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Abstract

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusion
  8. References

Background:

This study was designed to assess the credibility of YouTube video information on acute myocardial infarction by exploring the relationship between accuracy of information on the topic, source of expertise, and perceived credibility of the message.

Hypothesis:

Health information videos in YouTube possess a diverse mix of information and can easily mislead online information seekers.

Methods:

The Web site http://www.YouTube.com was queried for the following search terms: “acute myocardial infarction,” “heart attack,” “acute coronary syndrome,” and “ST-elevation myocardial infarction.” The resulting videos were categorized according to the source of the video and content was analyzed for discussion of different aspects of disease, ranging from pathophysiology to treatment.

Results:

Only 6% of videos touched upon all aspects of acute myocardial infarction. These were mostly from professional societies, were of long duration, and were among the least viewed. Videos that described personal experiences were “liked” or “disliked” most and had the majority of comments. Only 17% of the videos discussed the preventive aspects of the disease and stressed weight-loss and exercise programs. Videos that stressed prevention were advertisements for specific weight-loss programs (45%) and diet pills (30%). Very few videos stressed other risk factors. A large number of videos were irrelevant.

Conclusions:

YouTube is a popular platform across the globe for sharing video information, including videos related to health and disease. However, the information on this platform is not regulated and can easily mislead those seeking it. We suggest that authoritative videos should come from reputable sources such as professional societies and/or academic institutions and should provide unbiased and accurate information on all aspects of diseases like acute myocardial infarction. Clin. Cardiol. 2011 DOI: 10.1002/clc.21981

The authors have no funding, financial relationships, or conflicts of interest to disclose.


Introduction

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusion
  8. References

Use of the Internet to search for information about health issues represents a participative approach to healthcare and is rapidly gaining momentum. A number of studies have confirmed the growing use of the Internet to obtain information on health issues. For instance, in 2005, 53% of the adults in the United States accessed the Internet to obtain health information. This number increased to 61% in 2006, and to 71% in 2007.1 Ease of access and an intuitive interface makes the Web site http://www.YouTube.com (YouTube) a popular platform across the globe for sharing information, including that related to health and disease.

YouTube is an online public communication Web site owned by Google Inc. on which registered users can upload and share videos, as well as view videos and make comments on them. The videos cover thousands of subjects; of those related to healthcare, videos range from homemade ones expressing personal opinions and experiences to videos made by various healthcare entities and clinicians for professional education.

However, free and unregulated information available on the Internet carries the potential hazard of misinformation. Individuals accessing health-related information on the Internet are often oblivious to issues such as who uploaded the material, when the material was last updated, and how accurate the information is. As the number of information-seekers as well as providers continues to rise, it is essential to assess how online health information is being perceived by the public and how accurate it is.

This study was designed to assess the credibility of YouTube video information on acute myocardial infarction (AMI) by exploring the relationship between accuracy of information on the topic, the source of expertise, and perceived credibility of the message. This particular disease entity was selected for its high incidence in the United States; AMI affects 1.5 million people each year,2 which makes it prudent for everyone to have a correct understanding of it.

Methods

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusion
  8. References

YouTube was queried on September 1, 2011, for 4 search terms: “acute myocardial infarction,” “heart attack,” “acute coronary syndrome,” and “ST-elevation myocardial infarction.” This search revealed >1000 videos. All irrelevant videos and videos in languages other than English were discarded, along with those beyond the tenth results page (with an assumption that most viewers do not look beyond that point). Videos without sound were also excluded. This returned a total of 116 videos. Finally, videos in multiple parts and duplicated videos were considered as 1 video, and average view count was used for analysis. Thus, a total of 104 videos were selected. This selection process is summarized in Figure 1.

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Figure 1. Flow diagram showing method of video selection.

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Videos were categorized into 6 source groups: personal experience, news reports, professional societies, pharmaceutical companies, lectures from medical institutions or teaching centers or by individual teachers, and “other media” (videos that did not fall into any of the other categories but had some information relevant to the topic). This included anything from animations from unknown sources to videos from nonteaching hospitals to media other than news channels. The following parameters were recorded: upload date, number of views, duration of the video, opinion of viewers (in the form of “like” or “dislike”), type of the video other than regular (eg, humor, song, animation, or mere advertisement for a drug, a hospital, or doctor[s]), and intended audience (layperson or medical personnel).

Next, all videos were assessed for their content. For the purpose of simplicity of assessment, the following parameters were considered and evaluated: pathophysiology of the disease, signs and symptoms, immediate measures to be taken on suspicion of AMI or acute coronary syndrome, laboratory tests, and preventive measures, with a focus on lifestyle management and control of risk factors, treatment, and complications associated with the disease.

