YouTube™ is a social media platform that is easily accessible and open 24/7 to everyone. In this platform billions of users share information about everything and thousands of people all around the world watch those videos every day. Despite its wide usage and rich content, it is full of non-standardized videos and has many gaps in terms of reliability because of the absence of regulations [8]. In the present study, we aimed to evaluate the quality and reliability of information on prostatitis provided in YouTube™ videos by using a combination of three validated assessment tools and two different expert opinion. To the best of our knowledge, no studies have been conducted on this subject.
With a wide range of clinical presentations, pelvic pain and lower urinary tract symptoms are the two main complaints of patients having prostatitis [9]. Its serious negative impact on patients’ quality of life has been frequently documented [10–12]. Many doctors find prostatitis problematic to treat effectively, and patients are not always satisfied with the treatments given and turn to other alternative solutions. Due to the difficulty and cost of accessing the health system in many countries, patients may apply to obtain information on the internet. Sometimes, in cases where the expected benefit from the treatments given cannot be seen, patients may turn to related videos on YouTube™ to find additional solutions. Before applying to the hospital, some patients watch YouTube™ videos in the hope of doing preliminary research about their diseases or to resolve their complaints without going to doctor. Today, YouTube™ videos form an important part of the health information seeking behavior of our patients with prostatitis.
On YouTube™, viewers can also watch the videos to reach the opinion of the physicians and to learn about the applications to be made in the presence of certain complaints. In our study, “doctors or medical institutions” ranked first (33%) as a source, it constituted nearly 1/3 of all videos, followed by patients (28%), and the rarest source was “health information websites” (9%). The fact that prostatitis is a specific subject and is not widely known by other disciplines may explain why "doctors or medical institutions" are the most common video source, they spend more effort to enlighten the audience. Similarly, with our finding, Melchionna et al. reported that medical doctors were dominant as video uploaders in their study about YouTube™ videos on testicular pain [13]. The fact that patients are in the second place as video uploaders shows the importance of sharing experiences. Patients who have felt distressed or helpless during the chronic disease processes feel the need to share their experiences, especially the useful treatment options with others who suffer from the same disease. This behavior, which reflects an empathetic point of view, is quite understandable. Chronic diseases can easily push patients to seek different solutions when medical and pharmacological methods are tried and sufficient results cannot be obtained. Considering of the chronic and bothersome nature of prostatitis, patients can easily turn to non-medical solutions [14]. We often see this orientation on the intimate anamneses taken from patients in our daily practice. Along this way, we witness that they prefer to watch informative videos rather than read long and boring articles based on guidelines to get medical information. This makes sense from the patient's point of view, especially at limited times. However, a group of patients take this information seeking behavior one stage further and try to manipulate treatment process with what they have learned from YouTube™ videos and may conflict with health professionals [15]. In this case, healthcare professionals have difficulty in explaining costs and risks that may occur to the patients. As a solution, we can recommend some videos of our own choice to our patients. Although we cannot restrict patients' access to false information, we can direct them to sources that provide accurate information. Mistreatments, treatment delays and complications can be prevented and also time saved. At this point, it becomes important to be able to objectively assess video quality. There are various scales and tools that can be used for this purpose. In the current study, three of the most convenient, JAMA, GQS and modified DISCERN, were used. Apart from these, checklist scores [16], and the Patient Educational Materials Assessment Tool (PEMAT) have also been used in the literature [13, 15, 17–20]. Evaluation of videos using some objective scales instead of subjective evaluation criteria will also provide more satisfactory information in joint evaluations with colleagues and in council-like settings. We would like to emphasize the importance of standardization and the creation of a common language.
Evaluating video contents, we have seen that “general information” about prostatitis is given the most frequently (27%) on YouTube™ videos. It may have been aimed to increase the awareness of the patients by giving general information and to direct their applications to certain institutions. Fewer videos were uploaded about symptoms, treatment, and side effects. Since prostatitis was treated with certain prescription drugs such as antibiotics and analgesics, probably there was little need for speculation about treatment and side effects, or explanation of symptoms with videos. The “other” contents for prostatitis included herbal treatments (phytotherapy), traditional medical recommendations, interventions such as, hot baths, homeopathic and/or alternative medicine, acupuncture, prostatic massage, exercises include pelvic region.
Although YouTube™ is an extremely popular video sharing platform, their content can be quite biased and of poor information quality [8, 20–22]. High number of views of a video does not indicate that it is of high-quality. In our study, we found that videos with a higher view ratio were of lower quality. The reason for this may be that people turn to the most watched videos in the first place, and accordingly, the number of watching such videos may increase. Another reason may be that they sort the videos according to the number of views during the video search and head to the most watched videos. In the present study, poor quality videos had the highest view ratio, thus disseminating a lot of misinformation. Similar findings were observed in studies dealing with YouTube™ videos on erectile dysfunction [17, 20], Peyronie’s disease [23], and penile prosthesis [18]. Like ratio (like/ [like + dislike]) and video power index (like ratio × view ratio) are two parameters used to evaluate the video rating and popularity [24]. In November 2021, YouTube™ removed the public dislike count from all its videos [25]. While creators can still see the number of dislikes within YouTube™, viewers can now only see how many likes a video has received. Since we could no longer reach the number of dislikes, we could not use the video power index and the like ratio in our study.
When we examined the quality scores in our study, we found that both the mean and median scores for all three scales were above the average and correlated with each other. Besides, according to modified DISCERN scores, high-quality videos ranked first (44%). These findings show that English information content about prostatitis on YouTube™ is quite satisfactory in terms of quality and reliability. While the video quality was found to be low in many urological diseases analyzed in YouTube™ studies [17, 18, 20, 23], it is pleasingly high in prostatitis. If the viewers do not turn only to popular videos, they will be able to reach the necessary information for themselves by watching videos especially uploaded by doctors/ medical institutions.
According to the modified DISCERN score, we observed that high quality videos were significantly shorter than poor ones. Analyzing YouTube™ videos about male infertility, Ku et al. reached similar findings [16], however, on the contrary, Toprak et al. reported that DISCERN and GQS scores were significantly associated with durations of YouTube™ videos on delayed ejaculation [22]. In our opinion, the quality of the short videos may be attributed to the fact that the information desired to be given to the viewer is conveyed in a clear and striking way as soon as possible. Long videos distract viewers and make it difficult to focus on the messages that need to be delivered. The introduction is the most important part. It should be quick and attractive, otherwise viewers will lose interest in the subject and may not watch the rest of the video.
Ours is the first study evaluating YouTube™ videos on prostatitis. This makes the current study more valuable, but we do have some limitations: (1) In order to reduce the observer bias, the knowledge of two researchers was consulted, but this is still not enough, the observer bias can be reduced by increasing the number of researchers, (2) Only videos in English were selected. The fact that the word “prostatitis” is also used in Spanish has brought Spanish videos in the second place in the search bar. However, the authors' lack of knowledge of Spanish resulted in the elimination of many Spanish videos, (3) Only the word "prostatitis" was used as the search term. For example, videos that can be accessed by different searches such as “prostate infection,” “prostate inflammation,” etc. have been involuntarily eliminated, (4) YouTube™ settings may vary geographically and periodically. Even we used a VPN engine, we were not able to disable that bias.