The purpose of this article is to assist these practitioners to prepare a manuscript for publication. It provides general guidelines, shortcuts and tricks of the trade. After reading it, health professionals who have not previously published should be more confident in attempting to write for publication.

Why write for publication?
Why would anyone want to endure the stress of writing for publication? As Margaret Smith stated in her keynote address at the 15th AAOT Conference in Sydney in 1988, "Writing is a dreadful labour". But, she continued to say that it is important because it is "the means by which others judge the profession". [1]

Participants in our workshops on Writing for Publication have identified a number of reasons for publishing. Writing helps to consolidate thoughts and ideas. It provides an 'end point' to a project or program. Publishing helps to communicate knowledge and builds a theoretical base for the profession. It also enhances personal and professional esteem, furthers career prospects and can even earn money. The question then is: why aren't more practitioners submitting articles for publication?

The basic fact is that most community-based practitioners do not feel confident in their ability to write for scientific journals. The reason for this may be that they have not been trained to be researchers or writers. By analysing the steps involved in writing and the experience gained in helping others prepare manuscripts, we have formulated some basic guidelines that will help a practitioner to develop a manuscript for publication.

Guidelines

1. Read
The single most important thing you can do in preparing to submit a manuscript for publication is to read professional journals for content and style. Analyse them carefully to determine which subjects are currently of interest and which research topics are generating discussion. Be aware of the writing style, the technical language, and the level of detail. Pay careful attention to the introduction section in each article where the authors review the literature, and remember the names of contributors and their fields of interest.

Professional journals help create a network for everyone in the field, what Rogers has called 'the invisible college'. [2]

You should read regularly several journals in your own field and at least two from related fields. Usually you will receive journals associated with your professional membership and you should make arrangements with a library (or with other professionals) to receive the contents page from relevant publications. Read these contents pages and select for photocopying any article relevant to your line of study. This serves three purposes: 1) you can keep the article with you and read it in your spare moments e.g. while waiting for an appointment; 2) you will feel free to mark it; 3) you can keep it in a special file for papers on a specific topic. The last two points will greatly facilitate the process of writing an article.

Mark articles with a pen while reading. Using a fluorescent marker to highlight every important point in an article is not recommended as it can slow down reading rate, but it is helpful to tick, circle or underline a word or important phrase while you read. As you become familiar with concepts and technical language your reading speed will increase.

It is useful to set aside a two to three hour period at least once a week to read the current literature. Some people are able to do this at work; others have to set aside an evening or Sunday afternoon. When you have finished reading an article there is one more important thing to do: create a bibliography card for it.

Index cards (3x5 inches) are perfect for this purpose. Decide on the reference style you will use most often and do your cards in that format. The Australian Journal of Public Health, the Health Promotion Journal of Australia and the Medical Journal of Australia use the Vancouver System. [3] In this system, references are numbered consecutively in the text and then listed at the end of the article. If you are following the Vancouver System your cards should look like this:

Author's last name and initial, (up to three authors, then use et al.) Title of article. Journal year; vol. (issue):page numbers.

For examples see references this issue.

You may like to put a few notes about the article on the back of your bibliography card and you may find it helpful to colour-code different subjects or aspects of your professional reading. File the cards in alphabetical order by author in a file box. Over the next few years this will provide a record of your reading and the foundation for all your writing.

When you have organised your reading program you are ready to start thinking about your written contribution.

2. Design a study.
While reading the journals you will frequently come across an article or study that interests you. These articles may give you ideas for an intervention, an evaluation or a research study. Keep a notebook handy to sketch out your ideas. Once you determine whether your contribution will be a description of a program or technique you are using, an evaluation of an intervention, or a pure research investigation, you will need to design your study. It is not the purpose of this article to describe appropriate research or evaluation designs. There are a number of excellent books on the subject.

Do not be discouraged by accounts of expensive, long-term, controlled experiments conducted at universities. Health journals are also interested in practical applications of theories in field settings. Single case studies with pre- and post-intervention measurements can be very useful. Descriptive studies and position papers are also published regularly. A good example of a descriptive study is the article on 'Palliative care: views of patients and their families' published in the British Medical Journal. It is also possible to take data from a larger survey and reinterpret part of it. A good example of this is an article by Chetwynd on the attitudes of New Zealanders to health care policy. [8]

It is important to think through your study: decide which questions you will address; how you will analyse the data, and how you will present the results. Keep careful records of your intervention and report exactly what you did.

3. Use a standard format for writing the article
Once you have completed your intervention, your study or your evaluation, you are ready to sit down and write. Or are you? The problem is: Where to begin? Who to write for? How long the article should be and what form it should take?

