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Recent publications on YouTube have advocated its potential for patient education. However, a reliable description of what could be considered quality information for patient education on YouTube is missing.
To identify topics associated with the concept of quality information for patient education on YouTube in the scientific literature.
A literature review was performed in MEDLINE, ISI Web of Knowledge, Scopus, and PsychINFO. Abstract selection was first conducted by two independent reviewers; discrepancies were discussed in a second abstract review with two additional independent reviewers. Full text of selected papers were analyzed looking for concepts, definitions, and topics used by its authors that focused on the quality of information on YouTube for patient education.
In total, 456 abstracts were extracted and 13 papers meeting eligibility criteria were analyzed. Concepts identified related to quality of information for patient education are categorized as expert-driven, popularity-driven, or heuristic-driven measures. These include (in descending order): (1) quality of content in 10/13 (77%), (2) view count in 9/13 (69%), (3) health professional opinion in 8/13 (62%), (4) adequate length or duration in 6/13 (46%), (5) public ratings in 5/13 (39%), (6) adequate title, tags, and description in 5/13 (39%), (7) good description or a comprehensive narrative in 4/13 (31%), (8) evidence-based practices included in video in 4/13 (31%), (9) suitability as a teaching tool in 4/13 (31%), (10) technical quality in 4/13 (31%), (11) credentials provided in video in 4/13 (31%), (12) enough amount of content to identify its objective in 3/13 (23%), and (13) viewership share in 2/13 (15%).
Our review confirms that the current topics linked to quality of information for patient education on YouTube are unclear and not standardized. Although expert-driven, popularity-driven, or heuristic-driven measures are used as proxies to estimate the quality of video information, caution should be applied when using YouTube for health promotion and patient educational material.
Founded in February 2005, YouTube is a free video-sharing site that allows people to find, view, and share videos [
Currently, YouTube has over 100 million videos, and has become a valuable resource to find videos containing personal stories about health and illnesses [
Taking into account the exponential growth and popularity of YouTube, it has been suggested this video-sharing site could be considered an effective channel and a powerful tool for health education. While the most popular use of YouTube at present is primarily for entertainment sources, as people become increasingly comfortable and familiar with social media sites, the number of people using social media for health purposes will likely rise. In fact, a recent report from the Pew Internet & American Life Project showed that 72% of online 18-29 year olds use social networking websites, and that 31% of online teens (aged 12-17) get their information on health, dieting, or physical fitness from the Internet [
Studies are emerging to recognize the role and relevance of YouTube for health promotion [
A conscientious literature review by adapting the systematic review approach was performed on the concept of quality of information for patient education on YouTube. The electronic databases consulted were MEDLINE, ISI Web of Knowledge, Scopus, and PsychINFO. Since research on the use of YouTube for patient education is limited, we gave priority to primary sources that were published in peer-reviewed journals providing outcome data.
Two search strategies were used in MEDLINE, one based on the use of only Medical Subject Headings (MeSH) and the second based on text-word searches. For the first search, researchers used the following MeSH terms: Internet; Health Communication; Health Literacy, Personal Satisfaction; Information Literacy; Access to Information; Consumer Health Information; Communications Media; and Computer Communication Networks. These terms were combined with the word “YouTube” limited to publications in English. For the second search, free terms were used: YouTube; and quality of information; health; healthcare; and patient education in combination with YouTube, and also limited to publications in English.
Similar search strategies were applied in other databases, and all publications containing the concepts “YouTube” and “Quality of information” in ISI Web of Knowledge, Scopus, and PsychINFO were also included. All searches were performed in November 2011.
Titles and abstracts identified in the bibliographic databases were reviewed by two researchers (AL and EG) independently in the first abstract review. Duplicated studies and those with missing abstracts were excluded. Abstracts meeting any of the following exclusion criteria were also excluded: (1) the scope was not YouTube, and/or (2) the concept of quality of information for patient education was absent. A second abstract review was performed, where discrepancies between the first two reviewers were discussed with two additional independent reviewers (LF and MA) until consensus was reached. Full text of studies with agreement from at least two reviewers were retrieved for careful data extraction of the concepts, definitions, and topics used by its authors on the quality of information on YouTube for patient education. Search results are summarized in
The complete data extraction process and analysis was performed adapting the PRISMA recommendations for systematic reviews [
Literature search and study selection process of quality of information for patient education on YouTube.
