The Absence of Evidence is Evidence of Non-Sense: Cross-Sectional Study on the Quality of Psoriasis-Related Videos on YouTube and Their Reception by Health Seekers

Psoriasis knowledge gaps and misconceptions in the Middle East and North Africa (MENA) regions: patients' survey-based study

BACKGROUND

Misconceptions among psoriatic patients often lead to a negative impact on disease outcomes.

OBJECTIVES

Our main target was knowledge assessment among a sample of psoriatic patients in the Middle East and North Africa (MENA) region where data are scarce.

METHODS

The present study is a cross-sectional descriptive survey. It consists of an online questionnaire comprising 19 questions designed to assess psoriasis knowledge and five demographic questions. The questionnaire link was posted on the official Facebook page of the Kasr Al Ainy Psoriasis Unit (KAPU).

RESULTS

The questionnaire was taken by 527 participants, but only 396 responses were complete and adequate for analysis. The mean psoriasis knowledge score was higher in females (P = 0.005) and participants with advanced education degrees (P < 0.001). Patients reporting regular follow-ups with dermatologists were more likely to acknowledge joint involvement (P = 0.044) but also incorrectly assume biologics are a final cure (P = 0.038). In addition, they were more likely to assume psoriasis affects pregnancy (P = 0.013). Patients with a family history of psoriasis showed a better mean knowledge score than those without (P = 0.01). Only 54.55% of participants reported knowledge of possible disease exacerbation by drugs. A minority (26.77%) of our patients responded that a diet change could not permanently cure psoriasis.

CONCLUSION

This study reports knowledge gaps in a cohort of Arabic-speaking psoriasis patients, especially regarding areas of extracutaneous involvement, the hereditary nature of the disease, and the effect of psoriasis on pregnancy and fertility. Most participants were unaware that biological therapy and a change in diet do not offer a permanent cure. Dermatologists in our region must reach out to their patients and correct the various misconceptions reported in this study.

YouTube™ as a source of parents' information for craniosynostosis

OBJECTIVE

This study aimed to evaluate the content, reliability and quality levels of YouTube™ videos regarding craniosynostosis for parents' information.

METHODS

A keyword search for 'craniosynostosis' was conducted on YouTube, and the uniform resource locators of the first 160 videos were initially recorded and evaluated. Ninety-four videos that met the inclusion criteria were analysed. Each video received a score ranging from 0 to 9 points, classifying them as low-content (0-3), moderate-content (4-6) and high-content (7-9). The reliability scores adapted from DISCERN and Global Quality Scale (GQS) scores were recorded.

RESULTS

The median content score for the videos was 4. According to the content scores, 34% of included videos (n = 32) were classified as low-content, 60.6% (n = 57) as moderate-content, and 5.3% (n = 5) as high-content. The median reliability score for the videos was 3, and the median GQS score was 3. The reliability and quality levels of videos classified as high-content and moderate-content were significantly superior to low-content videos (P < .05). Laypersons were identified as the most frequent source of information in the videos. However, most of the videos lacked information about syndromic/non-syndromic forms and specific complications. The importance of early referral/timing of surgery and minimally invasive surgical treatment techniques was mentioned in all high-content videos.

CONCLUSION

The results of the present study suggest that YouTube™ in its current format, is not a fully trustable source for parents seeking information on craniosynostosis. Craniofacial units must increase the content, quality and reliability level of videos on craniosynostosis.

Quality assessment of available Internet information on early orthodontic treatment

BACKGROUND

This study aimed to evaluate the content, reliability, quality and readability of information on Internet websites about early orthodontic treatment.

METHODS

The "early orthodontic treatment" search term was individually entered into four web search engines. The content quality and reliability were reviewed with DISCERN, Journal of American Medical Association (JAMA), and Health on the Net code (HONcode) tools using the contents of websites meeting predetermined criteria. The readability of websites was evaluated with Flesch Reading Facilitate Score (FRES) and Flesch-Kincaid Grade Level (FKGL).

RESULTS

Eighty-six websites were suitable for inclusion and scoring of the 200 websites. 80.2% of websites belonged to orthodontists, 15.1% to multidisciplinary dental clinics and 4.7% to professional organizations. The mean DISCERN score of all websites (parts 1 and 2) was 27.98/75, ranging between 19 and 67. Professional organization websites had the highest scores for DISCERN criteria. Moreover, 45.3% of websites were compatible with JAMA's disclosure criterion, 7% with the currency criterion, 5.8% with the authorship criterion and 5.8% with the attribution criterion. Only three websites met all JAMA criteria, and these websites belonged to professional organizations. None of the websites had the HONcode logo. Mean FRES and FKGL were 47.6 and 11.6, respectively.

CONCLUSIONS

The quality of web-based information about early orthodontic treatment is poor, and readability is insufficient. More accurate and higher quality Internet sources are required on the web.

The status quo of short videos as a source of health information regarding bowel preparation before colonoscopy

Background

For high-quality colonoscopies, adequate bowel preparation is a prerequisite, closely associated with the diagnostic accuracy and therapeutic safety of colonoscopy. Although popular-science short videos can help people quickly access health information, the overall quality of such short videos as a source of health information regarding bowel preparation before colonoscopy is unclear. Therefore, we intend to conduct a cross-sectional study to investigate the quality of bowel preparation information before colonoscopy through short videos taken on TikTok and Bilibili.

Methods

The Chinese phrases "colonoscopy" and "bowel preparation" were used as keywords to search for and screen the top 100 videos in the comprehensive rankings on TikTok and Bilibili. The Global Quality Score (GQS) and the modified DISCERN score were used to assess the quality of the information provided in these short videos.

Results

A total of 186 short videos were included in this study; 56.5% of them were posted by health professionals, whereas 43.5% of them were posted by nonhealth professionals. The overall quality of these videos was unsatisfactory, with a median DISCERN score of 3 (2-4) and a median GQS of 3 (3-4). The radar maps showed that videos posted by gastroenterologists had higher completeness scores regarding outcomes, management, and risk factors, while nongastroenterologists had higher completeness scores concerning adverse effects, symptoms, and definitions of bowel preparation. Additionally, the median DISCERN score and GQS of the videos posted by gastroenterologists were 3 (3-4) and 3 (3-4), respectively, whereas the quality of the videos posted by patients was the worst, with a median DISCERN score of 2 (1-2) and a median GQS of 2 (1.25-3).

Conclusion

In conclusion, the overall quality of health information-related videos on bowel preparation before colonoscopy posted on specified short video platforms was not satisfactory. Gastroenterologists provide more information on the outcomes, management, and risk factors for bowel preparation before colonoscopy, while nongastroenterologists focus on adverse effects, symptoms, and definitions of bowel preparation.

Developing a Comprehensive List of Criteria to Evaluate the Characteristics and Quality of eHealth Smartphone Apps: Systematic Review

BACKGROUND

The field of eHealth is growing rapidly and chaotically. Health care professionals need guidance on reviewing and assessing health-related smartphone apps to propose appropriate ones to their patients. However, to date, no framework or evaluation tool fulfills this purpose.

OBJECTIVE

Before developing a tool to help health care professionals assess and recommend apps to their patients, we aimed to create an overview of published criteria to describe and evaluate health apps.

METHODS

We conducted a systematic review to identify existing criteria for eHealth smartphone app evaluation. Relevant databases and trial registers were queried for articles. Articles were included that (1) described tools, guidelines, dimensions, or criteria to evaluate apps, (2) were available in full text, and (3) were written in English, French, German, Italian, Portuguese, or Spanish. We proposed a conceptual framework for app evaluation based on the dimensions reported in the selected articles. This was revised iteratively in discussion rounds with international stakeholders. The conceptual framework was used to synthesize the reported evaluation criteria. The list of criteria was discussed and refined by the research team.

RESULTS

Screening of 1258 articles yielded 128 (10.17%) that met the inclusion criteria. Of these 128 articles, 30 (23.4%) reported the use of self-developed criteria and described their development processes incompletely. Although 43 evaluation instruments were used only once, 6 were used in multiple studies. Most articles (83/128, 64.8%) did not report following theoretical guidelines; those that did noted 37 theoretical frameworks. On the basis of the selected articles, we proposed a conceptual framework to explore 6 app evaluation dimensions: context, stakeholder involvement, features and requirements, development processes, implementation, and evaluation. After standardizing the definitions, we identified 205 distinct criteria. Through consensus, the research team relabeled 12 of these and added 11 more-mainly related to ethical, legal, and social aspects-resulting in 216 evaluation criteria. No criteria had to be moved between dimensions.

CONCLUSIONS

This study provides a comprehensive overview of criteria currently used in clinical practice to describe and evaluate apps. This is necessary as no reviewed criteria sets were inclusive, and none included consistent definitions and terminology. Although the resulting overview is impractical for use in clinical practice in its current form, it confirms the need to craft it into a purpose-built, theory-driven tool. Therefore, in a subsequent step, based on our current criteria set, we plan to construct an app evaluation tool with 2 parts: a short section (including 1-3 questions/dimension) to quickly disqualify clearly unsuitable apps and a longer one to investigate more likely candidates in closer detail. We will use a Delphi consensus-building process and develop a user manual to prepare for this undertaking.

