language summaries are written by the researchers and professionals who performed or drafted the research. He said, ‘The value is about the fact that the researchers or scientists still have ownership over it and are accountable for it being accurate’. Judi advises people to look at the credentials and qualifications of the authors. She also thinks that plain language summaries are more credible when the authors acknowledge the limitations of their research, such as small sample sizes. ‘I think it's more trustworthy. You feel this person knows their limitations’, said Judi. ‘A red flag would be somebody trying to make more of what they've done’. Another thing to consider is where a plain language summary is hosted. Louise noted that plain language summaries are likely to be trustworthy if they come from established organizations such as Cochrane and PubMed.

Peer review was also considered an important factor in ensuring plain language summaries are reliable. Some interviewees admitted, however, that sometimes readers will need to use their own knowledge of the field to judge whether the content of a plain language summary is valid, just as people have to when reading research articles. Judi noted that this can be particularly important for plain language summaries about topics thought to be fringe or contentious within a specific research community.

Making the most of plain language summaries

Several of our interviewees thought that plain language summaries are currently mostly used by other researchers. In James’ view, ‘The main audience is other researchers’. He added, ‘If you're someone who's affected by a particular condition, you might want to do some digging around and get some background [by] reading research, but even that I think is quite unusual’. However, he also thinks that more research should be done into who is really using plain language summaries; efforts are underway to characterize plain language summary users^7,8, but further work to better understand the audience will help to clarify and streamline the production, publication and dissemination of plain language summaries. Judi noted that many patients are unlikely to seek out medical research themselves. She said, ‘In my nursing career, we wouldn't ever expect a patient to have picked up an academic journal, even a very educated patient’. However, she also noted that healthcare has changed significantly since she was practicing and that nowadays many patients take a more proactive role in their healthcare decisions. Plain language summaries may be a gateway into the literature for proactive patients to learn more about their conditions and participate in shared decision-making⁹.

All our interviewees remarked that plain language summaries should be written so that they can be understood by non-experts. Several felt that the best way to achieve this is to involve non-experts in the plain language summary writing and reviewing process; best practice guidelines for co-creation with patients have been developed to aid this process¹⁰. Emma thought it should be a given that plain language summaries are shared with a patient or non-expert before being published. In David’s ideal world, plain language summaries would be accessible to the likes of patient advocacy groups and organizations. He pointed out that co-production with patient groups could help ensure that the summaries contain the information that patients are really looking for. Louise said 'I couldn't imagine creating [a plain-language summary] without having somebody who was a patient or public member either writing it with you or at least after you've written it, checking “Does this make sense? Is it reasonable?”’

In terms of what makes a good plain language summary, the group was nearly unanimous that they should be short – short words, short sentences, short paragraphs. James joked that he keeps ‘a pot of full stops’ on his desk that he uses to break up the paragraph-length sentences he sometimes encounters when reviewing plain language summaries for the NIHR. James also thinks that some of the lessons that are important for good science communication can be applied to producing good plain language summaries. ‘The key things are message and audience’, he said. ‘You need to know what it is you're trying to say and who you're trying to say it to because that's going to inform the tone and the manner and the vocabulary that you use’.

Good plain language summaries also need to capture the key points of the research. Judi recommends that people think like a teacher when writing plain language summaries and ask themselves, ‘What is your main learning objective? What do [you] want the person who's reading this to leave with?’ James recommends that researchers ask themselves ‘Is it giving us the headline?’

Finally, in terms of what kinds of research should have plain language summaries, several of the interviewees felt that they are especially important for medical research and health topics. ‘I think they should be on all healthcare research papers, including laboratory-based things’, said Louise. ‘Where there is an aim that at some point it would have an impact on health, then it should [have a plain language summary]’. Judi thinks that plain language summaries are particularly important for research into rare diseases. ‘Often, [patients with rare diseases] are just so desperate for really hard information’, she said, ‘and if it's a condition that's being looked into as we speak, you want that really up-to-date information’.

David goes one step further. He thinks that plain language summaries are important for any areas of research in which people are asked to make up their own minds or make choices about their behavior. This includes healthcare but also environmental and social policy issues. He said, ‘We have a better chance of having a well-informed public making critical decisions if they've got access to [plain language summaries]’.

Conclusions

Although the small number of interviewees who contributed to this article are already well informed on the topic and provide only a UK-specific perspective, their insights raise important points to consider as advocates of plain language summaries continue to increase awareness and improve their uptake, quality and discoverability. Gathering more diverse perspectives from the global community and from additional stakeholder groups will help strengthen the case for plain language summaries.

Whether it’s a researcher who wants to perform literature reviews faster or a patient who wants to make informed choices about their health, plain language summaries offer many people an accessible shortcut into the academic literature. With research articles becoming harder to understand^2,3, and the volume of research articles growing exponentially¹¹, it’s plain that we need plain language summaries now more than ever.

We would like to thank all our interviewees for their participation in this article. Some quotations have been edited for clarity and concision.

Transparency

Declaration of funding

This work was supported by Open Pharma. Open Pharma is a multi-sponsor collaboration facilitated by Oxford PharmaGenesis Ltd and receives sponsorship funding from Alexion Pharmaceuticals, Inc., AstraZeneca Pharmaceuticals LP, Boehringer Ingelheim International GmbH, F. Hoffmann-La Roche AG, Galápagos NV, Gilead Sciences, Inc., GlaxoSmithKline Biologicals SA, Ipsen Biopharm Ltd, Janssen Global Services LLC, John Wiley & Sons Ltd, Novartis Pharma AG, Novo Nordisk A/S, Pfizer, Inc., Takeda Development Center Americas, Inc. and UCB Biopharma SRL.

Declaration of financial/other relationships

CE and AR are employees of Oxford PharmaGenesis Ltd. A reviewer on this manuscript has disclosed that they are an employee of McCann Health Medical Communications, which is a medical communications group that provides professional medical writing and editing services, mostly for pharmaceutical clients. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Author contributions

CE and AR designed and conducted the interviews, and wrote the article.

Acknowledgements

The authors thank Emma Georgiou, Louise Hailey, James Piercy, David Schley and Judi Smith for participating in the interviews and consenting to the inclusion of their perspectives in this article. Joana Osório provided comments on a version of this article and editorial support was provided by Velissaria Vanna, both of Oxford PharmaGenesis Ltd.