Data were analyzed with SPSS software version 17 (SPSS Inc., Chicago, IL). Measures of central tendencies were used to express descriptive statistics. To observe the degree of agreement between 2 of the authors who assessed each video for viewability, the kappa (inter-rater agreement) coefficient of agreement using linear weights was used. Data are presented as mean ± SD.

Results

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusion
  8. References

The interobserver agreement was 80% with a kappa coefficient of 0.67 (P = 0.001).

The number of videos in each of the 6 categories is presented in the Table 1 along with other specifics related to the videos. The majority of videos (98%) were uploaded within the last 3 years. Among these, 64% were uploaded in the last year.

Table 1. Analysis of General Attributes of Videos From Different Sources
Type of Video UploadedPersonal ExperienceNews ReportProfessional SocietyPharmaceutical CompanyLectures From Medical InstitutesOther Media
  1. All numbers are expressed as mean ± standard deviation. Numbers in parentheses reflect percentage.

No.19 (16)11 (9)15 (13)5 (4)12 (10)42 (35)
Duration, sec622 ± 2424525 ± 1961095 ± 1194386 ± 2201137 ± 1009448 ± 373
No. of views25 615 ± 55 40524 718 ± 58 5798392 ± 18 9028280 ± 464118 742 ± 24 35553 923 ± 1508
Opinion: Like22 ± 2116 ± 1415 ± 911 ± 915 ± 1124 ± 22
Opinion: Dislike17 ± 1312 ± 87 ± 613 ± 98 ± 716 ± 10
Type      
 Humor2 (11)0003 (25)14 (33)
 Animation00001 (8)1 (2)
 Song2 (11)00001 (2)
 Advertisement for drug/hospital/physician2 (11)005 (100)016 (38)
Information for patients6 (32)3 (27)3 (20)1 (20)011 (26)
Information for healthcare professionals04 (36)15 (100)2 (40)12 (100)10 (24)
Awareness raising3 (16)03 (20)1 (20)05 (12)

Videos coming from “other media” were viewed most often. The duration of these videos ranged from 56 seconds to 1 hour and 14 minutes. In general, videos from professional societies and lectures were longer in duration than those from other sources (P < 0.05).

Videos from “other media” had the most “likes” in the opinion section (mean 24 ± 22) followed by those based on personal experience (mean 22 ± 21). The mean number of views was highest for the videos presented by “other media” (53 923 ± 1508), followed by those based on personal experience (25 615 ± 55405). Personal-experience videos often included humor (11% of the videos) and songs (11%).

Videos with maximum number of “dislikes” were those from personal experience (17 13) and “other media” (16 10).

One hundred percent of videos with advertisements embedded in them came from drug manufacturers. Videos from “other media” had many fewer advertisements (38%) but often included animation (33%).

Data on the extent of patient education, information for healthcare providers, and disease awareness in videos from different sources are shown in the Table 1.

Next, we analyzed videos for their focus on the following: discussion of pathophysiology of the disease, signs and symptoms, immediate treatment, complications, diagnostic tests, prevention, and treatment. As shown in Figure 2, most videos by “other media” focused on pathophysiology, whereas those from personal experience and professional societies emphasized signs and symptoms. The pathophysiology and complications were illustrated in a very lucid manner in animated videos from “other media.” Only 6% of the videos touched upon all these aspects of AMI, and they were prepared mainly by professional societies. These videos contained an elaborate discussion of the topic. Whereas the personal videos mainly focused on individual experiences of sign and symptoms (58%), the news reports related to new test(s) (9%) or prevention and treatment (45%).

thumbnail image

Figure 2. Analysis of content of videos from different sources. Abbreviations: Co., company.

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Only 7% of videos discussed immediate treatment that victims should employ when suspecting a heart attack, and 99% of them were in videos from professional societies. Prevention of disease was stressed in only 17% of the videos; among these, 10% were from professional societies, 2% were from pharmaceutical companies, 2% were didactics, and 2% were from the “other media.”

Discussion

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusion
  8. References

YouTube is a video-sharing Web site created in February 2005 and is ranked third among the most-visited Web sites on the Internet across the globe.3 The widespread use of smartphones, which frequently embrace YouTube as one of their applications, has made its use even more common. Health information available on the Internet is vast and diverse, ranging from accounts of personal illnesses to disease support groups, medical breakthroughs, updates in health and disease, peer-reviewed journal articles, and clinical support tools for laypersons and health-related professionals. Defining a single quality standard for assessing credibility of such a disparate collection of resources is indeed challenging.