TRIAL REGISTRATION

PROSPERO International Prospective Register of Systematic Reviews CRD42021227064; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021227064.

The status quo of short videos as a health information source of Helicobacter pylori: a cross-sectional study

Background

Health education about Helicobacter pylori (H. pylori) is one of the most effective methods to prevent H. pylori infection and standardize H. pylori eradication treatment. Short videos enable people to absorb and remember information more easily and are an important source of health education. This study aimed to assess the information quality of H. pylori-related videos on Chinese short video-sharing platforms.

Methods

A total of 242 H. pylori-related videos from three Chinese short video-sharing platforms with the most users, TikTok, Bilibili, and Kwai, were retrieved. The Global Quality Score (GQS) and the modified DISCERN tool were used to assess the quality and content of videos, respectively. Additionally, comparative analyzes of videos based on different sources and common H. pylori issues were also conducted.

Results

The median GQS score and DISCERN score was 2 for H. pylori-related videos analyzed in this study. Non-gastroenterologists posted the most H. pylori-related videos (136/242, 56.2%). Videos from gastroenterologists (51/242, 21.0%) had the highest GQS and DISCERN scores, with a median of 3. Few videos had content on family-based H. pylori infection control and management (5.8%), whether all H. pylori-positive patients need to undergo eradication treatment (27.7%), and the adverse effects of H. pylori eradication therapy (16.1%).

Conclusion

Generally, the content and quality of the information in H. pylori-related videos were unsatisfactory, and the quality of the video correlated with the source of the video. Videos from gastroenterologists provided more correct guidance with higher-quality information on the prevention and treatment of H. pylori infection.

Users' experience with health-related content on YouTube: an exploratory study

BACKGROUND

This study focuses on health-related content (HRC) on YouTube and addresses the issue of misinformation on this platform. While previous research centered on content evaluations by experts, this study takes a user-centered approach and aims to explore users' experiences with and perceptions of HRC videos and to establish links between these perceptions and some socio-demographic characteristics including age, gender, profession, and educational level.

METHODS

A quantitative research design was used in the study. 3,000 YouTube users responded to a 35-item anonymous questionnaire to collect information about the content they watch toward decision-making, their perceptions of the usefulness and bias of this content, what they identify as quality indicators for HRC, and what they recommend to improve the quality of such content on YouTube. The data were analyzed using descriptive statistics, frequency, and correlation analyses.

RESULTS

The results reveal that 87.6 percent (n=2630) of the participants watch HRC on YouTube, and 84.7 percent (n=2542) make decisions based on what they watch. Exercise and bodybuilding videos are the most popular, with over half of the participants watching them. 40 percent of the users watch YouTube videos to decide whether to consult a doctor or adopt specific health-related practices. In contrast to evaluations by experts in previous studies, most respondents perceive HRC videos on YouTube as useful and do not find connections between video quality and surface features like the number of views and likes. Weak or no correlations were observed between the perceived usefulness of HRC videos and age, gender, profession, or educational level. Participants' recommendations for enhancing HRC quality align with previous research findings.

CONCLUSIONS

Users turn to YouTube not only for health information but also as a decision-making tool. Combined with their generally positive attitudes towards content quality on this platform, this can have significant consequences for their health. Follow-up studies are needed to get more insights into decision-making behaviors and how users assess their decisions in retrospect.

Social Media and Urticaria - A Data Audit of Facebook®, LinkedIn®, and Twitter® Posts

Introduction

Urticaria is a common debilitating dermatological disorder impairing a patient's quality of life. Such patients are increasingly using socialmedia to manage their health and interact with peers, particularly during the ongoing COVID-19 pandemic.

Objectives

To explore and analyse the quality of urticaria related social-media information available to patients.

Materials and Methods

An in-depth data audit of the three most commonly used social networks viz. Facebook®, LinkedIn®, and Twitter® were done on a single day, as posts may change or lose relevance over time. The word "urticaria" was searched on three social media, and the first 100 posts in each were further analysed. The post-creator was either categorised as "individual" or "group", and non-English posts were excluded. All types of posts have been analysed, including text, images, video, and website links. We also collected the comments/replies, share/re-tweet, and likes on the posts.

Results

Among the total 300 social-media posts, the highest number of "individual" posts was on LinkedIn® followed by Twitter® and Facebook® (χ2 = 82.86, P < 0.0001). Regarding thematic content, most Facebook® posts discussed disease symptoms, followed by the promotion of journal or blog posts, and discussion about causative and triggering agents. LinkedIn® was primarily used for the promotion of journal articles or blog posts, followed by educational webinars and urticaria treatment stories. Twitter® users mostly interacted with peers about their urticaria symptoms and perceived etiologic and triggering factors. Regarding the type of post, images were maximally shared on Facebook®, while video/video links and web links were highest on LinkedIn® (χ2 = 21.59, P < 0.0001).

Conclusion

The overall quality of urticaria related information on these 3 social media platforms is satisfactory for patients. Dermatologists may consider utilising social media to further educate such patients and improve the overall treatment outcome. The use of such networking channels will continue to grow, as communication remains crucial for urticaria management.

YouTube as a source of information for cryptococcal infection: A cross-sectional study

Objective

Immunocompromised individuals, particularly HIV patients, worldwide are at risk from cryptococcal infection. There are a number of videos of cryptococcal infection and more and more individuals may search these videos, but the quality of videos on YouTube is unclear. This study set out to assess the content and quality of YouTube videos regarding cryptococcal infection.

Methods

The keywords "Cryptococcus," "Cryptococcosis" and "Cryptococcal infection" were searched on YouTube. The videos were evaluated and graded by two impartial raters. A 14-point content score was used to categorize videos as bad, good or exceptional. The reliability and quality were evaluated utilizing the DISCERN instrument and a 5-point global quality score. Videos were then divided into groups based on uploading sources and content types.

Results

A total of 46 videos were located, and the ratings provided by the two raters were identical. Our scoring algorithm determined that 54.3% (n = 25), 32.6% (n = 15) and 13.0% (n = 6) of the videos were poor, decent and exceptional, respectively. Regarding quality, no difference was identified between the various video categories. The global quality scale, number of views, days posted, content score and DISCERN showed a significant positive relationship.

Conclusions

Professional individuals or healthcare organizations should be encouraged to submit high-quality videos for the expanding internet population, as only a small proportion of available videos had exceptional quality.

Evaluation of the reliability and educational quality of YouTube™ videos on sport nutrition topics

BACKGROUND

YouTube is one of the most widespread social media channels, which is of growing importance in science communication and health education. The validity of medical and health-related information available on YouTube cannot be assured, and videos often contain potentially misleading or inaccurate information. Communication on sport nutrition may have a profound effect on the change in nutrition behavior among athletes, so evidence-based nutrition information must reach athletes. The main goal of the research is to evaluate the quality, reliability, and applicability of sports nutrition YouTube videos as educational material for athletes.

METHODS

A descriptive cross-sectional design was applied, and a systematic search was performed on YouTube. The quality and reliability of the videos were evaluated by applying the most frequently used and highly reliable scoring systems in the literature (e.g., DISCERN, Global Quality Score, and JAMA criteria) and a sports nutrition-specific scoring system (SNSS). Descriptive statistical analyses, two-sample t-test, Spearman correlation, Kruskal - Wallis, and Mann - Whitney U test were used to evaluate the results. A total of 114 YouTube videos met the inclusion criteria.

RESULTS

In 25% of the videos, the sports nutrition information was presented by a dietitian, while in two-thirds, coaches and athletes and other professionals shared sports nutrition knowledge. In terms of video content, the three most common topics were nutrition and health (33%), special diets (21%), and the training diet (17%). For the majority of the videos that received low GQS, JAMAS, DISCERN, and SNSS scores, the accuracy and quality of the analyzed YouTube videos on sports nutrition were inadequate. Videos uploaded by dietitians achieved significantly higher DISCERN, JAMAS, GQS, and SNSS scores. The GQS, SNSS, and DISCERN scores of videos from sports organizations, nonprofit organizations, and independent user sources were lower compared to videos uploaded by academic and professional organizations. Popular sport nutrition videos among users that contain personal stories or the experiences of athletes were deemed less reliable by experts or showed lower educational quality. Henceforth, we found a negative correlation between video popularity and JAMAS, GQS, and SNSS scores.

CONCLUSION

This study revealed that sports nutrition videos on the YouTube video platform show low accuracy and reliability. Professionals working with athletes need to consider misconceptions from sports nutrition videos in their nutrition counseling practice. Due to the popularity of the videos, professionals and professional organizations could use YouTube as an online educational tool to increase the nutrition knowledge of athletes.

Are Social Media Platforms Appropriate Sources of Information for Patients Regarding the Topic of Facial Trauma?

BACKGROUND

Internet technologies have made a wide variety of information available to the public. Social media platforms (SMPs) can also be used as a source of information for patients seeking health care information. However, the quality of health information on SMPs is not clear and standardized.

PURPOSE

To evaluate the content, reliability, and quality levels of videos reporting on facial trauma on a SMP (YouTube [Google LLC, San Bruno, California]) regarding patients' information.

STUDY DESIGN, SETTING, SAMPLE

This was a cross-sectional study, and the sample is composed of videos found on a SMP based on searching the keyword "facial trauma." English-language videos with acceptable audiovisual quality and content related to facial trauma were included in the study.

