Video Parameters and Scoring System
The videos included in the study were watched by two independent
surgeons, both specialized in endourology. In case of inconsistent
evaluation between the two surgeons (non-matching results), a third
physician evaluated the videos. In addition, the reactions of the
viewers to the videos were assessed by recording the parameters of total
views, views/month, and video likes and dislikes. The data were divided
into two groups based on the source of upload: Group 1 consisted of
healthcare providers (doctors, universities, academic journals,
university or non-profit physicians, or professional organizations) and
Group 2 comprised commercial companies or for-profit organizations. The
presence or absence of commercial bias was evaluated as described by
Cornish et al. (8). The degree of misinformation was assessed with
reference to currently available evidence on surgical BPH treatment as
reported by the EAU guidelines (9). In addition, we rated the extent of
misinformation of the videos based on a Likert scale of 1 to 5 (‘none’,
‘low’, ‘moderate’, ‘high’ and ‘extreme’) (10). All videos were
systematically evaluated using the Patient Education Materials
Assessment Tool for Audiovisual Materials (PEMAT) and the validated
DISCERN quality criteria (11–13).
PEMAT is a systematic method developed to select printable and
audiovisual patient education materials, which are easier to understand
and easier to act on. We used the version for audiovisual materials,
which consists of 13 items measuring understandability and four items
measuring actionability. The PEMAT provides two scores for each
material—one for understandability and a separate score for
actionability. Every item have a 1 point (Agree) or 0 points (Disagree)
and N/A was not included the calculation. There is no set cut-off value
for the scores.
DISCERN is a standardized index of quality of consumer health
information on treatment choices, which can be used by anyone without
the need for specialist knowledge. The questionnaire consists of a total
of 15 items plus an overall quality rating, with each item representing
a separate quality criterion rated from 1 to 5 points (1–2 points: low;
3 points: moderate; and 4–5 points: high quality). Thus, a total score
of 80 points is possible, with higher scores indicating higher quality.
For the purposes of this study, we rated the videos using all relevant
items and gave them an overall quality rating although not all the
videos were directly concerned with treatment choices.
To determine the overall quality of the videos, the Global Quality Score
(GQS), a five-point scale, was used (GQS: 1 = poor quality; 5 =
excellent quality). This tool measures the accessibility quality and
overall flow of the information contained within a video (14).
JAMA is a scoring system with a total of 4 points scored evaluating
whether the authors, institutions, references and sources are clearly
stated in the video, whether there is information about copyright,
whether there is any clear conflict of interest, and whether the dates
of uploading and publication are clearly given (15).