Editorial policies on local authorship in rural health

Introduction: Community engagement in health research potentially benefits researchers, institutions and local people. Objective: This work reviews health journal policies looking for local authorship instructions, and clear specific recommendations on ethic issues for rural, remote or communities from low and middle income countries research publications. Methods: A research at National Library of Medicine, CAPES and Embase identified 37 journals related to rural health. A review of all instructions to authors were conducted independently by two authors, looking for any mention of local co-authorship or how to relate to local communities in the publication guidelines of the included journals. Results: Eleven [n=11] journals fit the inclusion criteria and just one [n=1] had any instruction or ethic concern about local authorship on the author’s instructions. Most journals are from high income countries. Although the care in rural areas are more concentrated in Primary Care the journals were varied in its scope. Only four journals include in its description and scope primary care, general practice or family medicine. Conclusions: Authorship and publication policies should include specific and clear ethical recommendations related to community engagement in all major scientific communication vehicles. This should stimulate local participation through clear guidance to authors as a way of promoting a more inclusive, active and horizontal relationship between researchers and communities. Abstract


INTRODUCTION
Research in rural areas creates meaningful connections between researchers, institutions and local people. It generates good opportunities for local communities, smaller research centers and universities to learn and improve skills in contact to more experienced centers. It is also a great chance to those who are far and in another cultural context to learn and to get other insights related to this and future projects.
Unfortunately, these partnerships are not as commonplace in the scientific world as they could be. In the literature, there are many studies of researchers from large centers without the concern of local involvement of the communities studied. In fact, most publications carried out in the least developed countries do not have co-authorship of local research institutes. 1 There is an unjustifiable underrepresentation of co-authorship from low and middle income countries (LMIC) in research. 1,2 Although international collaboration in research co-authorship is common, the number of partnerships decline according to the income level of the study country, even if the research is actually conducted in the LMIC. 3 It is not today that we hear expressions like "Publish or Perish" in the academic world 2 and the amount of scientific output is often spurred on to the detriment of quality. One of the consequences of this pressure for scientific production can be seen in rural, remote and LMIC communities, which suffer from the so-called "research fatigue". 4 This occurs for many reasons and in many ways but basically consists in the excess of local research (in length or repetitions), not always making clear to all participants about its means and objectives and not prioritizing locally applicable actions derived from outcomes or appropriate feedback.
In one study, using the terms health, rural and Brazil in January 2017, 1,611 publications were initially found in the Scientific Electronic Library Online (SciELO). 5 After excluding no health related articles were identified 444 studies that assess the health of populations living in rural contexts or that analyze health policies directed at these scenarios. 5 The recent and avid interest in rural research in the country, could be a sign of a paradigm shift and understanding of the specificity of rural health and the fruitful place for research.
Scientific journals can induce more ethically concerned practices through clear instructions to authors and a careful selection of what will be published. This work is a review of health periodic policies, looking for specific recommendations on ethic issues for rural, remote or underdeveloped communities. Introducción: La participación de la comunidad en la investigación en salud potencialmente beneficia a investigadores, instituciones y personas locales. Objetivo: Este documento analiza las políticas de las revistas de salud en busca de instrucciones de autores locales y recomendaciones claras y específicas sobre cuestiones éticas para la investigación en comunidades en áreas rurales o remotas de países de ingresos bajos y medianos. Método: Una encuesta en la Biblioteca Nacional de Medicina, CAPES y Embase identificó 37 revistas relacionadas con la salud rural. Dos autores realizaron una revisión de todas las instrucciones para los autores de forma independiente, buscando cualquier mención de coautoría local o cómo relacionarse con las comunidades locales en las pautas de publicación de las revistas incluidas. Resultados: Once [n = 11] revistas cumplieron con los criterios de inclusión y solo una [n = 1] tuvo alguna instrucción o preocupación ética con la autoría local en las Instrucciones para los autores. La mayoría de las revistas son de países de altos ingresos. Si bien la atención médica en las zonas rurales está más concentrada en la atención primaria, el alcance de las revistas fue variado. Solo cuatro revistas incluyen atención primaria, medicina general o medicina familiar en su descripción y alcance. Conclusiones: Las políticas de autoría y publicación deberían incluir recomendaciones éticas específicas y claras relacionadas con la participación de la comunidad en todos los principales vehículos de comunicación científica. Esto debe alentar la participación local a través de directrices claras para los autores, como una forma de promover una relación más inclusiva, activa y horizontal entre investigadores y comunidades.