PREDICTOR VARIABLE

The descriptive features such as number of views, number of likes, number of comments, video duration, date of uploading, and the demographic features such as source and uploader were recorded.

MAIN OUTCOME VARIABLES

The primary outcome variable was content level. Secondary outcome variables were reliability and quality levels measured by DISCERN and Global Quality Scale.

COVARIATES

The name and uniform resource locator of the videos were recorded as additional data.

ANALYSES

The Mann-Whitney U test was used to compare low-content and high-content videos with a significance level of P < .05. The Kappa test was used to assess the inter-rater reliability.

RESULTS

The sample was composed of 50 videos that met study's inclusion. The mean total content score for the videos was 2.87 (range: 0 to 7), with 64% of all videos (n = 32) classified as low-content. The reliability and quality levels of videos classified as high-content were significantly superior (P < .001). In addition, the video duration was significantly higher in the high-content videos (P = .045). High-content videos were uploaded by health care professionals with a ratio of 39%, and the sources of these videos were predominantly oral and maxillofacial surgeons; however, low-content videos were mostly uploaded by clinics (75%), with the sources of these videos predominantly laypersons.

CONCLUSION AND RELEVANCE

Given the generally low content, reliability, and quality of online videos regarding facial trauma, clinicians should be cautious in recommending or referring patients to SMPs.

Realfood and Cancer: Analysis of the Reliability and Quality of YouTube Content

This study analyzes the quality and reliability of videos related to nutrition and cancer on YouTube.

STUDY DESIGN

An observational, retrospective, cross-sectional, time-limited study analyzing activity on the social network YouTube was proposed.

METHODS

The information from the videos was extracted through an API search tool, using the NodeXL software. The criteria to select the videos on YouTube were the keywords "real food", "realfood", and "cancer" and the hashtags #realfood and #cancer were present, videos in English and videos available on 1 December 2022.

RESULTS

The DISCERN value in the total number of videos viewed was 2.25 (±0.88) points, indicating low reliability. The videos uploaded by HRU represented only 20.8%. Videos suggesting that the use of foods defined as "real food" could cure cancer without the intervention of any other treatment accounted for 12.5%. Videos that provided external links to scientific/technical evidence verifying the information represented only 13.89% of the total number of videos. Of these videos, 70% corresponded to HRU. The DISCERN value for videos from HRU users was 3.05 (0.88), a value that reflects a good reliability of videos from these users.

CONCLUSIONS

This study provides information on the content and quality of the videos that we can find on YouTube. We found videos of non-health users who do not base their content on any scientific evidence, with the danger that this entails for the population, but it also highlights that the videos published by HRU have greater reliability and quality, being better perceived by the population, so it is important to encourage healthcare professionals and health institutions to share verified information on YouTube.

Is TikTok a high-quality source of information on thyroid cancer?

PURPOSE

Increased Internet users tend to use online video platforms as a source of medical information. There are many thyroid cancer-related videos on TikTok, the most popular short-video application in China. However, quality evaluation of these videos remains absent. The aim of this study is to evaluate the quality of thyroid cancer-related videos on TikTok.

METHODS

A search was performed on TikTok with the keyword "thyroid cancer". The top 100 videos in the search results were selected. Characteristics of videos including video length, duration on TikTok, thumbs up, thumbs up/day, comments, comments/day, favorites, favorites/day, reposts, and reposts/day were collected. The Patient Education Materials Assessment Tool (PEMAT), modified DISCERN (mDISCERN), Video Information and Quality Index (VIQI), and Global Quality Score (GQS) were applied to assess the quality of videos.

RESULTS

Among the 100 videos in this study, most were uploaded by surgical physicians (n = 50), and the most common topic was anatomy/basic facts (n = 21). The mean scores of the PEMAT, PEMAT-U, and PEMAT-A were 71.18 ± 16.56, 82.23 ± 15.00, and 44.00 ± 37.57, respectively. Among the five questions of the mDISCERN tool, 71, 90, 82, 9, and 28 videos were evaluated as "yes", respectively. The mean scores of mDISCERN, VIQI, and GQS were 2.80 ± 1.03, 14.87 ± 2.27, and 3.72 ± 1.00, respectively. The characteristics and quality of videos are significantly different based on the uploader and content.

CONCLUSIONS

The quality of thyroid cancer information on TikTok is unsatisfactory. There is a need for high-quality thyroid cancer-related information on short-video platforms for patient education.

The Reliability and Quality of Short Videos as a Source of Dietary Guidance for Inflammatory Bowel Disease: Cross-sectional Study

BACKGROUND

Dietary management is considered a potential adjunctive treatment for inflammatory bowel disease (IBD). Short-video sharing platforms have enabled patients to obtain dietary advice more conveniently. However, accessing useful resources while avoiding misinformation is not an easy task for most patients.

OBJECTIVE

This study aimed to evaluate the quality of the information in IBD diet-related videos on Chinese short-video sharing platforms.

METHODS

We collected and extracted information from a total of 125 video samples related to the IBD diet on the 3 Chinese short-video sharing platforms with the most users: TikTok, Bilibili, and Kwai. Two independent physicians evaluated each video in terms of content comprehensiveness, quality (rated by Global Quality Score), and reliability (rated by a modified DISCERN tool). Finally, comparative analyses of the videos from different sources were conducted.

RESULTS

The videos were classified into 6 groups based on the identity of the uploaders, which included 3 kinds of medical professionals (ie, gastroenterologists, nongastroenterologists, and clinical nutritionists) and 3 types of non-medical professionals (ie, nonprofit organizations, individual science communicators, and IBD patients). The overall quality of the videos was poor. Further group comparisons demonstrated that videos from medical professionals were more instructive in terms of content comprehensiveness, quality, and reliability than those from non-medical professionals. Moreover, IBD diet-related recommendations from clinical nutritionists and gastroenterologists were of better quality than those from nongastroenterologists, while recommendations from nonprofit organizations did not seem to be superior to other groups of uploaders.

CONCLUSIONS

The overall quality of the information in IBD diet-related videos is unsatisfactory and varies significantly depending on the source. Videos from medical professionals, especially clinical nutritionists and gastroenterologists, may provide dietary guidance with higher quality for IBD patients.

Temporomandibular disorders-related videos on YouTube are unreliable sources of medical information: A cross-sectional analysis of quality and content

Objective

The amount of online medical information available is rapidly growing and YouTube is considered as the most popular source of healthcare information nowadays. However, no study has been conducted to comprehensively evaluate YouTube videos related to temporomandibular disorders (TMD). So this study aimed to evaluate the content and quality of YouTube videos as a source of medical information on TMD.

Method

A total of 237 YouTube videos that were systematically searched using five keywords (temporomandibular disorders, tmd, temporomandibular joint, tmj, and jaw joint) were included. Included videos were categorized by purpose and source for analysis. The quality (DISCERN, Health on the Net (HON), Ensuring Quality Information for Patients (EQIP), and Global Quality Scale (GQS)) and scientific accuracy of video contents were evaluated.

Results

Total content, DISCERN, HON, EQIP, and GQS scores were 7.5%, 38.9%, 35.2%, 53.0%, and 48.6% of the maximum possible score, respectively. Only 69 videos (29.1%) were considered as "useful" for patients. News media, physician, and medical source videos showed higher evaluation scores than others. Quality evaluation scores were not significantly correlated or negatively correlated with public preference indices. In the ROC curve analysis, content and DISCERN score showed above excellent discrimination ability for high-quality videos based on GQS (P < 0.001) and total score (P < 0.001).

Conclusions

YouTube videos related to TMD contained low quality and scientifically inaccurate information that could negatively influence patients with TMD.

Translating and Adapting the DISCERN Instrument Into a Simplified Chinese Version and Validating Its Reliability: Development and Usability Study

BACKGROUND

There is a wide variation in the quality of information available to patients on the treatment of the diseases afflicting them. To help patients find clear and accessible information, many scales have been designed to evaluate the quality of health information, including the Patient Education Materials Assessment Tool; the Suitability Assessment of Materials for evaluation of health-related information for adults; and DISCERN, an instrument for judging the quality of written consumer health information on treatment choices. These instruments are primarily in English. Few of them have been translated and adapted into simplified Chinese tools for health information assessment in China.

OBJECTIVE

This study aimed to translate and adapt DISCERN into the first simplified Chinese version and validate the psychometric properties of this newly developed scale for judging the quality of patient-oriented health information on treatment choices.

METHODS

First, we translated DISCERN into simplified Chinese using rigorous guidelines for translation and validation studies. We tested the translation equivalence and measured the content validity index. We then presented the simplified Chinese instrument to 3 health educators and asked them to use it to assess the quality of 15 lung cancer-related materials. We calculated the Cohen κ coefficient and Cronbach α for all items and for the entire scale to determine the reliability of the new tool.

RESULTS

We decided on the simplified Chinese version of the DISCERN instrument (C-DISCERN) after resolving all problems in translation, adaptation, and content validation. The C-DISCERN was valid and reliable: the content validity index was 0.98 (47/48, 98% of the items) for clarity and 0.94 (45/48, 94% of the items) for relevance, the Cronbach α for internal consistency was .93 (95% CI 0.699-1.428) for the whole translated scale, and the Cohen κ coefficient for internal consistency was 0.53 (95% CI 0.417-0.698).

