Popular science and education of cosmetic surgery in China: Quality and reliability evaluation of Douyin short videos

Abstract Background Douyin APP is the short video APP with the largest number of users in China. Objective This study aimed to evaluate the quality and reliability of short videos about cosmetic surgery on Douyin. Methods In August 2022, we retrieved and screened 300 short videos related to cosmetic surgery from Douyin, extracted basic video information, encoded the content and identified the video source. The quality and reliability of short video information were evaluated using the DISCERN instrument. Results A total of 168 short videos of cosmetic surgery were included in the survey, and the video sources included personal accounts and institutional accounts. Overall, the total proportion of institutional accounts (47/168, 27.98%) is significantly less than that of personal accounts (121/168, 72.02%); nonhealth professionals received the most praises, comments and even collections and reposts, while for‐profit academic organizations or institutions received the least. The DISCERN scores of 168 short videos of cosmetic surgery were 3.74–4.58 (average 4.22). Content reliability (p = .04) and overall short video quality (p = .02) are significantly different, but short videos published from different sources have no significant difference in treatment selection (p = .052). Conclusion The overall information quality and reliability of short videos about cosmetic surgery on Douyin are satisfactory in China. Patient or Public Contribution The participants were involved in developing research questions, study design, management and conduct, interpretation of evidence and dissemination.


| INTRODUCTION
In theory, the pandemic of COVID-19 in recent years will inevitably lead to a decrease in the business volume of the cosmetic surgery industry. 1 However, on 14 December 2021, the New Oxygen Data Research Institute released the 2021 white paper on medical and beauty industry, showing that 2021 has become the fastest year-on-year growth year of cosmetic surgery industry over the past 3 years during the period of repeated epidemics in China. The number of cosmetic surgery customers in China has increased instead of decreasing, and the number of users has increased by about 3 million; one of the driving forces behind this is Douyin APP. 2 The number of monthly users of Douyin APP exceeds 680 million. It is worth mentioning that these data do not include TikTok, the international version of Douyin. As one of the most successful representatives of China's overseas App, the number of users of TikTok's overseas version is also very large. 3 With 500 million daily users in China, Douyin has become a breakthrough for cosmetic surgery to attract customers. 4 The originality, interactivity and sociality of Douyin provide a better user experience and sense of participation for the younger generation while seeking health information. 5 Douyin offers rich modes of information (such as text, images, audio and video) and contains a large number of technical functions, such as commenting, chatting, tracking, liking and livestreaming. The features make the app easier for the public to use as a source of health information 6 ; also, Douyin's penetration and usage among some older age groups are on the rise. 7 In the years since the advent of Douyin APP, everyone has gradually opened their own horizons, accepted cosmetic surgery more and more and improved their sense of urgency for their own image management.
At present, there are more than 2 million medical institutions engaged in plastic surgery in China, and when we search for 'plastic surgery' in Douyin, there are more than 60,000 institutional certification accounts, which means that on average, 3 out of every 100 cosmetic and surgical institutions make short videos in Douyin to attract customers. This is not counting individual users and beauty bloggers. It is conceivable that the competition in the cosmetic surgery industry is fierce, but it also proves that the popular science and education of Douyin short video is an excellent channel for cosmetic surgery institutions to attract customers on the internet. However, the huge number of users also means that the quality of short videos may be uneven, and the quality and reliability of the information provided by them need to be evaluated. Therefore, the purpose of this study is to evaluate the quality and reliability of Douyin short videos related to cosmetic surgery by investigating the characteristics, sources and contents of related videos in Douyin APP. advertisements. A total of 168 short videos were included in the analysis and research after excluding the above videos ( Figure 1).
In terms of data collection, in this study, Questionnaire Star (Changsha Ranxing Information Technology Co., Ltd.) was chosen as a professional questionnaire platform to establish an online questionnaire, encode the short video content and classify and count the source, duration, number of likes, comments, collections and shares of short videos ( Table 1).
The DISCERN instrument was used as a method to evaluate the information quality and reliability of each short video. The DISCERN instrument is a statistical scale developed by the Oxford University research team that is used to evaluate the information quality and reliability of the content related to health science education. 9 The scale consists of 16 questions and 3 sections: assessment of the reliability of the publication content (8 questions); choice and information about treatment (7 questions) and overall quality assessment of publications (1 question). Each question is graded from a maximum score of 5 (absolutely yes) to a minimum score of 1 (absolutely not). Finally, the total score of short videos is 16-80. The higher the score, the higher the quality and reliability of short video information ( Table 2). DISCERN scores were independently counted and scored by two senior doctors who have been engaged in plastic surgery for many years. The overall rating agreement (Cohen κ) was 0.821 (p < .001), which indicated that the rating process had satisfactory interrater reliability. Any between-group analysis regarding DISCERN scores was performed using the Kruskal-Wallis H test in SPSS 22.    (Table 4).  Table 5).

| Health education information on the internet
With the rise and advancement of the internet, information related to health education is flooding the network. 10  to reduce the number of activities away from home. In order to pass the time, there are a huge number of short videos of different types on Douyin, which can meet the interests and viewing needs of different groups of people. 16 Douyin has become the most used short video APP in China, so Douyin has great communication potential. 17 A large amount of health education-related information can be disseminated through Douyin, which makes it more convenient and easy for ordinary people to obtain health education information. However, the huge number of users also means that the quality of short videos may be uneven, and the quality and reliability of the information provided by them need to be evaluated.

| Principal findings
A total of 168 short videos of cosmetic surgery were included in the survey, and the video sources included personal accounts and institutional accounts. On the whole, the total proportion of institutional accounts is significantly less than that of personal accounts. In personal accounts, the proportion of health professionals is high, which is mainly due to the rapid development of We Media, which makes more and more professionals aware of the knowledge differences between themselves and the public.
Through this difference, they can use short videos as tools to expand their personal influence, and finally bring economic and social benefits to Although the DISCERN score, which evaluates the quality and reliability of short video content, is not as high as that for the short videos released by health professionals, the communication effect of short videos is difficult for ordinary health professionals to achieve.
However, for-profit academic organizations or institutions receive the least number of praises, collections, comments and reposts, which may be related to the decrease of patients' trust caused by the chaotic cosmetic surgery results of for-profit organizations.
Overall, the reliability and overall quality of 168 short videos of cosmetic surgery were high, but there was no significant difference in treatment choices between short videos released from different sources. conclusions may not be applicable to short videos in other languages.

| Limitations and future research
Therefore, we call for more cross-language comparative studies in the future.

| CONCLUSION
The Xi analyzed the data. Jianfei Zhang and Xia Xiao wrote the paper.