METHODS
A search was conducted from December 2017 to January 2018 using "rural" in the National Library of Medicine and using search fields filters for titles for "Journals referenced in the NCBI DBs", in the CAPES periodic research gate and on EMBASE Journal List. The criterion to determine whether the journal was health-related was the existence of the terms "health", "healthcare", "medical" or "disease" in their scope.
A check was made regarding the activity of the journals through the links available from the PubMed record and through Google search tools. The authors repeated the research in April 2020 to update the results that remain equal to what was conducted in December 2017 to January 2018.
The inclusion criteria were: to be a scientific publication related to the health area and to be an active publication today. The activity criteria used was to have an active website at the moment of the search. Any periodic scientific publication presented in the databases above, was considered valid for the purpose of this research. The exclusion criteria: to be a newsletter or a government publication, to not have instructions for authors and not meeting the inclusion criteria.
A review of all instructions to authors were conducted by the two researchers independently, looking for any mention of local co-authorship or how to relate to local communities in the publication guidelines of the included journals. In case of divergence, there would be discussion between reviewers and a third evaluator could be invited. The data obtained from one or more journals would be cited and analyzed in the results and discussion of this work.

RESULTS
After the first appraisal, 37 of the initial 43 journals were selected because they were health related,  A complete list of included journals links to their instructions to authors and the respective countries can be seen in Table 1.

DISCUSSION
It is interesting to note that from the eleven countries where the journals are based just one is a LMIC.
Although the care in rural areas are more concentrated in Primary Care the journals were varied in its scope, the journals that include in its description and scope primary care, general practice or family medicine are  focused in neurosciences and not in primary care nor family medicine or general practice. This could also be related to the lack of research in continents out of high incomes countries and the lack of local authorship.

From the eleven [n=11] rural health journals that fit on the criteria just one [n=1] had any instruction
or ethic concern about local authorship on the author's instructions. "Rural and Remote Health" states that: "For studies conducted in the developing world and for research into the Indigenous population of any country, there must be at least one local/Indigenous author. "Rural and Remote Health" aims to promote cross-cultural respect -and research should promote health by empowerment. In an era when Indigenous communities in many countries are using the phrase 'research fatigue', the presence of an author from the community of study hopefully indicates appropriate consultation, and culturally sensitive research that is at the least guided by the priorities of the community studied. No matter how enculturated the external researcher might be, subtle cultural barriers can impede the interpretation of data. The voice of the local community is clearest to those within that community, and an outsider's view is always that. Better results could be obtained if the relations between peripheral and central research centers would be stimulated to work together as we can see in many cases. 7,8 The methodology used in this review has limited the search for medical journals found in the main Western databases and is limited to some languages, although relevant. In addition, although they are not explicitly included in the instructions to authors, it is possible for some editorial bodies of the journals studied to carry out some type of informal filter and ethical control regarding research in rural communities.
In order to stimulate the knowledge and investigative capacity of professionals and the health service, it is suggested to use participatory approaches with the rural population and not for it. 5,9 To involve authors and local communities in its educational processes developed collectively and whose principles are the construction of new knowledge, the taking of joint decisions, awareness of the reality experienced, knowledge of the real and solid possibilities of finding solutions to common problems, the identification of priorities that will be objects of work and motivation for action. 9 All of these are part of bringing the co-authorship to the editorial policies.

CONCLUSIONS
Although half the world's population lives in rural areas, 10 scientific production related to rural communities' health is markedly limited. When rural health research is done, special ethical concerns should exist in order to prevent dissociation between local and distant interests. Rural research is a great opportunity for all involved to learn and to share their specific skills and points of view, enriching the research process, results and satisfaction.
Editorial policies have a potential role inducing good practices. Specific authorship and publication policies should include ethical recommendations related to community or local engagement in all major scientific vehicles, especially those that publish research in rural and remote areas avoiding the "neocolonial science" in research. 1 This should stimulate local participation through clear guidance to authors as a way of promoting a more inclusive, active and horizontal relationship between researchers and between researchers and communities. All involved in this process have potential benefits in establishing less asymmetric relations and exchanging experience and information.