Start by selecting an audience and a title. Deciding on the audience helps to define the language and style of the article; the title limits the topic and creates a framework for discussing your study. This technique will help you decide what to leave in and what to omit.

After choosing a title, brainstorm what you want to cover in the paper or presentation. You can do this by writing the following section titles on a blank page and putting all your ideas on the page. Next choose the key points for each section and prioritise them.

Introduction [Review of the Literature]
Methods
Results
Discussion
Conclusions/Recommendations

The Introduction gives the reader some background to the problem or issue being investigated. The Introduction usually contains a review of the literature relevant to the issue being discussed. This is an important part of the article because it allows you to acknowledge the work already done in the field, to combine or reinterpret previous research and to initiate discussion of important issues.

In the Methods you will describe the number and nature of the subjects, the methods and instruments used, when the measurements were taken and the procedures followed. Good examples of method sections are contained in a paper on the evaluation of a dry-chemistry analyser and in a survey of recent graduate dietitians. (9, 10)

The Results section should be short and to the point. Do not discuss the results or interpret the data in this section; save that for the Discussion. In the Results section you may use tables or graphs to illustrate the data. Explain the data in plain language and avoid repetition of information that appears in tables and graphs. The Results section is often the shortest part of the paper. A good model for the Results section is a paper by Lefebvre et al. (11)

After describing the results, Discuss issues raised by the data. This will be the most interesting and creative part of the hole process. This section provides an opportunity for discussion of any confounding variables, bias, or problems encountered in the study that might qualify the results or their implications.

The discussion of results will lead directly to your conclusions or recommendations. Although there has been a reluctance on the part of many scientists to make recommendations from data, it is important for health professionals to end their articles with specific recommendations for action rather than just a call for more research. Journals such as The Journal of the American Dietetic Association and the American Journal of Health Promotion now require authors to end their articles with suggestions for applying the results in practice.

4. Write
The first step is to set aside at least two or three hours of uninterrupted work. It seems to take most people 15-30 minutes to really warm up, to get the words flowing and to develop a theme. It takes several hours to really make progress on an article. If you allocate too little time for a session you will probably need to start from the beginning the next time. If you are serious about writing for publication you will need to set aside at least one evening a week and probably one afternoon (or evening) on the weekend. Most community-based health professionals are paid to implement programs, not write papers, so much of your writing will have to be done in your own time.

Adhere to your outline and don't wander off the topic. Get the first draft done and then, if necessary, make revisions to your outline. Don't try to say everything; confine yourself to what is relevant to your audience.

If you have copies of relevant articles you can refer to them, reread them, and cross-reference data. As you write refer to the articles for examples of style, language and vocabulary. You may also need a work-place where material can be left for a few weeks while working on early drafts of your article Arrange to write in a place where there are few distractions.

It is essential to type your first draft or have the draft typed. If possible, use a word processor. The real benefit of word processing is that text can be changed, words or sentences can be added or deleted, and paragraphs moved without having to retype the whole page. You do not have to be a good typist to take advantage of a word processor. You will so-on find you can type faster than you can write longhand and when the paper is completed you can go back and correct misspellings and typographical errors. Most word processing packages have a spell-check facility.

When you have finished your first draft, leave the paper for a few days before revising it. Once you have completed two or three drafts and you think you have a good, readable story, get someone else to read it.

Those who review your paper should be people you trust and who know something about the topic. It may be difficult to accept criticism of your work but it is vital to listen to suggestions. Most scientific papers require several drafts and at least three major revisions. On the other hand, you cannot revise indefinitely; there comes a Lime when you must stop writing and submit the article for review. When you feel that your paper is almost ready to send to a journal ask someone who does not know about your area of study to read it. This person should be able to understand what you are trying to communicate and find it interesting reading. These final comments will help polish the paper.

The best tools for improving your writing style and grammar are a dictionary, a thesaurus, and Strunk and White's The Elements of Style. "Aim for brevity in your writing. Omit needless words ... Vigorous writing is concise. A sentence should contain no unnecessary words, a paragraph no unnecessary sentences.[12]

5. Footnotes/References
Footnotes are usually not appropriate for articles in scientific journals. You should be able to explain everything that is necessary in the body of the text. However, ideas, facts or quotations taken from someone else's work must be referenced. Some authors write a paper and then go back and add references; some find it easier to make a list of the references as they write.

Type the author's name and the date of publication in the text. Do not attempt to replace author's names with reference numbers until you have completed all revisions and you are nearly ready to submit the article. At this point take out all the relevant bibliography cards from your file and place them in order. References should then be typed on a separate page in exactly the style used by the journal to which you are submitting your article.