We retrieved 456 references from scientific databases (
The 13 abstracts selected in the first round were analyzed by two additional independent reviewers (LF and MA), who classified them as included or excluded using the same pre-determined criteria. After this second abstract review, 4 references were considered for inclusion by two reviewers, 5 references by three reviewers, and 4 references by all four reviewers. Overall, 13 abstracts that were selected by at least two reviewers were incorporated for full text analysis.
A careful review of the selected papers were performed by EG and LF, looking for concepts related to (1) quality of information for patient education, (2) characteristics analyzed by authors to consider if a video had “quality”, (3) the dimensions used to classify quality, and (4) who was involved in conducting the classification. We also considered metadata of a video (eg, labels, title, description) as part of the video. Recurrent topics linked to quality of information for patient education are summarized in
Topics linked to quality of information for patient education on YouTube.
|
Almeida et al |
Backinger et al |
Dawson et al |
Figueiredo et al |
Figueiredo et al |
Lim et al |
Gooding and Gregory |
Murugiah et al |
Pandey et al |
Sajadi and Goldman |
Sood et al |
Steinberg et al |
Tian |
Frequency |
Quality content (includes accuracy-credibility of content, scientifically correct information, and/or evidence-based practices) |
|
✓ | ✓ |
|
|
✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 10 (77%) |
View count / popularity | ✓ | ✓ | ✓ |
|
|
✓ | ✓ | ✓ | ✓ |
|
✓ |
|
✓ | 9 (69%) |
Rated by expert (medical staff) |
|
✓ | ✓ |
|
|
✓ |
|
✓ | ✓ | ✓ | ✓ | ✓ |
|
8 (62%) |
Adequate length / duration |
|
|
|
|
|
|
✓ | ✓ | ✓ |
|
✓ | ✓ | ✓ | 6 (46%) |
Public ratings |
|
✓ |
|
|
|
✓ |
|
|
|
|
✓ | ✓ | ✓ | 5 (39%) |
Good description / comprehensive narrative provided | ✓ |
|
|
✓ | ✓ |
|
✓ |
|
|
|
|
|
|
4 (31%) |
Technical quality (light, sound, angle, resolution) |
|
|
|
|
|
✓ | ✓ |
|
|
|
|
✓ | ✓ | 4 (31%) |
Further contact info provided / credentials |
|
|
|
|
|
|
✓ | ✓ |
|
✓ | ✓ |
|
|
4 (31%) |
Suitability as a teaching tool |
|
|
|
|
|
✓ |
|
|
✓ | ✓ |
|
|
✓ | 4 (31%) |
Comments (by viewers) | ✓ |
|
|
✓ |
|
|
✓ |
|
|
|
|
|
✓ | 4 (31%) |
Title and tags | ✓ |
|
|
✓ | ✓ |
|
|
|
|
|
|
|
|
3 (23%) |
Amount of content / enough information to identify its objective | ✓ |
|
|
✓ | ✓ |
|
|
|
|
|
|
|
|
3 (23%) |
Viewership share (number of links to the video and/or number of shares in other social media) |
|
|
|
|
|
|
|
|
✓ |
|
✓ |
|
|
2 (15%) |
Description of video | ✓ |
|
|
✓ |
|
|
|
|
|
|
|
|
|
2 (15%) |
Health professional(s) and patient(s) seen in video |
|
|
|
|
|
|
✓ |
|
|
|
|
|
|
1 (8%) |
Mention intended target audience |
|
|
|
|
|
|
|
✓ |
|
|
|
|
|
1 (8%) |
Judgment include patients/parents/users |
|
|
✓ |
|
|
|
|
|
|
|
|
|
|
1 (8%) |
Examples of criteria used to judge quality of health information for patient education on YouTube.
