Evaluating YouTube as a Source of Patient Information for Pediatric Tracheostomy Care

doi:10.21203/rs.3.rs-2573859/v1

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Evaluating YouTube as a Source of Patient Information for Pediatric Tracheostomy Care

https://doi.org/10.21203/rs.3.rs-2573859/v1

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Purpose:To evaluate YouTube's usefulness as a source of information concerning pediatric tracheostomy care.

Materials and Methods: On August 10, 2022, the top 50 YouTube search results for "pediatric tracheostomy care" were displayed. Each “video was evaluated by a jury of three otolaryngologists with at least 2 years of professional experience in pediatric otolaryngology using DISCERN, scoring system of Journal of the American Medical Association (JAMA), and the Global Quality Score (GQS).

Results:After exclusion criteria 24 videos were evaluated. Fifteen of the evaluated videos were produced by health professionals, and the other nine videos were produced by independent users. The average duration of the video was 337.5 seconds, varying between 82 seconds and 1364 seconds. The average Discern score of videos produced by health professionals was 38.9 ± 13, compared to 36.6 ± 14 for independent users. The mean JAMA score was 1.04 ± 0.68 for health professionals and 1.11 ± 0.94 for independent users. The GQS score was 2.82 ± 0.73 for health professionals and 3.19 ± 0.84 for independent users. There was no statistically significant difference between the two groups for Discern, JAMA, and GQS scoring.

Conclusion:YouTube does not seem to be a good option for parents to get useful information about pediatric tracheostomy care at this time. Health professionals should provide websites with high-quality materials to improve awareness of pediatric tracheostomy care.

pediatric tracheotomy care

YouTube

video analysis

Discern

JAMA

GQS

YouTube is the world’s most popular video-sharing platform and ranks second for the sheer volume of user interactions [1]. It is being used to disseminate healthcare information, and both casual and professional users publish content aimed at a large of audiences. It is an accessible and engaging source of medical information with the potential to enhance patients' understanding of their condition and treatment options. Parents of children with common otolaryngological conditions regularly search and use the internet to better understand the child's condition. While physicians remain the most influential source of information for guiding parents' decisions, the significance and impact of medical based information on the internet is undeniable [2].

Tracheostomies are performed more frequently on children with complex medical issues, such as congenital heart disease, lung disease, and neurological disorders [3]. More than 4,800 pediatric tracheostomies are performed each year; however the exact number of children requiring tracheostomy is uncertain [4]. Children who require medical equipment, such as tracheostomies, ventilators, feeding tubes, and other medical devices, need extensive care, not just in the hospital and throughout rehabilitation but also at home from their families or caretakers. Improving the knowledge and abilities of nurses, other healthcare personnel, families, and caregivers can improve the results for tracheostomy patients [3, 5].

Given the need for accurate, unbiased information and the known unreliability of internet sources, the purpose of this study was to evaluate YouTube's usefulness as a source of information concerning pediatric tracheostomy care.

On August 10, 2022, the top 50 YouTube search results for "pediatric tracheostomy care" were displayed using the default setting that organizes results by "most relevant." Non-English, non-tracheostomy-related, and low-quality audiovisual were eliminated from the study. This research did not require permission from an ethical committee because it utilized only publicly accessible data.

Each film was viewed in its entirety. For each one, the total amount of views, time (in seconds), and “like" count were recorded. Each “video was evaluated by a jury of three otolaryngologists with at least 2 years of professional experience in pediatric otolaryngology using DISCERN, scoring system of Journal of the American Medical Association (JAMA), and the Global Quality Score (GQS). The final score was based on the mean of the three scores provided by each participant. Coefficients of intraclass correlation were calculated. The DISCERN scoring system draws on sixteen questions, separating them into three sections. The first section features eight questions, the second section includes seven questions, and the last section consists of one question. This scoring method analyzes the objectiveness and usability of therapeutic medical data in particular. Totaling 8 questions, the first section examines the credibility of a publication (in this example, an online video), the second section evaluates the treatment methods, and the third section analyzes the overall and usefulness of the information disclosed. The final section and the video material are not scored, and 15 questions are used to determine the final score. DISCERN scores are divided into five categories: excellent, good, fair, poor, and extremely poor. Excellent scores range from 63 to 75 points, good from 51 to 62 points, fair from 39 to 50 points, bad from 27 to 38 points, and very poor from 16 to 26 points.

JAMA is a well-known scoring system that measures the quality of online health sources, enabling consumers to assess the reliability of the material. A score between 0 and 1 is assigned to each of these four criteria: authorship, citation, description, and currency. Four points signify the highest level of achievement. The GQS rates the overall video quality on a 5-point scale: 1 = Extremely bad quality, disjointed flow, insufficient information, and not beneficial for patients to use; 2: Generally poor quality, bad flow, and information of poor quality and of little benefit to patients; 3: moderate quality, less-than-ideal flow, acceptable discussion of certain key facts, but inadequate discussion of other material; marginally helpful to patients; 4 = Good quality; typically smooth flow; listing of the majority of pertinent data; however, some subjects are not covered; beneficial to patients; and 5: Outstanding quality, outstanding flow, and quite beneficial to patients

Statistical Methods

For descriptive statistics, the mean, standard deviation, median, minimum and maximum values, frequency, and percentage were utilized. Using the Kolmogorov-Smirnov test, the distribution of variables was examined. The Mann-Whitney U test was applied to compare quantitative data. Spearman Correlation was used to assess the relationship between variables. Intra Class Correlation was used to assess correlation between observers. For statistical studies, SPSS 28.0 was applied.

