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*Corresponding Author: Berrin Erok, Department of Radiology, Prof Dr Cemil Tascıoglu City Hospital, İstanbul, Turkey.
Citation: H Akyol, B Erok. (2021). Quality of Information Available on YouTube Videos Pertaining to Bariatric Surgery. International Journal of Clinical Case Reports and Reviews. 9(2); DOI: 10.31579/2690-4861/173
Copyright: © 2021 Berrin Erok, This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 07 September 2021 | Accepted: 29 November 2021 | Published: 09 December 2021
Keywords: bariatric surgery; hospital; disadvantages; gastrectomy; surgical technique
YouTube is one of the most frequently used online sources providing easy access to health information with a large, diverse, and searchable video library. However, an unregulated policy and lack of peer-review process are important disadvantages. Accordingly, while based on thousands of surgical, animated, oral presentation and patient-experience videos, the information provided by YouTube videos is considered questionable in terms of quality, accuracy and credibility.
YouTube is one of the most frequently used online sources providing easy access to health information with a large, diverse, and searchable video library [1-3]. However, an unregulated policy and lack of peer-review process are important disadvantages [1-3]. Accordingly, while based on thousands of surgical, animated, oral presentation and patient-experience videos, the information provided by YouTube videos is considered questionable in terms of quality, accuracy and credibility [4-7].
Obesity has become a serious public health problem worldwide and is one of the most searched topics about health issues on the internet [5,6,8]. Bariatric surgery, the laparoscopic sleeve gastrectomy in particular, has increasingly been performed as the only long-standing effective treatment method of morbid obesity [5-7,9]. Accordingly, there is an increased popularity of bariatric surgery as well as the improved desire to have a rapid access to information through related YouTube videos, necessitating the evaluation of the quality of videos that can be found on that platform [6,7,10]. However, there are limited number of studies regarding quality of YouTube videos on bariatric surgery or sleeve gastrectomy and most of them were focused mainly on educational quality of surgical technique videos [5-7,11].
We have hypothesized the likelihood of lower quality of information provided by YouTube videos pertaining to bariatric surgery if were uploaded by sources other than academic institutions and physicians, as well as the likelihood of a discordance between video quality and user engagement, depending on the consideration of usefulness rather than optimal quality and accuracy of video content as the criteria for favorable public response.
This study was designed to assess the quality of information available on YouTube videos pertaining to bariatric surgery, based on well-recognized quality scoring systems and entire context available.
A search of YouTube (http://www.youtube.com) was performed on the June 20, 2020 using the search term “bariatric surgery”. The first 100 videos that appeared on each search were reviewed. Videos were independently analyzed by two authors. Video characteristics including the publishing source of upload (doctor, hospital, commercial), continent of origin, content (surgical technique, information, patient experience) and video statistics including the video length (min), number of views, number of likes, number of dislikes and days since upload were recorded. The quality of information was assessed using the Global Quality Scale (GQS) [12], DISCERN [13] and Journal of American Medical Association (JAMA) benchmark [14] scores, while video power index (VPI) was also calculated using the formula: “Number of likes / (Number of likes + dislikes) x 100”
The quality assessment scores were compared according to video source and content, while the correlations between descriptive parameters (scale scores and video statistics) were also analyzed.
The GQS is a subjective measure of overall quality of information, graded on a 5-point Likert scale, with 1 representing poor quality (most information missing, not all useful for patients) and 5 representing excellent quality (very useful for patients) [12].
The DISCERN is an instrument to evaluate written consumer health information that comprises of 16 questions scored from 1 to 5. The total score ranges from 6 to 80, with higher scores indicating a better quality [13]. Although DISCERN was developed to assess written health information, it is considered applicable online quality tool and several studies confirmed its use as an in a variety of settings including evaluation of YouTube videos [14-18]
The JAMA benchmark evaluates the quality of online information using four distinct criteria including authorship (authors, contributors, affiliations, and credentials), attribution (references and sources used for the content, copyright information), disclosures (sponsorship, advertising, commercial funding, potential conflicts of interests), and currency (dates of posted and updated information). Each criterion is scored 1 if present and the total score ranges from 0 to 4, with 4 indicating better quality [19].