The most frequently-used concept to assess patient education information in a video is the quality of its content, assessed by experts such as health professionals, IT researchers, and other researchers [
The next most frequently used criteria for quality assessment was
Heuristic measures based on metadata and other attributes of a video were also used to assess quality. For example,
Unlike medical and health information websites where it is possible to guarantee the quality and trustworthiness of its contents through certificates, measuring quality of health videos on YouTube is an under-developed area, requiring much attention. Only 13 papers focused specifically on YouTube have reported on quality measures of online videos for patient education, covering a wide spectrum of 17 quality measures.
Moreover, 10 of these selected papers were published in journals related to health and medicine, and generally referring to chronic conditions. We did not find any paper that reported on the potential of YouTube for educating consumers and patients on disease prevention, where knowledge could potentially influence behaviors and decrease risks, such as obesity or sexually transmitted diseases.
There are 3 main ways that researchers used as quality assessment measures on YouTube: expert-driven [
Related to YouTube, content rated by an expert (such as medical or health professional staff) is the most frequently used criterion for assessing quality when referring to videos focused on health education. In fact, health and medical websites are increasingly being encouraged to apply for quality certificate assessments as proof of evidence that they are reliable sources of information which have been evaluated by experts [
Alternative solutions, such as using the social networking approach, could represent a sustainable approach, taking the advantage of collective intelligence to assess the trustworthiness of social media content on YouTube [
Popularity is the second most frequently cited concept in assessing quality on YouTube, often referred to as view count and/or public ratings. Unlike the focus on the assessment of the quality of content, which relies on human judgement and evaluation, view count or video views per day are quantitative measures that are readily accessible for each video on YouTube. However, some videos have higher view counts due to marketing campaigns, viral effects, because the video has been posted for a longer period of time, or was linked from several webpages. Users need to be aware that frequency of views may be manipulated by parties with specific agendas to achieve its “perceived” popularity.
Although video popularity is often used as a proxy to assess for quality, previous research has shown that online crowd influence can potentially lead consumers to making unsafe health decisions [
As YouTube becomes one of the major outlets for organizations, news sources, and consumers alike for channelling and expressing their opinions and points of view [
Although researchers have used video metadata such as adequate length of the video to assess its quality, there are no evidence-based justifications on why these features could be used as quality measures. These measures should be considered as
Given the exponential growth of YouTube videos, a multi-faceted approach that utilizes a social network approach [
Our main focus was to identify (not evaluate) the different quality features related to the quality of information for patient education on YouTube, which have been reported by researchers in the literature. The focus on peer-reviewed journal papers (and not on grey literature) in our approach was to ensure that the literature extracted that informs our view was peer-informed and of quality standard. We conducted a preliminary search for other video platforms (eg, Vimeo) but did not find any publications, thus we focused primarily and specifically on YouTube. Literature assessing health information on the Internet that includes presentations presented in video format was not considered in this review.
As YouTube is relatively new (started in 2005, although its popularity came quickly), there are only a handful of studies analyzing its quality for patient health education. Although 20% of traffic on YouTube comes via mobile devices [
We must emphasize that although our search was limited to publications in English, we found that one of them was written in Brazilian Portuguese [
Our review confirms that the current topics linked to quality of information for patient education on YouTube are unclear and not standardized. Studies assessing quality on YouTube are few but emerging, with a variety of measures (such as expert-based, popularity-based, and heuristics-based) proposed to clarify and expand the concept of quality. Future research should investigate the types of measures that consumers and patients would actually use and/or find beneficial when assessing quality for health purposes on social media sites.
With the role of the Internet as a social network, typified by growing interest in Medicine 2.0 and Health 2.0, patients and consumers are increasingly seeking health information and advice from online peer networks. Although YouTube has the potential to be used for health education and health promotion [
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human papillomavirus
Medical Subject Headings
The authors acknowledge the contributions of J. Artur Serrano for his support, advice and suggestions for improving the manuscript. This work was supported by the Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway. LFL's work is supported by the Tromsø Telemedicine Laboratory co-funded by the Research Council of Norway (Project 174934). And at the time of writing, AL was supported by the National Health and Medical Research Council Centre of Research Excellence in Informatics and E-Health (1032664).
None declared.