CONCLUSIONS

C-DISCERN is the first simplified Chinese version of the DISCERN instrument. Its validity and reliability have been attested to assess the quality of patient-targeted information for treatment choices.

YouTube as a Source of Information on Pilonidal Sinus Disease: A Reliability and Quality Analysis

Aim This study aimed to assess the quality and reliability of the information in YouTube videos regarding pilonidal sinus disease (PSD). Methods A total of 100 most-viewed videos on PSD were included in the analysis by two general surgeons. Video duration and content, date of upload, qualification of the video uploaders, and number of daily and total view, like, and comment counts were analyzed. We grouped the videos as those uploaded by healthcare professionals and non-professionals. The quality of the video contents was assessed with the Global Quality Scale (GQS) and the reliability of the video content with the DISCERN scoring system. Results Eighty-five (85%) videos were uploaded by professionals and 15 (15%) videos by laypersons. The average DISCERN score of the reviewed video contents was 3.18 ± 1.23, and the average GQS score was 3.39 ± 1.24. In the overall subjective evaluation, the mean DISCERN value was found as 4.01 ± 1.24 and the mean GQS value as 4.25 ± 1.25 in the useful videos. The mean DISCERN value was found as 2.32 ± 1.22 and the mean GQS value as 2.48 ± 1.25 in the misleading videos. Conclusion Our results showed that most of the YouTube videos on PSD were loaded by healthcare professionals. However, the mean quality and reliability scores were lower in videos uploaded by laypersons. Given the prevalence of PSD, physicians should be promoted for uploading accurate and professional video contents to direct patients to the right solutions for their problems.

What do Patients Want to See on Social Media? Evidence From a Two-Year Experiment

INTRODUCTION

Dermatological information on social media is dominated by misleading and potentially harmful content from nonexperts. Literature suggests that, to address this issue, dermatologists should develop an online presence. However, the successful presence of dermatologists on social media has been criticized for focusing on cosmetic dermatology and not representing the broad spectrum of the specialty.

OBJECTIVES

The aim of this study was to systematically analyze which dermatological topics interest the public most, and to find out whether it is feasible for a dermatologist to become influential on social media while presenting all dermatological topics equally.

METHODS

The study was performed on an educational dermatology YouTube channel. The 101 videos published in a two-year period were divided into cosmetic (51 videos) and medical dermatology (50 videos). Student's t-test was conducted to determine whether there were significant differences in views. Medical dermatology videos were then classified into three categories: Acne, facial dermatoses (excluding acne) and other dermatological diseases. A Kruskal-Wallis test was used to compare these three categories and cosmetic dermatology.

RESULTS

When comparing cosmetic and medical dermatology, no significant differences were found. When comparing the four categories, cosmetic dermatology and acne were found to generate significantly more views that other dermatological diseases.

CONCLUSIONS

The public seems to be particularly interested in cosmetic dermatology and acne. This might make it challenging to become successful on social media while presenting a balanced portrayal of dermatology. However, focusing on popular topics can provide a real chance to be influential and protect vulnerable people from misinformation.

Quality of healthcare information on YouTube: psoriatic arthritis

BACKGROUND

YouTube is an increasingly used platform for medical information. However, the validity of health-related information on psoriatic arthritis (PsA) on YouTube has not been determined.

OBJECTIVE

The purpose of this study was to evaluate the accuracy and quality of YouTube videos concerning PsA.

MATERIALS AND METHODS

A YouTube search was performed on April 18, 2021, using the keyword "psoriatic arthritis." Two independent raters accessed the content, source, and detailed characteristics of the included videos. The reliability and quality of the videos were analyzed using the modified DISCERN score, Journal of the American Medical Association benchmark criteria score, and global quality scale score.

RESULTS

Of the 200 videos screened, 155 were included in the study after applying the exclusion criteria. A total of 132 (85.2%) videos revealed useful information about PsA, whereas the remaining 23 (14.8%) were misleading. Video interaction parameters including the median number of views, views per day, likes, dislikes, and comments demonstrated no significant difference between the two groups. The videos posted by universities and professional organizations displayed the highest reliability and quality scores.

CONCLUSION

The majority of YouTube videos on PsA contained useful information. However, physicians should alert patients to the possibility of misinformation and non-validated sources. Professional organizations in the field of rheumatology, such as the American College of Rheumatology and European League Against Rheumatism, should consider collaborating with YouTube to deliver high-quality content.

Social media in health communication: A literature review of information quality

BACKGROUND

Social media is used in health communication by individuals, health professionals, disease centres and other health regulatory bodies. However, varying degrees of information quality are churned out daily on social media. This review is concerned with the quality of Social Media Health Information (SMHI).

OBJECTIVE

The review sought to understand how SMHI quality issues have been framed and addressed in the literature. Health topics, users and social media platforms that have raised health information quality concerns are reviewed. The review also looked at the suitability of existing criteria and instruments used in evaluating SMHI and identified gaps for future research.

METHOD

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the forward chaining strategy were used in the document search. Data were sourced according to inclusion criteria from five academic databases, namely Scopus, Web of Science, Cochrane Library, PubMed and MEDLINE.

RESULTS

A total of 93 articles published between 2000 and 2019 were used in the review. The review revealed a worrying trend of health content and communication on social media, especially of cancer, dental care and diabetes information on YouTube. The review further discovered that the Journal of the American Medical Association, the DISCERN and the Health on the Net Foundation, which were designed before the advent of social media, continue to be used as quality evaluation instruments for SMHI, even though technical and user characteristics of social media differ from traditional portals such as websites.

CONCLUSION

The study synthesises varied opinions on SMHI quality in the literature and recommends that future research proposes quality evaluation criteria and instruments specifically for SMHI.

An Analysis of Information Sources of YouTube Videos Pertaining to Tattoo Removal: Cross-sectional Study

Background

The American Academy of Dermatology and the Food and Drug Administration recommend consultation with a dermatologist prior to undergoing laser tattoo removal. However, non–health care professionals offer tattoo removal. Understanding the information available on the internet for patients regarding tattoo removal is important given that individuals are increasingly consulting digital sources to make decisions regarding skin care. Prior research has identified that YouTube contains misinformation on dermatologic health.

Objective

Here, we present a cross-sectional study that determined the sources of information in YouTube videos that discuss tattoo removal and described the content presented to viewers.

Methods

Using the query “tattoo removal,” we reviewed English-language YouTube videos that explicitly discussed tattoo removal. The following data were recorded: profession of the presenter, tattoo removal method discussed, whether an explicit recommendation to see a dermatologist or physician was present in the video, and number of views.

Results

We analyzed 162 YouTube videos. We found that the majority were presented by non–health care professionals (n=125, 77%), with only 4 (3.7%) records of this subset recommending viewers to seek consultation from a dermatologist to ensure safe and adequate tattoo removal.

Conclusions

Based on our findings, we recommend that dermatologists and other health care professionals provide high-quality, evidence-based information to viewers on tattoo removal and encourage dermatology societies to share via their social media platforms information about the importance of consulting a dermatologist for tattoo removal.

YouTube as a source for information on newborn male circumcision: Is YouTube a reliable patient resource?

INTRODUCTION

YouTube is the most popular open access media-sharing platform and is the second most visited websites worldwide. However, due to a lack of peer-review, YouTube is largely unregulated and can be susceptible to the spread of biased or misleading information.

OBJECTIVE

To evaluate the quality and potential bias of videos pertaining to newborn male circumcision (NMC) on YouTube.

MATERIALS & METHODS

A YouTube search was performed on August 27, 2021 using the search term 'circumcision', and the top 100 videos were analyzed by two independent reviewers. Videos were categorized into groupings based on their source, and each video was evaluated for bias and was determined to be either pro-circumcision, anti-circumcision or neutral. Video quality was assessed using the DISCERN instrument (1-5 scale) and the Global Quality Scale (GQS) (1-5 scale). Video popularity was measured using the video power index (VPI).

RESULTS

We found that the overall quality of videos on YouTube pertaining to NMC is generally low (DISCERN: 2.9 ± 0.7, GQS: 2.9 ± 1.1). When describing potential bias, 56% of videos were neutral and 44% were biased, of which 30% being anti-circumcision and 14% being pro-circumcision. Videos which were neutral, produced by health channels, or which featured physicians were associated with the highest quality ratings. However, when correlating total video views and likes with our quality assessments, we observed a significant negative correlation between the overall popularity of a video and its DISCERN (ρ = -0.297, p = 0.031) and GQS quality ratings (ρ = -0.274, p = 0.048).

CONCLUSION

Information pertaining to NMC on YouTube is generally of low quality and has a high potential for bias. Lower quality content is overrepresented on YouTube and tended to be more popular than higher quality content. Patients and their families should be cautious when accessing YouTube for health information pertaining to NMC.

Public Perception of SARS-CoV-2 Vaccines Among Psoriasis Patients in Social Media: Content, Sentiment, and Engagement Analysis

Background

Psoriasis patients may seek information about the SARS-CoV-2 vaccine and their disease from social media platforms. Analyses of social media interactions may help guide dermatologists' educational efforts during this pandemic.