Statistical analysis
Statistical analysis was made using IBM SPSS Statistics for Windows, version 22.0 (IBM Corp., Armonk, NY). Average distributions of quantitative data were tested with the Shapiro-Wilk test. The Kruskal-Wallis test and post hoc Dunn’s test were used for two-way intergroup comparisons of quantitative variables with no normal distribution. Spearman correlation analysis was used to evaluate the relationships between quantitative variables according to the results of normality test. The ICC (intra-class correlation coefficient alpha) was calculated to evaluate the compliance between the observers with consideration of α< 0>
Video characteristics
Overall, most of the videos (59.0%) were uploaded by hospitals, as followed by commercial uploads (26.0%) and videos uploaded by doctors (8.9%). The continent of origin was America in all videos. Video content was related to general information on disease or surgery in 53.0% of videos, while related to patient experience and surgical technique in 32.0% and 15.0% of cases, respectively (Table 1).
Descriptive statistics for YouTube videos
Average duration of videos was 3.44 (0.17-59.04) min. Median number of views was 12965, number of likes was 52 and the number of dislike was 4. (Table 1).
The median video power index was 8.7 (range, 0.25 to 1047.73) (Table 2).
GQS score was median 3 (range, 1 to 5) for both reviewer 1 and reviewer 2, along with a high level of concordance between reviewers (90.3%, ICC: 0.904;
Our findings revealed most of the YouTube videos pertaining to bariatric surgery to be hospital-sourced videos related to information on disease or patient experience rather than the surgical technique. Overall JAMA, GQS and DISCERN scores were consistent with moderate quality (mean scores: 2.33, 3.22 and 53.42, respectively) of information provided.
Data from past studies indicate the unreliability and poor quality of YouTube videos related to various diseases [3,18,20-23]. In a systematic review of 18 studies regarding the health-care information available on YouTube, only 17% to 61% of videos were reported to be useful in terms of content and accuracy of health-care information [24].
In the current study, majority of videos reviewed were related to information on disease/surgery or the patient experience, and only 15% of videos were related to the surgery technique. The average scores for DISCERN, JAMA and GQS in the current study were slightly higher than scores reported in previous studies that have mainly addressed the educational value of surgical technique videos [5-7,11]. This seems to emphasize the likelihood of slightly higher informative quality of bariatric surgery YouTube® videos that provide general information on disease/surgery or patient experience rather than the educational videos on surgical technique.
In the current study, videos uploaded by the doctors were associated with the highest VPI, while hospital-sourced videos and videos related to patient experience were associated with the lowest GQS scores. Past studies revealed the superiority of academic institution and physician websites over websites of commercial and unspecified groups in terms of quality of information provided [18,23,25]. Identification of higher VPI scores for videos uploaded by more reliable sources (i.e. doctors or hospitals) in our study seems to indicate high popularity of videos with increased likelihood of providing correct information. However, given that less than 10% of videos reviewed in this study were uploaded by experts, our findings emphasize the need for a more active participation from surgical professionals, professional organizations and/or governments as a source of higher quality information [3,6,18,26].
Notably, in a past study on YouTube sleeve gastrectomy videos, the videos uploaded by a university-affiliated physician (vs. those uploaded by patients) and the surgical technique videos (vs. patient experiences and advertisement videos) to have significantly higher DISCERN, JAMA and GQS scores, whereas a lower VPI [7]. The authors also reported a negative correlation of VPI both with JAMA and GQS scores, indicating that YouTube users to have a favorable response to less optimal or less educational videos and less desire to watch long run time videos with higher chance of providing more accurate and reliable information [7].
