From the Journals

Novel YouTube study detects colonoscopy misinformation, guides better content creation

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Accessiblity vs. quality

The advent of social media ushered in the promise of a new age of information democratization. Unfortunately, the reality of increasingly accessible information – including misinformation – has disabused us of the notion that this increased accessibility is an unalloyed good. “Fake news” abounds, and in an era in which “truth” seems to be in the eye of the beholder – or influencer – medical misinformation appetizingly presented to the public is a particular hazard to public health. This is one of the first studies to offer an objective description of the medical information landscape as it pertains to the field of gastroenterology.

Jason M. Brown, M.D., assistant professor and Grady Site Fellowship Director, division of digestive diseases, Emory University School of Medicine, Atlanta.

Dr. Jason M. Brown

We must thank Dr. Austin Chiang and colleagues for their cohort study examining this misinformation landscape surrounding colonoscopy on YouTube. Although health care providers and laypeople were both guilty of poor-quality content creation, laypeople were more so, which, though not entirely surprising, is somewhat reassuring. Abiding the aphorism “know thy enemy,” the authors suggest that perhaps the do-gooders can arm themselves with factual content that avoids complexity. Being “gross” or funny might help too. Focusing on at-risk populations and partnering both with professional societies and laypeople might be the right formula.

There is a tension between accessibility and quality of information within social media, the modern public forum. This study highlights that tension and serves both as a call-to-arms and a guide for experts on how to displace the amateurs and hucksters who are confusing those who’ve come to the forum not for entertainment but for information.

Jason M. Brown, MD, is assistant professor and Grady site fellowship director, division of digestive diseases, Emory University School of Medicine, Atlanta. Dr. Brown reported no relevant conflicts of interest.



Don’t just sit there. Post something.

To combat misinformation about colonoscopy, health care providers (HCPs) should engage more with social media platforms and create accurate, engaging educational videos, according to investigators.

An assessment of top-ranking YouTube videos about colonoscopy by both lay people and HCPs revealed numerous inaccuracies, which have potentially contributed to public hesitancy to undergo appropriate screening, reported lead author Austin L. Chiang, MD, MPH, of Thomas Jefferson University Hospitals, Philadelphia, and colleagues.

“The prevalence and predictors of misinformation among contents on social media platforms such as YouTube with regard to colonoscopy remain unknown,” the investigators wrote in Gastro Hep Advances. They noted that previous research characterized YouTube as a “suboptimal” resource for information about colonoscopy, although those studies did not use validated instruments.

For the present cohort study, Dr. Chiang and colleagues performed a YouTube search for “colonoscopy” on Nov. 21, 2020. Results with more than 250,000 views were included in the analysis, netting 69 videos. Of these, 39 were posted by lay people, while the remaining 30 were posted by HCPs.

Three board-certified gastroenterologists measured video quality with two validated instruments for evaluating consumer health information: DISCERN and the Patient Education Material Assessment Tool (PEMAT) understandability score. Any video with a DISCERN score less than 2 or a PEMAT score less than 50% was deemed “inaccurate or of low scientific quality per established standards.” The investigators also scored likelihood of recommending a video to a patient on a 5-point Likert scale.

More than half of the videos were low quality based on DISCERN (52.2%) and PEMAT (59.4%) criteria. Videos that featured an HCP scored significantly higher on both scales, while videos created by HCPs were more likely to meet minimum-quality criteria and be recommended to patients.

Specifically, only 20.5% of videos created by laypeople made the grade, compared with 66.7% (PMAT) and 83.3% (DISCERN) of videos made by HCPs, depending on the quality instrument. It therefore follows that an HCP creator was the greatest predictive factor for a high-quality video, according to the area under the receiving operating characteristic curve.

“Our analysis demonstrates a disturbing proportion of inaccuracies and poor scientific quality information among the most viewed YouTube videos around colonoscopy using validated instruments for consumer information,” the investigators wrote.

Types of misinformation varied. Some of the videos contradicted current recommendations and intentionally overstated colonoscopy risk, while others called for screening every year.

“Although it is disheartening to imagine the influence of these inaccurate videos on millions of people, it may be helpful to learn from them and dissect why they have succeeded in attracting viewers,” the investigators wrote.

So which videos had the most views? To put it bluntly, it was the funny, “gross” stuff. The top-ranking colonoscopy videos featured comedians talking about their colonoscopies or had shocking footage, like worms wiggling during an endoscopic exam of a patient with a parasitic infection.

How to create better content

While these acts may be hard to follow for the average gastroenterologist-YouTuber, Dr. Chiang and colleagues did detect one video characteristic that should be avoided: complexity. Multivariate analysis showed that endoscopic footage was a negative effect modifier for clarity and understandability.

“The main challenge of any video content is striking a balance between brevity and accuracy/comprehensiveness,” the investigators wrote. “When describing endoscopic videos to lay audiences, gastroenterologists must be careful to provide appropriate clinical context and use wording that is concise and easily comprehended.”

More broadly, the investigators called for a three-pronged approach to combat misinformation by creating better content.

First, they advised HCPs to increase participation on social media channels, with a focus on promoting health equity among at-risk and non–English-speaking audiences. Second, they asked professional societies such as the American Gastroenterological Association to assist HCPs with the fundamentals of content creation, including techniques in storytelling and videography. Finally, they proposed HCPs partner with lay creators, following a common strategy in traditional media in which celebrities share scientifically grounded medical information.

“Although the prevalence of inaccurate colonoscopy videos is concerning, an understanding of existing health misinformation and a proactive approach to cultivate professional content creation may help provide patients with high-quality information to help achieve colorectal cancer screening targets and improve health outcomes,” the investigators concluded.

The study was partially funded by the National Institutes of Health. Dr. Chiang is an employee of Medtronic and holds a seat on the YouTube Health Advisory Board. The other investigators disclosed no competing interests.

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