Objectives

This study analyzes social media interactions among patients with psoriasis and psoriatic arthritis regarding the SARS-CoV-2 vaccine to determine the misinformation circulating and the apprehension to receiving the vaccine.

Methods

Publicly accessible Facebook and Reddit groups regarding psoriasis and psoriatic arthritis were identified. Posts uploaded between March 1, 2021 and July 31, 2021 which contained information about the SARS-CoV-2 vaccine were extracted. First-order themes, sub-themes, sentiment scores and engagement scores were assigned to each post.

Results

345 posts within the first-order theme of vaccination decision and 1379 posts within the first-order theme of vaccine reaction were analyzed. Within vaccination decision, common sub-themes for refusing the vaccine include fear of psoriasis flare up, vaccine is experimental, vaccine is unnecessary, vaccine is dangerous, and concern for reaction/vaccine efficacy while on psoriasis medications. 41.4% of posts contained positive sentiment; whereas, 38.3% contained negative sentiment. Within vaccine reaction, common sub-themes identified were no change to psoriasis, skin/joint flare up, skin flare up attributed specifically to stopping psoriasis medications, skin/joint improvement, and skin flare up but vaccine was worth it. 77.8% of posts contained positive sentiment; whereas, 6.2% contained negative sentiment.

Conclusions

Our study identified common SARS-CoV-2 vaccine concerns within the psoriasis community which should be used to guide educational efforts.

Superlatives, clickbaits, appeals to authority, poor grammar, or boldface: Is editorial style related to the credibility of online health messages?

Adolescents, as active online searchers, have easy access to health information. Much health information they encounter online is of poor quality and even contains potentially harmful health information. The ability to identify the quality of health messages disseminated via online technologies is needed in terms of health attitudes and behaviors. This study aims to understand how different ways of editing health-related messages affect their credibility among adolescents and what impact this may have on the content or format of health information. The sample consisted of 300 secondary school students (M_age = 17.26; SD_age = 1.04; 66.3% female). To examine the effects of manipulating editorial elements, we used seven short messages about the health-promoting effects of different fruits and vegetables. Participants were then asked to rate the message’s trustworthiness with a single question. We calculated second-order variable sensitivity as the derivative of the trustworthiness of a fake message from the trustworthiness of a true neutral message. We also controlled for participants’ scientific reasoning, cognitive reflection, and media literacy. Adolescents were able to distinguish overtly fake health messages from true health messages. True messages with and without editorial elements were perceived as equally trustworthy, except for news with clickbait headlines, which were less trustworthy than other true messages. The results were also the same when scientific reasoning, analytical reasoning, and media literacy were considered. Adolescents should be well trained to recognize online health messages with editorial elements characteristic of low-quality content. They should also be trained on how to evaluate these messages.

An initial preparation for human cadaveric dissection ameliorates the associated mental distress in students

It is universally recognized that cadaveric dissection is an essential part of anatomy training. However, it has been reported to induce mental distress in some students and impair their intrinsic motivation (IM) to study. One of the postulated reasons for this behavior is the lack of adequate information and preparation of students for cadaveric dissection. Therefore, it is hypothesized that providing relevant information prior to cadaveric dissection will ameliorate the mental distress, enhance the IM of students, and improve their academic performance. A cohort of occupational therapy students enrolled in an anatomy course were psychologically prepared for cadaveric dissection. Students were provided with a curated list of YouTube videos and peer-reviewed journal articles related to cadaveric dissection prior to the commencement of the anatomy course. All students were also required to attend an oral presentation immediately before commencing dissection. The control group included students who had not been provided with any resources in preparation for cadaveric dissection. Compared to the control group, students who had been prepared demonstrated better quality of cadaveric dissection, improved academic performance, reported less mental distress and greater IM. Moreover, students reported the oral presentation to be most relevant and journal articles to be least useful in their preparation. Therefore, this is an effective approach in the amelioration of mental distress and improvement of performance in anatomy students. Consequently, this study represents a paradigm shift in the pedagogy of anatomy, and could represent a vital element in the evolution of a revitalized anatomy curriculum.

The Role of Lifestyle and Nutrition in Psoriasis: Current Status of Knowledge and Interventions

Extrinsic environmental factors, including patient lifestyle (alcohol intake, smoking, stress, sleep disturbances, and sedentary habit), diet and single nutrients intake may affect psoriasis clinical presentation, severity, and course. All English language articles dealing with psoriasis and lifestyle factors or diet gathered by an extensive PubMed search were carefully examined in order to explore their impact on the disease. Current authoritative knowledge confirms that low‐calories, Mediterranean, and protein restricted/vegetarian diets may be beneficial. Psoriatic patients are also recommended to engage regular physical activity, to avoid alcohol intake and to consume fish rich in omega‐3 polyunsaturated fatty acids, as well as fruit and vegetables. Prebiotics and probiotics may also provide potential benefit, whereas vitamin D supplementation and gluten‐free diet are useful in selected cases only. Changing of dietary and lifestyle habits alone does not replace conventional treatment, but must be considered as an adjuvant. Physicians may play a crucial role, by adequately acknowledging psoriatic patients on the advantages of proper lifestyle and diet habits as well as providing clues to reliable sources of dietary advice.

Health Literacy and Web-Based Audiovisual Multimedia in Pituitary and Endoscopic Skull Base Surgery

Introduction The internet presents a rich milieu of multimedia options relating to pituitary and endoscopic skull base surgery (ESBS). Misinformation can create discordance between patient and provider expectations. The purpose of this study is to analyze the understandability and actionability of available ESBS and pituitary surgery audiovisual information on YouTube and Google.

Methods The top 50 videos generated by searching “pituitary surgery/transsphenoidal surgery” and “endoscopic skull base surgery” in both YouTube and Google were sorted by relevance. Two independent reviewers evaluated each for understandability and actionability based on the Patient Education Materials Assessment Tool for audiovisual material (PEMAT-A/V). Source, authorship, audience, and education/advertisement variables were collected. Chi-square test followed by univariate and multivariate regression analyses assessed the association between these variables and quality.

Results A total of 85 videos (52 YouTube and 33 Google) met inclusion criteria for analysis. There was no significant difference in the presence of the aforementioned variables between YouTube and Google (p < 0.05). Also, 72% of videos targeted patients and 28% targeted surgeons. Academic institutions uploaded 58% of videos. Surgeon-targeted videos were more educational (p = 0.01) and patient-targeted videos involved more advertisement (p = 0.01). Understandability and actionability scores were below the 70% threshold for both YouTube (65 ± 15, 38 ± 33, p = 0.65) and Google (66 ± 12, 38 ± 26, p = 0.94). Patient-targeted videos (p = 0.002) were more understandable, while surgeon- (p < 0.001) and education-focused videos (p < 0.001) were more actionable.

Conclusion Understandability and actionability of YouTube and Google audiovisual patient information on ESBS and pituitary surgery is poor. Consideration should be given to the formation of a standardized patient information resource.

Takotsubo syndrome on TikTok: An analysis of information quality and audience engagement (Preprint)

Background

The incidence of Takotsubo syndrome (TTS), also known as the broken heart syndrome or stress cardiomyopathy, is increasing worldwide. The understanding of its prognosis has been progressively evolving and currently appears to be poorer than previously thought, which has attracted the attention of researchers. An attempt to recognize the awareness of this condition among the general population drove us to analyze the dissemination of this topic on TikTok, a popular short-video–based social media platform. We found a considerable number of videos on TTS on TikTok; however, the quality of the presented information remains unknown.

Objective

The aim of this study was to analyze the quality and audience engagement of TTS-related videos on TikTok.

Methods

Videos on the TikTok platform were explored on August 2, 2021 to identify those related to TTS by using 6 Chinese keywords. A total of 2549 videos were found, of which 80 met our inclusion criteria and were evaluated for their characteristics, content, quality, and reliability. The quality and reliability were rated using the DISCERN instrument and the Journal of the American Medical Association (JAMA) criteria by 2 reviewers independently, and a score was assigned. Descriptive statistics were generated, and the Kruskal-Wallis test was used for statistical analysis. Multiple linear regression was performed to evaluate the association between audience engagement and other factors such as video content, video quality, and author types.

Results

The scores assigned to the selected video content were low with regard to the diagnosis (0.66/2) and management (0.34/2) of TTS. The evaluated videos were found to have an average score of 36.93 out of 80 on the DISCERN instrument and 1.51 out of 4 per the JAMA criteria. None of the evaluated videos met all the JAMA criteria. The quality of the relayed information varied by source (All P<.05). TTS-related videos made by health care professionals accounted for 28% (22/80) of all the evaluated videos and had the highest DISCERN scores with an average of 40.59 out of 80. Multiple linear regression analysis showed that author types that identified as health professionals (exponentiated regression coefficient 17.48, 95% CI 2.29-133.52; P=.006) and individual science communicators (exponentiated regression coefficient 13.38, 95% CI 1.83-97.88; P=.01) were significant and independent determinants of audience engagement (in terms of the number of likes). Other author types of videos, video content, and DISCERN document scores were not associated with higher likes.