6. Abstract/Summary
The abstract or summary is important as it may be all that most people ever read of your paper. The abstract should provide a concise description of your study. Writing a good abstract can be difficult and it may be useful to examine a few published abstracts to find a suitable model. A good example is the abstract for an article written by Wilson et al. [13]

An abstract should contain between 200 and 300 words and the following features:

• the first sentence states the purpose of the study;
• the methods are briefly described;
• key results are presented;
• main conclusions are given and
• recommendations are outlined.

7. Send it in
When you are satisfied with the content and presentation of your paper, re-check the journal's guidelines for submitting manuscripts. Be sure to include a separate title page letter and a covering letter to the editor. It is useful to write a short paragraph explaining the importance of your paper and the implications of your study. This will help the editor decide who should be asked to review your paper. The Medical Journal of Australia has published a paper on the 'Uniform requirements for manuscripts submitted to biomedical journals' and Day's book, 'How to write and publish a scientific paper', may also be helpful. [14, 15]

It usually takes 8 to 12 weeks for a paper to be reviewed. If you have not received a reply after three months, contact the journal editor and ask about the status of your paper. Remember that most reviewers volunteer for this job and they may have other papers to read in addition to their normal workload. When a paper comes back to you, your peers will have decided that:

• it is accepted as is (very rare);
• it is accepted with minor revisions (about 20%);
• it needs some major revisions (about 50%);
• it is rejected (30%).

It usually takes at least six months for an article to be reviewed, revised and accepted and at least another six months before it appears in print There is usually no way the process can be rushed and the editor will not appreciate too many telephone enquiries.

Conclusion
The purpose of this article is to stimulate your interest in sharing your work with others through publishing in health-related journals. If you have something interesting to say and are prepared to have others help you revise the drafts, you should be well on your way to a successful experience with writing for publication.

Good luck with your writing. We hope you find it enjoyable and satisfying.

Acknowledgements
This paper is based on a workshop on Writing for Publication that has been developed by one of the authors. An earlier version of this paper appeared in the Australian Occupational Therapy Journal. [16]

Ray James MA MPH EdD
Senior Research Fellow
National Centre for Research into the Prevention of Drug Abuse

Betty Durston BAppSc DipEd PostGradEngl (Joumalism)
Coordinator Information and Publications Section
Health Promotion Services Branch, Health Department of WA

References

1. Smith M. Why research? Tales of the unexpected. Aust Occup Therapy J 1989;36:4-13.
2. Rogers EM. Diffusion of innovations. New York: Free Press, 1983.
3. Style Manual (4th Edition). Canberra: Australian Government Publishing Service, 1988. Reprinted with corrections, 1990.
4. Campbell DT, Stanley J. Experimental and quasi-experimental designs for research on teachings. In: Gage NL, ed Handbook of Research on Teaching. Chicago: Rand McNally & Co, 1963.
5. Shortell SM, Richardson W. Evaluation designs. In: Health Program Evaluation. St Louis: CV Mosby Co, 1978.
6. Patton MQ. Qualitative evaluation methods. Beverly Hills: Sage Publications, 1980.
7. Yates DW, Ellison G, McGuiness S. Care of the suddenly bereaved. Br MedJ 1991;301:29-31.
8. Chetwynd SJ. New Zealanders' attitudes to health care policy. Community Health Stud 1989;13(2):186-190.
9. James R, Tyler C, Henrikson D. An evaluation of the accuracy of the Reflotron System in the field. Med J Aust 1988;149:130-131.
10. Scott J. A survey of recent graduate dietitians: career choices, plans and aspirations and satisfaction with academic preparation. Aust J Nutr Diet 1991;48(4):132-137.
11. Lefebre RC, Harden EA, Rakowski W, et al. Characteristics of participants in community health promotion programs: four year results. Am J Public Health 1987;77(9):1342-1344.
12. Strunk W, White EB. The elements of style. New York: Macmillan Publishing Co, 1972.
13. Wilson D, Wakefield MA, Steven ID, et al. "Sick of Smoking": evaluation of a targeted minimal smoking cessation intervention in general practice. Med J Aust 1990;152.-518-521.
14. International Committee of Medical Journal Editors. Uniform requirements for manuscripts submitted to biomedical journals. Med J Aust 1988;148:189-194.
15. Day RA. How to write and publish a scientific paper. Cambridge: University Press, 1990.
16. James R. Writing for Publication. Aust Occup Therapy J 1990,-37.-57-60.