The association of longer videos with lower JAMA and DISCERN scores, and thus the lower likelihood of higher quality of information provided via longer duration videos in our study seems interesting, given that long run time videos are considered to have potential to be more accurate and reliable [7]. Nonetheless, it should be noted that the actual view duration of YouTube health videos of variable lengths was considered to be 6 minutes on average [27,28], and there was no significant correlation between VPI and duration of the video in our study.
Overall, GQS score seems to be more comprehensively describing the quality of information provided by the YouTube videos on bariatric surgery reviewed in this study, given that this score was lowest for hospital-sourced and patient experience-related videos, while positively correlated with VPI, video length, and the number of view, dislike and likes. However, given the negative correlation of JAMA scores both with VPI and GQS scores, our findings indicate higher chance of videos that were considered to be useful, to be viewed and commented, despite their potential to offer poor quality information. The positive correlation between GQS scores and VPI in our study emphasizes the likelihood of videos published in accordance with GQS scoring scale to enable a greater user engagement, while neither usefulness nor the frequent view of a video does guarantee its accuracy or reliability. Likewise, past studies also reported a discordance between video quality and user engagement to optimal videos with even a greater user engagement for inaccurate videos [29-31]. In fact, supporting the likelihood of lower quality videos to be more commonly viewed, the JAMA scores were also correlated negatively with the number of views and the number of dislikes in the current study.
Notably, in a past study on YouTube videos related to bariatric surgery, authors concluded that majority of videos were useful or very useful, particularly those were uploaded by doctor or hospital or medical web site, with no significant difference in the number of likes, dislikes and views as well as in the length of videos according to usefulness [6]. In addition, in a study on surgical technique videos related to sleeve gastrectomy, authors reported no relationship between the reliability of videos and likes, dislikes and duration [5].
Inclusion of the first 100 videos that appeared on search term in our study seems consistent with the public viewer characteristics that most people take the time to look at search results for a few pages [2,18]. Thus, limiting the page number and search rank of videos provides an accurate representation of what the public is viewing [2,18]. However, since trustworthiness is not a criteria for YouTube ranking, there is a likelihood of videos from trustworthy sources to appear lower in the ranked list, whereas that of misleading and incorrect videos to be popular with a high ranking [20,31]. Notably, use of a new YouTube algorithm based on the number of visualization minutes of a video instead of the use of number of clicks or likes was reported to provide a better ranking system allowing higher user acceptance and trusted videos to remain stable in the top positions [20].
Certain limitations to this study should be considered. First, use of ‘snap shot’ approach in selection of videos seems to be the major limitation of this study given that results might vary with use of different search terms as well as according to the search date and time. Second, while inclusion of only the first 100 videos for each search is consistent with actual view characteristics, it is possible that more popular videos with higher likelihood of being posted by non-expert sources to be analyzed. Nonetheless, providing data on quality of information provided by YouTube videos pertaining to bariatric surgery, our findings seem to contribute raising the public, patient and physician awareness on reliability and accuracy of YouTube videos.
Our findings revealed moderate quality of information provided by YouTube videos pertaining to bariatric surgery based on GQS, DISCERN and JAMA scores. The videos uploaded by the doctors were associated with the highest VPI, while hospital-sourced videos and videos related to patient experience were associated with the lowest GQS scores. GQS scores were positively correlated with VPI, video length, and the number of view, dislike and likes. However, given the negative correlation of JAMA scores both with VPI and GQS scores, and negative correlation of JAMA scores with the number of views, our findings indicate higher chance of videos that were considered useful to be viewed and commented, despite their potential to offer poor quality information. Future studies are needed to develop optimal assessment criteria in predicting the accuracy and reliability of information provided by YouTube videos on bariatric surgery that would help in implementation of a filtering process to healthcare information videos through increased public, patient and physician awareness.
Conflict of interest: none
Funding: none
Ethical Approval: not required
Availability of data and materials: we confirm that the data supporting the findings of this study are available within the article
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