Conclusions

We found that the quality of videos regarding TTS for patient education on TikTok is poor. Patients should be cautious about health-related information on TikTok. The formulation of a measure for video quality review is necessary, especially when the purpose of the published content is to educate and increase awareness on a health-related topic.

Benefits, drawbacks, and challenges of social media use in dermatology: A systematic review

The presence of dermatological information on social media has grown exponentially over the last two decades. Consequently, the recent literature on this topic is abundant. Many authors have highlighted that social media constitutes a unique opportunity for patient education. Additionally, numerous other benefits of these platforms have been reported. However, other authors have focused on the potential risks that these networks involve. The main concerns are patient confidentiality, legal considerations and ethical issues. Therefore, we stand at a crossroads where the many advantages of social media use in dermatology seem to be underestimated due to the presence of potential drawbacks. At this point, we propose that a systematic review of the positive and negative aspects of using social media in dermatology is necessary. We carried out a comprehensive systematic review dating from inception to July 2021. Finally, 161 articles were included. Fifteen benefits, 11 drawbacks and 10 challenges of social media use in dermatology were identified and discussed. Suggested strategies to address the identified drawbacks were provided. Overall, while there are risks to using social media, they are outnumbered by their benefits. Therefore, dermatologists should embrace this opportunity to educate patients and aim to create rigorous and engaging content.

Amyotrophic lateral sclerosis in social media: Content analysis of YouTube videos

The purpose of this study is to analyze the characteristics, content, and quality of information available on YouTube regarding amyotrophic lateral sclerosis (ALS), and explore the search results and number of views and quality of the videos. A search was performed on YouTube on 10 June 2020, using the search term ''Lou Gehrig's disease" in the Korean language, and the first 100 videos were targeted for analysis. General characteristics (e.g., number of views, video length, etc.) were collected, and upload source, target audience, subject of the video, and quality of the videos using a global quality score (GQS) were assessed. About two-thirds of the videos were for the general public (62.0%), while the other third were made for patients and their families with ALS (38.0%). The mean GQS was 3.70 ± 1.42, and 60 videos were classified as high-quality videos. ALS-related videos on YouTube play a role in raising awareness among the general public of this devastating disease, however, practical information regarding disease management for patients and family is relatively insufficient. The quality and characteristics of the videos varied greatly and sometimes the lowest quality videos were shown in the top pages of search results.

A qualitative analysis of online misinformation and conspiracy theories in psoriasis

Psoriasis is a chronic, hereditary disease with a complex immunopathogenesis, rendering it susceptible to misinformation. Misinformation related to psoriasis can have negative effects both on the public perception of psoriasis and on patients' knowledge of psoriasis. To characterize misinformation related to psoriasis available online, we performed a formal literature review via PubMed and a thematic review via Google. Key themes of misinformation included 'victim-blaming' (hygiene), 'vector' (contagion), 'vaccination', 'vilification' of conventional therapy, 'validation' of natural treatment and diet, 'veneration' of cures and 'vocalization' from celebrities. Misinformation related to psoriasis is pervasive on social media and other websites. Dermatologists, as patient advocates, should be aware of the content of misinformation available online and combat misleading health information to optimize health outcomes for patients with psoriasis.

Fibromyalgia in social media: content and quality of the information analysis of videos on the YouTube platform

To evaluate the fibromyalgia (FM) content in YouTube videos and verify if American College of Rheumatology (ACR) guidelines are being met. The videos were searched with the keyword "Fibromyalgia." Two independent researchers evaluated and coded specific characteristics of the videos. The popularity of the videos, the presentation properties, and content related to FM according to the ACR criteria were analyzed. Of the 200 videos included, the majority were presented by health professionals, 61.5%. Most videos covered more than one subject, 38.5%. The videos presented by health professionals were the most viewed. Following the ACR guidelines, 38% defined FM, 24% described the etiology, 19.5% described the diagnostic criteria and 52% presented recommended management strategies. The results indicate that users mainly watch videos published by health professionals. Most of the published videos do not follow the information recommended by the ACR guidelines. Therefore, videos should be interpreted with caution, not being the most appropriate resource for health education for patients with FM. Most of the videos published on YouTube about FM do not meet the ACR guidelines for FM.

Social Media in Dermatology and an Overview of Popular Social Media Platforms

Purpose of Review

Social media provides an accessible and increasingly popular avenue for sharing healthcare information, networking, and outreach in dermatology. We provide an overview of prominent social media platforms, also known as applications or apps, as well as a discussion of their influence and implications for the field.

Recent Findings

The various collaborative features of Facebook, Twitter, Instagram, TikTok, YouTube, Snapchat, and other emerging platforms have proven appealing to organizations and users seeking dermatology-related content and medical advice. However, the potential for propagation of inaccurate or even dangerous information is high.

Summary

Despite the risks associated with social media usage, dermatology can benefit from opportunities to connect and engage with audiences through these platforms. Dermatologists should be encouraged to increase their presence on multiple social media apps to dispel and counteract misleading posts with evidence-based knowledge.

Social Media and Ethical Challenges for the Dermatologist

Purpose of Review

The purpose of review is to provide guidance on the use of social media within the context of dermatology and discuss its ethical, professional, and legal implications in education, mentorship, networking, business, and clinical settings.

Recent Findings

Despite its fundamental value as a means of communication and knowledge sharing, social media carries legal, ethical, and professional challenges. Healthcare providers have run into issues such as misinformation, conflicts of interest, and overstepping patient-physician boundaries when using social media. An interesting finding is that dermatologists commonly engage with an online audience through social media marketing or being an influencer to improve business and extend their reach to clients; however, this warrants formal training and the need to monitor their own online presence to prevent legal consequences.

Summary

Social media has become integral in everyday life; billions of people now receive information and stay connected with each other through social platforms. Within medicine, social media has enhanced various aspects of healthcare, such as professional networking, patient care, and patient education. In dermatology, social media allows dermatologists to promote their businesses and services through patient testimonials, posting advice on blogs, and networking with a large audience of potential patients. However, having a social media presence must be exercised with care, purpose, and transparency to maximize benefits and minimize harmful consequences. This is especially important when inappropriate social media posts by physicians can be scrutinized for breaching patient confidentiality, violating privacy, financial conflicts of interest, and possibly disseminating incorrect information.

Reliability and Quality of YouTube Videos on Ultrasound-Guided Brachial Plexus Block: A Programmatical Review

BACKGROUND

Ultrasound-guided regional anesthesia has gained popularity over the last decade. This study aimed to assess whether YouTube videos sufficiently serve as an adjunctive tool for learning how to perform an ultrasound-guided brachial plexus block (BPB).

METHODS

All YouTube videos were classified, based on their sources, as either academic, manufacturer, educational, or individual videos. The metrics, accuracy, utility, reliability (using the Journal of American Medical Association Score benchmark criteria (JAMAS)), and educational quality (using the Global Quality Score (GQS) and Brachial Plexus Block Specific Quality Score (BSQS)) were validated.

RESULTS

Here, 175 videos were included. Academic (1.19 ± 0.62, mean ± standard deviation), manufacturer (1.17 ± 0.71), and educational videos (1.15 ± 0.76) had better JAMAS accuracy and reliability than individual videos (0.26 ± 0.67) (p < 0.001). Manufacturer (11.22 ± 1.63) and educational videos (10.33 ± 3.34) had a higher BSQS than individual videos (7.32 ± 4.20) (p < 0.001). All sources weakly addressed the equipment preparation and post-procedure questions after BSQS analysis.

CONCLUSIONS

The reliability and quality of ultrasound-guided BPB videos differ depending on their source. As YouTube is a useful educational platform for learners and teachers, global societies of regional anesthesiologists should set a standard for videos.

Popular videos related to low back pain on YouTube™ do not reflect current clinical guidelines: a cross-sectional study

BACKGROUND

Quality of low back pain (LBP) information offered on YouTube ™ is unclear.

OBJECTIVE

To describe the current low back pain information available on YouTube ™ and determine if these videos report information that aligns with clinical guidelines. Further analysis explored whether specific features of the videos explain their popularity.

METHODS

A cross-sectional observational study was conducted on videos related to LBP on YouTube™ with the 200 most viewed videos using the term "low back pain." The videos were independently viewed and assessed by two researchers for specific video characteristics, LBP specific content, and compliance with guidelines. The association between video characteristics or content with popularity (i.e., views, likes, dislikes, and comments) was investigated using regression models.

RESULTS

The median number of views was 2 018 167. Only 59 (29.5%) of the videos reported at least one diagnostic recommendation from clinical guidelines, and only 100 (50%) reported a treatment recommendation that aligned with clinical guidelines. Apart from year of upload, no variables were identified that were independently associated with popularity or engagement of the videos.

CONCLUSION

The information related to LBP offered on YouTube™ is often not evidence-based and there is the tendency to prioritize information on interventions rather than understanding the LBP process. Factors related to engagement with content about LBP on YouTube™ remains uncertain, indicating further need for knowledge translation in this field.

YouTube as a source of information on breast cancer in the Arab world

BACKGROUND

The general population is increasingly using YouTube as a source of information on breast cancer, the most frequent cancer among women. Arabs are the most interested population in breast cancer on YouTube. The transmission of accurate information is important to reduce mortality rates. This cross-sectional study aims to evaluate breast cancer videos on YouTube in the Arab world.