Video-based information has been evaluated in the past as a source of information on vaccination, tobacco use, breastfeeding, the influenza pandemic, and basic life support.4–9 In these studies, the investigators used different criteria for quality assessment. Nonetheless, a basic framework that most of these studies, including ours, have used for determining video quality is the video's applicability to various aspects of disease, such as pathophysiology of the disease, signs and symptoms, and disease prevention and therapy. The studies also assess the quality of the video itself in terms of its content, type, source, and intended audience.

We observed that many videos were produced by professional societies, news reports, and didactic lectures from reputable universities. However, these were not the ones with the most views. The videos that were viewed most often were those posted by media not related to any professional society or part of a news report. Similarly, videos that described personal experiences were “liked” as well as “disliked” most often and had the majority of comments. This indicates that people are more interested in and show active participation in their peers' experiences about a disease rather than in professional conferences or didactic lectures, irrespective of authenticity or the source of such material. This observation is in accordance with the social learning theory, which asserts the significance of peer education in eliciting behavioral change in individuals. In our study, the distinction between videos targeting the layperson vs healthcare providers was unclear. This might be the reason for underutilization of available video resources by people in general. Further, we found that a large number of videos were irrelevant, which indicates that good videos are often mixed in with a plethora of irrelevant content. A layperson often has to sift through this vast information and runs the risk of being misinformed.

The second broad area of assessment was the content of the video, which focused on the pathophysiology of AMI, signs and symptoms, immediate measures that one should take when suspecting this condition, the consequences of this disease, diagnostic laboratory tests, and prevention and therapy of the disease. Interestingly, only 6% of the videos touched on all these aspects of AMI. However, these videos were mostly from professional societies, were of long duration, and were among the least viewed. Most videos utilized fancy animations to explain the pathophysiology of the disease but lacked reference to other aspects of the problem. There were only 4 videos, hidden behind others in the back pages in the results list, that actually stressed the significance of immediate use of aspirin and advice to summon emergency medical services without undue delay. Three videos were in song format, which, in real life, can mislead a viewer into regarding this problem as trivial. Most of the news reports were updates on recent issues like “calcium supplements and heart attack risk,” but none discussed awareness of the disease or indicated which patient group is at high risk of developing the disease. Overall, the content of videos in relation to patient education was poor. Few videos (17%) discussed preventive aspects of AMI or encouraged viewers to maintain ideal body weight and/or exercise regularly. Analysis of videos that focused on weight loss showed their purpose to be advertisement of a specific weight-loss program, and 30% advertised a diet pill. There were no videos that stressed other risk factors.

Finally, a large number of videos came from individuals with unknown credentials. It was notable that no professional organizations such as the American Heart Association or the American College of Cardiology had videos raising awareness of the top-ranked killer of people in the United States and across the globe. These organizations have their own separate Web sites; however, information on these Web sites has not been reviewed in the study.

Study Limitations

As mentioned earlier, because health information on YouTube varies extensively, defining a quality standard for such a disparate collection of resources is very challenging and the assessment framework used here is merely subjective. Further, this is a cross-sectional study based on current availability of information on YouTube. According to the YouTube press statistics, 48 hours of video are uploaded every minute, resulting in nearly 8 years of content uploaded every day. Hence, the information posted on this Web site shifts dramatically over time.10 Similarly, it is possible that video optimization and analytics may alter the search results listing for the same search item between 2 users. However, evaluation of a fairly large number of videos makes such variation less significant. Likewise, reputable authorities such as the American Heart Association or the American College of Cardiology have their own servers and Web sites with online videos hosted on YouTube. Information on these Web sites has not been reviewed in this study. Finally, this study was limited to a single video-broadcasting Web site on the Internet. Hence, the external validity of the data may be limited and may not project the scenario over the Internet as a whole.

Conclusion

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusion
  8. References

Although designed initially as a platform for the easy sharing of videos, YouTube also hosts a significant number of health-related videos. Considering its growing popularity and ease of accessibility, YouTube has become a popular platform for dissemination of knowledge and information on various topics. However, the present study suggests that the information on this platform is not regulated and contains unregulated high- and low-quality health information. Obtaining information from trusted sources is very difficult. This results in misinformation or disinformation for individuals seeking online healthcare information. Therefore, it is imperative that authoritative videos by reputable sources be posted to provide easily accessible and accurate information on diseases like AMI. Media literacy is essential to point online health-information seekers in the right direction and provide them with genuine knowledge.

References

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusion
  8. References