Our study provided a comprehensive overview of how many and to what extent Chinese medical journals adopt reporting guidelines. Taking CONSORT as an example, our previous study had shown that the number of Chinese medical journals which endorsed CONSORT consisted of less than 0.6% (7/1221) in 2012 [16]. In this study, we found that the endorsement proportion of CONSORT was 24.1% (250/1039). This is a substantial increase in endorsement. However, there is still much work that needs to be done to enhance the uptake of CONSORT and other reporting guidelines in Chinese medical journals.
The first reporting guideline CONSORT statement, which also founded the development path of reporting guidelines [14]. According to CONSORT group statistics, there are currently 585 journals and over 50% of the core medical journals listed in the Abridged Index Medicus on PubMed that endorse CONSORT [29]. The CONSORT statement was first introduced to China in 2001 [30], followed by SPIRIT, PRISMA, and other reporting guidelines. After the introduction, many studies found that the positive function of reporting guidelines in improving the reporting quality of Chinese clinical research [31–36]. Meanwhile, Chinese medical journals began to endorse CONSORT and other reporting guidelines. However, according to our study results, there existed a big gap between Chinese medical journals and core medical journals in the world.
As for clinical contents of Chinese medical journals, “medical and health integration”, which is like comprehensive medical journals accounted for the largest type, followed by TCM journals. The big proportion of TCM journals reflect the feature for the medical subject in China. Therefore, the quality and transparency of TCM research can represent an important part of the level of Chinese clinical research. Since 2001, the reporting guidelines system of TCM has gradually been established [37]. The existing TCM reporting guidelines have included major study designs and main TCM interventions [39]. Although the results of this study do not show that journal endorsement in TCM is better than other fields, given the efforts of Chinese scholars in TCM reporting guidelines and the finding that other studies have shown that TCM reporting guidelines do improve the quality of reporting of TCM research [40, 41], it is foreseeable that both the endorsement of reporting guidelines and the quality of TCM research in TCM will improve if the implementation of reporting guidelines continues to be promoted in the future.
Based on the results of regression analysis, whether the inclusion of SCI/SCIE and whether the publication language includes English are associated with the reporting guideline endorsement. On 23, June 2021, an opinion document jointly released by the Central Propaganda Department of the Communist Party of China, Ministry of Education, and Ministry of Science and Technology of China proposed to strengthen the bilingual construction of Chinese journals in English and Chinese and improve the academic evaluation system of journals [42]. Combined with our findings, promoting the journals to be published in English and indexed by an international evaluation system like SCI can contribute to the endorsement of reporting guidelines in Chinese medical journals. We believe that those journals only published in Chinese should also endorse reporting guidelines to meet the same standards.
During the past ten years, the efforts of Chinese scholars in promoting the reporting guidelines, especially in the introduction and translation of reporting guidelines, the establishment of the system for TCM reporting guidelines, and the leading role of the ministries of China in promoting the internationalization of journals should be admitted. However, there is a long way to go to be optimal. This current gap is likely to make it difficult to accurately assess the quality of clinical research in China and to track the raw data. It will also damage the credibility of Chinese clinical research in the international community. Knowing but not doing it will lead to research waste [43–45]. Some studies suggest that one of the barriers to the implementation of reporting guidelines in Chinese medical journals is the low level of awareness of reporting guidelines among stakeholders such as journal editors [46, 47]. To enhance the use of reporting guidelines in China, we proposed the following initiatives.
First, as the final guarantee to medical research publication, journals should take action to safeguard the reporting quality of medical research, for example, adopting the reporting guidelines as “active strong” [48]. Second, the authors, reviewers, editors, and other stakeholders must work together to ensure that research is reported in line with the relevant reporting guidelines. Third, the 1039 Chinese journal editors should be surveyed to find out their needs regarding implementing reporting guidelines and other issues, including implementing open science practices. Based on their need, the corresponding training courses could be provided. Forth, establishing bases of international reporting guidelines network in China. In January 2021, the Chinese EQUATOR centre launched [49]. The Chinese EQUATOR centre will implement the EQUATOR Network's vision and mission, thus promoting the reporting guidelines in China. Fifth, from the national level, the journals included by CPA should require the use of reporting guidelines as the Chinese Medical Association (CMA). Our previous study indicated that 69 journals of the CMA used a unified submission system, all of which recommended the use of reporting guidelines [50]. Sixth, we recommend that promoting the Chinese medical journals into the world journal evaluation system, publishing in English, and endorsing the reporting guidelines could be carried out simultaneously.
Our study has limitations. First, we only searched online databases without manual search, thus may omit some medical journals published in print only. Second, there is a certain degree of information delay as the collection of journal information is a one-off and the content of journal websites is updated in real-time.
In conclusion, the endorsement of reporting guidelines in Chinese medical journals has improved compared to 2012 but remains far from optimal. If the Chinese scientific community wants to improve and safeguard the quality and transparency of medical research, effective implementation strategies must be taken to promote the use of reporting guidelines in China.