METHODS

A YouTube search for "breast cancer" in Arabic was performed. The most viewed 60 videos included were evaluated for global quality (GQS score), reliability (modified DISCERN score), content (content score), and misleading claims. Recorded and calculated data included views, duration, videos power index, and viewers' interaction. Sources from legal persons (governments, universities, TV channels, physicians' groups), and blogs (online health channels, individuals) were categorized.

RESULTS

The median global quality (3/5), reliability (2/5), and content scores (4/11) were overall low. Misleading information was found in 42% of the videos. Although videos uploaded by legal persons were less popular (163,454 vs 327,488 views), they hosted more physicians (52% vs 15%), were less misleading (15% vs 64%), covered more content, and were of higher global quality and reliability than videos uploaded by blogs [p < 0.05]. While the topic of symptoms (55%) was discussed the most, genetic counseling (13%) and prevention (20%) were the least mentioned.

CONCLUSIONS

YouTube is poorly informational and inaccurate on breast cancer in the Arab World where it is highly used. Although videos uploaded by legal persons tend to be more adequate, they are of lower popularity. Governments and physicians are encouraged to upload more intelligibly informational videos, guide the population to reliable sources, and support regulations.

The impact of social media on dermatologists and in captivating their patients: a cross-sectional study

BACKGROUND

Dermatology practice has been impacted in the modern era of connectivity and social media (SM). Users' choice of dermatology practice may be influenced by SM. This study surveyed dermatologists for the use of SM as part of their practice, and the general population to assess the effect of SM on the practice of dermatology.

METHODS

This nationwide, cross-sectional study among dermatologists and the general population used two questionnaires, with the first (S1) targeting a random sample of the Saudi general population and the second (S2) addressing dermatologists.

RESULTS

Out of 965 participants in the first questionnaire. 53.78% (n = 519) of the responders followed dermatologists on SM, 57.8% did so to learn about treatment of dermatologic diseases. On the other hand, the S2 was completed by 58 dermatologists. Of them, 82.8% believed that SM had changed the practice of dermatology, 98.3% (n = 57) believed that it changed their own practice. When following a dermatologist on SM, a main reason (26.5%) was to evaluate before-and-after images.

CONCLUSION

SM plays a significant role in a physician's reputation and the practice of dermatology. It is a new era that is mainly fueled by technology; keeping pace with these advancements is an essential way to thrive.

Perspectives Toward Seeking Treatment Among Patients With Psoriasis: Protocol for a Twitter Content Analysis

BACKGROUND

Psoriasis is an autoimmune disease estimated to affect more than 6 million adults in the United States. It poses a significant public health problem and contributes to rising health care costs, affecting people's quality of life and ability to work. Previous research showed that nontreatment and undertreatment of patients with psoriasis remain a significant problem. Perspectives of patients toward seeking psoriasis treatment are understudied. Social media offers a new data source of user-generated content. Researchers suggested that the social network Twitter may serve as a rich avenue for exploring how patients communicate about their health issues.

OBJECTIVE

The objective of this study is to conduct a content analysis of Twitter posts (in English) published by users in the United States between February 1, 2016, and October 31, 2018, to examine perspectives that potentially influence the treatment decision among patients with psoriasis.

METHODS

User-generated Twitter posts that include keywords related to psoriasis will be analyzed using text classifiers to identify themes related to the research questions. We will use Symplur Signals, a health care social media analytics platform, to access the Twitter data. We will use descriptive statistics to analyze the data and identify the most prevalent topics in the Twitter content among people with psoriasis.

RESULTS

This study is supported by the National Center for Advancing Translational Science through a Clinical and Translational Science Award award. Study approval was obtained from the institutional review board at the University of Southern California. Data extraction and cleaning are complete. For the time period from February 1, 2016, to October 31, 2018, we obtained 95,040 Twitter posts containing terms related to "psoriasis" from users in the United States published in English. After removing duplicates, retweets, and non-English tweets, we found that 75.51% (52,301/69,264) of the psoriasis-related posts were sent by commercial or bot-like accounts, while 16,963 posts were noncommercial and will be included in the analysis to assess the patient perspective. Analysis was completed in Summer 2020.

CONCLUSIONS

This protocol paper provides a detailed description of a social media research project including the process of data extraction, cleaning, and analysis. It is our goal to contribute to the development of more transparent social media research efforts. Our findings will shed light on whether Twitter provides a promising data source for garnering patient perspective data about psoriasis treatment decisions. The data will also help to determine whether Twitter might serve as a potential outreach platform for raising awareness of psoriasis and treatment options among patients and implementing related health interventions.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/13731.

Public Interest in a Potentially Harmful, Non-Evidence-Based "Wellness" Practice: Cross-Sectional Analysis of Perineum Sunning

BACKGROUND

Perineum sunning/tanning is a potentially harmful yet popular new health trend cultivated by a viral social media post, famous public figures, and subsequent media coverage.

OBJECTIVE

Our primary objective is to evaluate public interest in perineum sunning/tanning.

METHODS

Using an observational study design, we extracted data from Google Trends for the terms "perineum sunning," "perineum tanning," "Metaphysical Meagan," and "Josh Brolin"; and Twitter (via SproutSocial) for "perineum sunning" and "perineum tanning" from November 1, 2019, to December 31, 2019. UberSuggest was used to investigate monthly search volumes and user engagement. We used data from Google Trends and Twitter to construct autoregressive integrated moving average (ARIMA) models to forecast public interest in perineum sunning and perineum tanning had the post on social media never occurred. Next, we performed an integral function to calculate the cumulative increase in "perineum tanning" from the day after the post occurred to the end of the year as the area between the forecasted values and the actual values. Using Welch t tests, we compared forecasted and actual values for "perineum sunning" and "perineum tanning" using Twitter and Google Trends data over 1-, 2-, and 4-week periods after the social media post to determine if the increased volumes were statistically significant over time. Lastly, we monitored Google Trends for "perineum sunning" and "perineum tanning" through September 30, 2020, to capture trends during the summer months.

RESULTS

Before the Instagram post went viral, there was no search interest in perineum sunning. ARIMA modeling for perineum tanning forecasted no increase in searches (0.00) if the post had not gone viral, while actual interest conveyed a relative cumulative increase of 919.00% from the day the post went viral through December 31, 2020. The term "perineum sunning" was mentioned on average 804 (SD 766.1) times daily for this 7-day period, which was also significantly higher than predicted (P≤.03), totaling 5628 tweets for these 7 days. The increased volume of tweets and relative search interest from Google Trends remained significantly higher for both terms over the 1-, 2-, and 4-week intervals. User engagement showed that nearly 50% of people who searched for "perineum sunning" were likely to click a returned link for more information. Continued observance of search interest in perineum sunning demonstrated interest spikes in the summer months, June and July 2020.

CONCLUSIONS

Google Trends and Twitter data demonstrated that one social media post claiming non-evidence-based health benefits of regular sun exposure-without the use of sunscreen-generated significant public interest. Medical journals, dermatologists, and other health care professionals are obligated to educate and correct public misperceptions about viral wellness trends such as perineum sunning.

Prevalence of Health Misinformation on Social Media: Systematic Review

Background

Although at present there is broad agreement among researchers, health professionals, and policy makers on the need to control and combat health misinformation, the magnitude of this problem is still unknown. Consequently, it is fundamental to discover both the most prevalent health topics and the social media platforms from which these topics are initially framed and subsequently disseminated.

Objective

This systematic review aimed to identify the main health misinformation topics and their prevalence on different social media platforms, focusing on methodological quality and the diverse solutions that are being implemented to address this public health concern.

Methods

We searched PubMed, MEDLINE, Scopus, and Web of Science for articles published in English before March 2019, with a focus on the study of health misinformation in social media. We defined health misinformation as a health-related claim that is based on anecdotal evidence, false, or misleading owing to the lack of existing scientific knowledge. We included (1) articles that focused on health misinformation in social media, including those in which the authors discussed the consequences or purposes of health misinformation and (2) studies that described empirical findings regarding the measurement of health misinformation on these platforms.

Results

A total of 69 studies were identified as eligible, and they covered a wide range of health topics and social media platforms. The topics were articulated around the following six principal categories: vaccines (32%), drugs or smoking (22%), noncommunicable diseases (19%), pandemics (10%), eating disorders (9%), and medical treatments (7%). Studies were mainly based on the following five methodological approaches: social network analysis (28%), evaluating content (26%), evaluating quality (24%), content/text analysis (16%), and sentiment analysis (6%). Health misinformation was most prevalent in studies related to smoking products and drugs such as opioids and marijuana. Posts with misinformation reached 87% in some studies. Health misinformation about vaccines was also very common (43%), with the human papilloma virus vaccine being the most affected. Health misinformation related to diets or pro–eating disorder arguments were moderate in comparison to the aforementioned topics (36%). Studies focused on diseases (ie, noncommunicable diseases and pandemics) also reported moderate misinformation rates (40%), especially in the case of cancer. Finally, the lowest levels of health misinformation were related to medical treatments (30%).

Conclusions

The prevalence of health misinformation was the highest on Twitter and on issues related to smoking products and drugs. However, misinformation on major public health issues, such as vaccines and diseases, was also high. Our study offers a comprehensive characterization of the dominant health misinformation topics and a comprehensive description of their prevalence on different social media platforms, which can guide future studies and help in the development of evidence-based digital policy action plans.

