The message is not clear
One criticism I often see from reviewers is the manuscript does not clearly articulate its contribution to advancing knowledge. A simple statement of purpose is often not enough to convey that contribution to the reader. The manuscript should provide the reader with information about 1) context; i.e. what is the general issue and what is already known about the topic that is being examined, 2) the knowledge gap; i.e. what is not known about the topic, and 3) how the proposed study relates to that knowledge gap. Such information is best presented in the introduction. I have read introductions to manuscripts that list a series of facts on a topic, but do not relate that information to the knowledge gap or the purpose of the study. Listing “everything you know” about a topic can be a distraction for the reader – one should only provide information that is needed to understand why the study was developed and executed or to follow the argument presented. Linking the findings of the study back to that knowledge gap and relating those findings to what is already known is also helpful in articulating the contribution of the work to advancing knowledge. Reviewers of healthcare research journals have come to expect the first paragraph of the discussion section will present a review of the major findings of the study. It is also common practice that subsequent paragraphs will be used to contextualize the findings within the previous literature. I will address what counts as a contribution in a later section.
How the material within the manuscript is organized also impacts how it will be received by the reviewer (which again, impacts the probability of success). There is little chance the manuscript will be published if the reviewers and editor cannot follow the argument. I have too often received manuscripts that (as discussed in the previous paragraph) have no clear statement of purpose, offer substantial (and often distracting) editorial content in the introduction, present some of the methods in the results section, present information that is pertinent to the analysis or important findings in the discussion section (or fail to present that at all, as I will discuss in the next section), etc. Conventional approaches to the organization of reporting empirical research findings have primed experienced scientific audiences to expect specific kinds of information in specific sections. Such conventions also help orient the reader who may not have deep familiarity with some aspects of the research. Misplaced information can confuse the reviewer and may lead to a misinterpretation of the intended message. Anyone who has a large volume of publications has experienced receiving a review from someone who appears to completely miss the point of the manuscript. Often that is a problem with how the information was presented and the message communicated and not with some characteristic of the reviewer.
Clear communication of the message is often blurred by poor use of language and grammar. When submitting a manuscript, the author is confident that the writing is sufficient to communicate to the reader the intended message. If not, why would the author be under any impression that it is appropriate for publication?3 Proofreading one’s own work to ensure the message is being conveyed in a clear manner cannot be relied upon because the author is already familiar with what the manuscript is about, as are the co-authors. In some cases, the message is lost simply because the prose is poor. It may be that the paper is full of jargon, several acronyms that are not intuitive, or terms that are vague in meaning or are unfamiliar to the reader. In his essay “How I write”, Bertrand Russell offers some simple advice, acquired through his brother-in-law, on how to communicate effectively in academic contexts. His maxims are: 1) “never use a long word if a short word will do”, 2) “if you want to make a statement with a great many qualifications, put some of the qualifications in separate sentences”, and 3) “do not let the beginning of your sentence lead the reader to an expectation which is contradicted by the end” [1; p.65]. In many cases, the use of complex terms and nuanced language cannot be avoided. However, the use of complicated language as an affectation (i.e. using difficult language so as to give the impression that you know what you are talking about) is unhelpful in getting a point across to the editor and reviewers – making the reader work hard to understand what the manuscript was written to communicate is counterproductive.