Discussion
In this study, we evaluated the quality of YouTube videos on HoLEP that
has gained popularity as a frequently preferred surgical method for BPH.
Across the world, there are approximately 3 billion internet users that
can share information through virtual communication and interaction via
the internet in contrast to the more traditional method (16). The huge
video archive on YouTube naturally consists of a large number of video
contents that examine each subject or topic from different perspectives.
However, available evidence has shown that patients can be exposed to
low-quality, biased, and/or commercial videos, which can lead to
dangerous consequences (7,17) Therefore, it is important to evaluate the
reliability and quality of YouTube videos providing health information.
Platforms such as YouTube allow patients to easily obtain information
about the issues in which they are interested. However, based on the
information presented here, patients can also make poor decisions or
resort to expensive treatments. Nevertheless, the literature shows the
increasing viewing of videos about the health field among patients or
healthcare professionals (18).
Depending on the upload source of surgical videos on YouTube, the
message conveyed to the viewer and its reliability may vary. In a study
conducted by Huang et al., it was found that the videos that did not
contain accurate information were viewed more and received more comments
(19). In another study, it was proven that fake news or inaccurate
content spread faster in the internet environment and created more
interaction (20). Other researchers similarly emphasized that training
videos for skill development might mislead patients due to the presence
of unreliable information (21). In our study, regardless of the upload
source, we observed that 16.2% had extreme- or high-degree
misinformation while commercial bias was present in 55.7%. In addition,
it was observed that complications and alternative treatments were not
mentioned in most of the videos. In previous studies, it was shown that
the majority of videos uploaded to YouTube were not reliable (22,23). In
a review, it was emphasized that most of the health-related YouTube
videos presented inaccurate and unreliable information (24). The
literature indicates that this misinformation is not necessarily caused
by a source being inappropriate or having insufficient expertise, and it
could actually be intentional (25). Therefore, we consider that surgical
videos on YouTube may pose more of a threat than guidance for patients
seeking information to make a treatment decision.
There is no study evaluating the information sources of patients with
BPH; therefore, it is not precisely known how the videos posted on
video-sharing sites reflect on or affect patients. In previous studies,
it was emphasized that the videos uploaded by universities or healthcare
institutions provided more comprehensive information and had higher
quality (26,27). In a study by Gul et al., the videos were classified as
those containing reliable and unreliable information, and the GQS and
reliability scores were found to be statistically higher in the former.
In addition, the authors showed that the majority of videos containing
reliable information had been uploaded by for-profit companies (28). In
our study, 23.0% of the total videos had been uploaded by Group 2. In
the literature, it has been reported that the vast majority of
educational videos without any financial gain such as those on breast
self-examination had been uploaded by universities or physicians, but
most on oral leukoplakia had been uploaded by commercial companies for
advertisement purposes (23,29). We attribute these differences to the
variations of the subjects discussed in videos. In our study, no
significant difference was observed in DISCERN, GQS and JAMA scores
between the upload source groups. There was also no difference between
the two groups in relation to the total number of views, likes and
dislikes. A previous study compared videos as useful and misleading, and
in contrast to our findings, the authors reported the comprehensiveness
score of GQS to be statistically significantly higher in useful videos
(21). In the same study, when the data were compared according to the
upload source, the GQS, misleading information and comprehensiveness
scores were found to be statistically higher for the videos that had
been uploaded by for-profit companies (21). In contrast, in our study,
we also evaluated the videos using JAMA, PEMAT and Likert scales and
found that the PEMAT and misinformation scores were higher in the videos
uploaded by Group 2. In a study conducted by Fode et al. to evaluate
videos containing medical information, the median PEMAT
understandability score was found to be 100% (range 50-100) and the
median PEMAT actionability score was 100% (range 33-100). It was
observed that 28% of 92 videos containing medical information contained
misinformation. The results of their multivariate regression analysis
revealed that all the parameters of videos uploaded by medical
institutions had a statistically significant effect on DISCERN rating
(30). In our study, the PEMAT score differed according to the upload
source of the videos. The understandability and actionability scores of
the videos uploaded by Group 2 were statistically significantly higher
compared to Group 1. Furthermore, although there was misinformation in
both groups, the number of videos with high-degree misinformation was
significantly higher in Group 2. We consider that the videos uploaded by
Group 2 aim to encourage or direct patients to undergo HoLEP surgery,
which is a new and expensive treatment. In addition, in the study
conducted by Fode et al., it was emphasized that there was no barrier
and/or restriction when uploading content to websites, especially in the
field of health. In the same study, the authors observed that the
majority of the videos had a DISCERN score of 3 or less (30). In a study
by Huang et al., there was no difference in the median number of viewers
and viewer interaction according to low or high DISCERN scores. However,
the authors observed that if a video had been uploaded by an academic
hospital, it had a higher DISCERN score (19). Similarly, in our study,
there was no difference between the DISCERN groups in terms of video
viewing parameters. This shows that people watch these videos without
distinguishing between poor and good content or they may even not know
how to make such a distinction. Thus, the videos they watch can direct
them to a wrong treatment or misinformation. The PEMAT score also showed
that these videos were easy to understand. Although the easy
understandability of a video is a favorable characteristic,
misinformation contained in some of the videos can have further negative
effects on viewers. The subject of misinformation has been previously
investigated and findings similar to our study have been presented by
many studies. However, in the literature, the rating of the extent of
misinformation as part of video analysis is usually undertaken in a
subjective manner, and the rating options are self-designed (e.g., very
little, moderate, high and extreme level of misinformation) (25). In our
study, all the videos were evaluated independently by two authors. In
the evaluation of misinformation, a Likert-type scale was used to
minimize possible bias. Inconsistencies were rare, but if any, they were
resolved through the evaluation of the third author.
Another cause of concern is the frequent mention of unreliable
information and sources of information in viewers’ comments related to
videos since it can mislead viewers. As emphasized earlier, false
information spreads faster on the internet than accurate information.
Doctors and healthcare institutions and associations have great
responsibility in preventing the spread of such misinformation.
Moreover, there are currently no measures to prevent the spread of false
information in the comment sections of high-quality videos. Therefore,
physicians should direct patients to videos that have been reviewed and
proven to be reliable, not only during face-to-face meetings but also
through digital interactions, including social media posts, online
communications, and telehealth visits. Our findings highlight the
importance of high-quality videos that objectively cover all spectrums
of a treatment modality and are able to explain it in a way that
patients can understand. High-quality information platforms are
available (31). In addition, urology associations should be encouraged
to upload high-quality and easy-to-understand videos to websites such as
YouTube, where patients can research theirs diseases and treatment
options.
Videos from a single video-sharing platform (YouTube) were viewed;
however, since YouTube is an ever-evolving website, the evaluation of
videos at a single time point may not accurately reflect what patients
view after this initial search. By excluding non-English language
videos, we may have further reduced the generalizability of our
findings. Our study did not include videos available on other online
video platforms such as Vimeo or those posted on academic department
websites that may not be available on YouTube due to license agreements.
Another limitation of the study can be considered as the inability to
obtain the demographic characteristics of video viewers. There is still
no complete consensus on how to fully evaluate health-related online
videos.