YouTube as a Source of Influenza Vaccine Information in Spanish

Our objective was to analyze the information in Spanish on YouTube about the influenza vaccine. In August 2020, a search was conducted on YouTube using the terms “Vacuna gripe”, “Vacuna influenza”, and “Vacuna gripa”. Associations between the type of authorship, country of publication, and other variables (such as tone, hoaxes, and vaccination recommendations) were studied via univariate analysis. A total of 100 videos were evaluated; 57.0% were created in Mexico (24.0%), Argentina (17.0%), and Spain (16.0%), and 74.0% were produced by mass media or health professionals. Positive messages were detected in 65.0%. The main topics were the benefits of the vaccine (59.0%) and adverse effects (39.0%). Hoaxes were detected in 19 videos. User-generated content, compared to that of health professionals, showed a higher probability of hoaxes (odds ratio (OR) = 15.56), a lower positive tone (OR = 0.04), and less evidence of recommendations to vaccinate pregnant individuals (OR = 0.09) and people aged 60/65 or older. Videos published in Spain, in comparison with those from Hispanic America, presented significant differences in the positive tone of their messages (OR = 0.19) and in the evidence of the benefits of vaccination (OR = 0.32). A higher probability of hoaxes was detected in videos from Spain and the USA. Information in Spanish about the influenza vaccine on YouTube is usually not very complete. Spanish health professionals are urged to produce pro-vaccination videos that counteract hoaxes, and users in Hispanic America should be advised to consult videos produced in Hispanic American countries by health professionals to obtain reliable information.

"Fake news" in dermatology. Results from an observational, cross-sectional study

BACKGROUND

Social networks have become a means for disseminating information on health-related matters.

OBJECTIVE

Describe the characteristics and analyze the accuracy of the dermatology content that is most often shared on the most popular social networks.

MATERIALS AND METHODS

The content most often shared on social networks (Facebook, Pinterest, Twitter, and Reddit) between March 2019 and March 2020 was analyzed using the keywords: acne, alopecia/hair loss, psoriasis, eczema, melanoma, skin cancer, rash, and rosacea. The total number of interactions, skin disease, topic, and origin was collected from each of the records. The content was analyzed and was categorized as precise, confusing, or imprecise based on the scientific evidence available.

RESULTS

A total of 385 websites were included. About 44.7% of the shared content was rated as imprecise, 20% as confusing, and 35.3% as precise. The records classified as imprecise obtained a higher mean number of interactions (P < 0.05). No differences were found in terms of the level of certainty and the dermatosis studied, whereas they did exist in relation to their topic and origin (P < 0.001). Of the contents classified as imprecise, the most frequent topic and origin were "alternative medicines" and "individual opinions, articles not affiliated with health institutions, nor peer reviewed," respectively.

CONCLUSIONS

The majority of the contents often shared on social networks are below acceptable quality standards. Strategies are needed to discredit imprecise information and promote the dissemination of evidence-based dermatology information.

Xigua Video as a Source of Information on Breast Cancer: Content Analysis

Background

Seeking health information on the internet is a popular trend. Xigua Video, a short video platform in China, ranks among the most accessed websites in the country and hosts an increasing number of videos with medical information. However, the nature of these videos is frequently unscientific, misleading, or even harmful.

Objective

Little is known about Xigua Video as a source of information on breast cancer. Thus, the study aimed to investigate the contents, quality, and reliability of breast cancer–related content on Xigua Video.

Methods

On February 4, 2020, a Xigua Video search was performed using the keyword “breast cancer.” Videos were categorized by 2 doctors based on whether the video content provided useful or misleading information. Furthermore, the reliability and quality of the videos were assessed using the 5-point DISCERN tool and 5-point global quality score criteria.

Results

Out of the 170 videos selected for the study, 64 (37.6%) were classified as useful, whereas 106 (62.4%) provided misleading information. A total of 41.8% videos (71/170) were generated by individuals compared to 19.4% videos (33/170) contributed by health care professionals. The topics mainly covered etiology, anatomy, symptoms, preventions, treatments, and prognosis. The top topic was “treatments” (119/170, 70%). The reliability scores and global quality scores of the videos in the useful information group were high (P<.001). No differences were observed between the 2 groups in terms of video length, duration in months, and comments. The number of total views was higher for the misleading information group (819,478.5 vs 647,940) but did not reach a level of statistical significance (P=.112). The uploading sources of the videos were mainly health care professionals, health information websites, medical advertisements, and individuals. Statistical differences were found between the uploading source groups in terms of reliability scores and global quality scores (P<.001). In terms of total views, video length, duration, and comments, no statistical differences were indicated among the said groups. However, a statistical difference was noted between the useful and misleading information video groups with respect to the uploading sources (P<.001).

Conclusions

A large number of Xigua videos pertaining to breast cancer contain misleading information. There is a need for accurate health information to be provided on Xigua Video and other social media; health care professionals should address this challenge.

Internet and social media use in dermatology patients: Search behavior and impact on patient-physician relationship

The traditional patient-physician relationship is being changed by the patients' searches for medical information on the Internet and in social media (SM). Freely available medical information online bears enormous potential but also holds dangers. In this cross-sectional, questionnaire-based study, the patients' motivation, preferences and unmet needs when searching for medical information online and the impact on the patient-physician relationship were assessed using Spearman's correlation coefficients, χ² -tests and paired t-tests. Among 460 participants, 82.4% had already used the Internet/SM to gain medical information, but in only 9.4% their dermatologists had raised this topic. Online search for medical information was associated with female gender (P = .048), a higher skin-related burden (P = .020), higher level of education (P = .072), higher income (P = .019), anxiety (P = .004), and adnexal skin diseases (P = .043). For 16.1% of patients, "the Internet/SM" was their most important source of medical information; 81.4% deemed the impact of their online searches on their patient-physician relationship as neutral, 16.0% as positive, 2.6% as negative. The patients' top three unmet needs were "Online consultations", "Professional content on YouTube" and "Chat opportunities". Online search for medical information is a very important topic for most dermatology patients but it may not be adequately addressed by dermatologists. Our results indicate that from the patients`perspective such online searches do not have a significant impact on patient-physician relationship.

Global Trends in YouTube and Google Search Activity for Psoriasis and Atopic Eczema: Detecting Geographic Hot Spots, Blind Spots and Treatment Strategies

To date, the geographical distribution and global trends of search activities on psoriasis and atopic eczema on Google and YouTube are widely unknown. The aim of this study was to identify geographic and temporal trends in YouTube and Google search activities for psoriasis and atopic eczema. We used specific filter settings on Google Trends to indicate the global search activity for ("Psoriasis") and ("Atopic Eczema") on Google and YouTube between January 1^st , 2008 and August 7^th , 2019. The four resulting data sets were analyzed and compared with respect to geographic distribution and temporal trends. Apart from a few "blind spots" (eg, Chad, Uzbekistan) the term "Psoriasis" was queried geographically fairly evenly distributed. The opposite was true for "Atopic Eczema", which was predominantly queried from a few "hot spots" (eg, United States, Commonwealth of Nations and Sweden). Since 2008, the search activity on YouTube for "Psoriasis" has tripled, while that for "Atopic Eczema" has decreased. On Google, by contrast, search activity has risen for both "Psoriasis" and "Atopic Eczema." Google Trends can be a useful tool to track people's/patients' interests and search search behavior over time, enabling, for instance, regionally tailored information and prevention campaigns.

Fiction, Falsehoods, and Few Facts: Cross-Sectional Study on the Content-Related Quality of Atopic Eczema-Related Videos on YouTube

Background

In recent years, YouTube has become a recognized source of medical information for health care consumers. Although YouTube has advantages in this context, there are potential dangers as videos may contain nonscientific, misleading, or even harmful information.

Objective

As little is known about YouTube as a source of information on atopic dermatitis (AD), we investigated the content-related quality of AD videos and their perception among YouTube users.

Methods

The quality of the 100 most viewed AD videos was assessed by using the Global Quality Scale (GQS) and the DISCERN instrument. Videos were classified as “useful,” “misleading,” and “potentially harmful,” and the correlations of viewers’ ratings (likes) with the GQS and DISCERN scores were assessed.

Results

Among the 100 videos, 68.0% (68/100) and 62.0% (62/100) were of poor and very poor scientific quality, respectively. Additionally, 32.0% (32/100) of the videos were classified as useful, 48.0% (48/100) were classified as misleading, and 34.0% (34/100) were classified as potentially harmful. Viewers’ ratings did not correlate with the GQS and DISCERN scores. Overall, 50.0% (50/100) of the videos were posted by private individuals and promoters of complementary/alternative treatments, 42.0% (42/100) by therapeutical advertisers, and only 8.0% (8/100) by nonprofit organizations/universities.

Conclusions

Our study demonstrated that two-thirds of the videos analyzed were below acceptable medical quality standards and that many videos were disseminating misleading or even dangerous content. Subjective and anecdotal content was overrepresented, and viewers did not appear to be able to distinguish between high- and low-quality videos. Health promotion strategies by professional medical organizations are needed to improve their presence and visibility on YouTube.