Work

Barriers and enablers for publishing results of randomized trials: a cross-sectional survey of principal investigators in sub-Saharan Africa

Year: 2026

Type: article

Abstract: OBJECTIVES: To investigate the views and experiences of principal investigators (PIs) based in sub-Saharan Africa (SSA) regarding publication bias of randomised controlled trials (RCTs) and strategies to mitigate it. DESIGN: Cross-sectional online survey, informed by previous reviews and prior surveys on publication bias. The survey consisted of closed-ended items with Likert scales and optional free text. SETTING: We emailed invitations to African-based PIs that we identified through the World Health Organization International Clinical Trials Registry Platform. PARTICIPANTS: 6056 invitations were sent, 610 opened the survey, 433 were eligible to partake, and 409 consented and proceeded with the survey. MAIN OUTCOME MEASURED: Awareness and perceived magnitude of publication bias in SSA, experiences of timely publication, non-publication, delayed publication and their perceived effectiveness of mitigating strategies. RESULTS: Awareness that all RCTs are to be published was 62.7% (227/362). More than 90% agreed that PIs are responsible for ensuring that their RCTs are published (295/323), and 84% (272/323) within 24 months of completion. Publication bias in SSA scored a median of 71/100 (IQR: 50 - 84) for geographical region and 66 (IQR = 40 -79) for the respondent's specific field of research. Of the respondents, 63.1% (219/347) published the findings of at least one RCT within 24 months, and 23.6% (82/347) were unable to publish at least one complete RCT. Notably, 74% (246/332) indicated not having had prior training in writing RCT-specific manuscripts. Of the 82 that were unable to publish, their reported reasons for non-publication included 30.5% (25/82) journal rejection, 29.3% (24/82) time constraints, 14.6% (12/82) non-significant or 13.4% (11/82) non-positive results, 13.4% (11/82) methodological concerns and 12.2% (10/82) lack of confidence in writing. 41.2% (143/347) of respondents reported delays greater than 24 months, 47.9% (69/347) attributed time constraint, 38.9% (56/347) time-consuming analysis, and 36.8% (53/347) journal rejection. Of the 332 participants that answered questions on mitigating strategies, the following were suggested to be very effective: 56.6%(188/332) dedicated writing time, 37.1% (123/332) guidance on writing a manuscript and 35.8% (119/332) peer-review prior to submission. Furthermore, 52.7% (175/332) rated the CONSORT checklist as effective/very effective, and 37.4% (124/332) noted artificial intelligence tools somewhat effective. CONCLUSIONS: SSA PIs note that publication bias is a problem, which is a result of barriers such as time constraints, analysis difficulties, journal rejection, and limited writing support. Enablers include mentorship, dedicated writing time, and structured reporting tools.

Source: Research Integrity and Peer Review

DOI: 10.1186/s41073-026-00207-0

Authors: Ameer Hohlfeld, Tamara Kredo, Michael Clarke

Institutions: South African Medical Research Council, Stellenbosch University, Queen's University Belfast

Language: English

Topic: Academic Publishing and Open Access

Subfield: Information Systems and Management

Field: Decision Sciences

Domain: Social Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,490