The first 50 videos were selected after searching for the term "pediatric tracheostomy care." According to the exclusion criteria, 26 videos were discarded, and the remaining 24 videos were evaluated. Fifteen of the evaluated videos were produced by health professionals, and the other nine videos were produced by independent users. The average duration of the video was 337.5 seconds, varying between 82 seconds and 1364 seconds. In the visibility evaluation, the least-watched video was viewed 56 times, and the most-watched video was viewed 213,035 times. The most popular video got 1,000 likes, and the most unpopular video got 0 likes. The mean Discern score was 38 ± 13.1, the mean JAMA score was 1.07 ± 0.77, and the mean GQS score was 2.96 ± 0.78 (Table 1).

Reliability scores for the DISCERN, JAMA, and GQS scores among the three observers are shown in Table 2. The duration of the videos, the number of views, and the number of likes did not have a significant effect on Discern, Jama, and GQS scores (Table 3). The average Discern score of videos produced by health professionals was 38.9 ± 13, compared to 36.6 ± 14 for independent users. The mean JAMA score was 1.04 ± 0.68 for health professionals and 1.11 ± 0.94 for independent users. The GQS score was 2.82 ± 0.73 for health professionals and 3.19 ± 0.84 for independent users. There was no statistically significant difference between the two groups for Discern, JAMA, and GQS scoring. There was no significant difference between the two groups in terms of the duration of the videos, the number of views, and the number of likes. (Table 4).

As a result of advancements in newborn and pediatric critical care, there is an increase in the number of children requiring tracheotomies. Moreover, due to underlying comorbidities, tracheostomy risks, device failure, and untrained caregivers, these youngsters are at risk for adverse outcomes [6]. Therefore, it is important that parents or caregivers of children with tracheostomies are trained in tracheostomy care. Popular social media websites, including YouTube, are increasingly used by parents as sources of health information [7]. In our study, the aim was to evaluate the quality of videos that addressed the topic of pediatric tracheostomy on YouTube. The study noted that most of the YouTube videos on pediatric tracheostomy care are uploaded by health professionals. Furthermore, it was concluded that the quality of the videos was generally low. This outcome will have implications, especially for parents and patients. Because most parents do not have the necessary clinical history from which to evaluate videos, they cannot decide if the information provided by a video is valuable when investigating pediatric tracheostomy care. Doctors with this information may advise their patients on which sorts of videos to seek out and which ones should be avoided.

Before calling on a doctor, parents seek answers to their children's health-related questions by browsing social media, listening to comments, or reading. The internet and social media appear to turn into information dumps. Our study demonstrates that it is incredibly challenging for patients to receive correct and comprehensive information. YouTubers and doctors utilize social media mostly for promotional goals; consequently, it is necessary to develop engaging and informative content. Since reliable information sources lack attention-grabbing titles, viewership numbers tend to be low. Health professionals should create informative YouTube videos that are captivating and factual to satisfy patients' curiosity. In our research, we found no quality difference between the videos created by health experts and those made by independent users. However, the overall quality of the videos was poor in both groups. Quality videos should be prepared by health professionals to inform parents and caregivers in a situation that requires continuous care, such as pediatric tracheostomy.

Although the majority of pediatric tracheostomy videos published on YouTube in our study were submitted by health professionals, the low quality of the videos may have driven the professionals to create and upload the videos. Healthcare practitioners may wish to consider making comprehensive, high-quality videos that explain the fundamentals of tracheostomy care for pediatric patients with detailed explanations of how to handle complex circumstances, and then inform patients of these videos. Given the quality of the YouTube content witnessed and reported in this study, this appears to be an extremely worthwhile endeavor. There should be more criticism of the number of "likes" a video receives and the consequences of this. After watching a video on YouTube, the "like" and "dislike" buttons allow viewers to easily submit their good or positive opinions. Thus, it informs a potential viewer as to whether a certain video will be informative, entertaining, or illuminating. One could intuitively conclude that a video with many "likes" will be better than a video with fewer "likes." Unfortunately, the number of "likes" did not correlate with a video's quality. This would be an example of "judging a book by its cover" or when viewers attribute the quality of a film solely to how clear the image is. Future patient education video makers should consider this. The importance of education for parents and caregivers in pediatric tracheostomy care is not a newly recognized issue. In a study conducted in 1995, it was mentioned that parental education would reduce tracheostomy complications and reduce the length of hospital stay [8]. In a study carried out in 2004, they noted the importance of parent and caregiver education before transferring children with tracheostomies to their homes [9]. In a study managed in 2011, it was asserted that parent education reduces the complications of pediatric tracheostomy [10]. In 2022, Antoniou et al. oversaw a similar study with caregivers of patients with pediatric tracheostomies. First of all, they prepared a pilot questionnaire using the qualitative data they obtained by interviewing the caregivers. They concluded that education increases knowledge and confidence in pediatric tracheostomy care [11]. All these studies show that the issue of education is important. The reason why we focus on YouTube videos in our study is that they are always accessible to parents and can be watched whenever and for as long as they want. We believe that this situation can be turned into an opportunity for education.

In studies evaluating YouTube videos on trigeminal neuralgia, endoscopic sinus surgery, blepharoplasty, thyroid surgery, and pediatric otolaryngological surgeries in the literature using binary combinations of DISCERN, JAMA, and GQS, or all three together, similar to our research, it was determined that the quality of the videos was often poor [12–16]. In our study, these three scoring systems were used together. In addition, three different ENT doctors, experts in their fields, scored each video independently, and an average score was determined. Thus, the effect of the differences in the video valuation due to the bias of the authors was effectively reduced.

This study has some limitations. YouTube's collection is variable, there is no way of knowing how video search results are ranked, and our rating standards are subjective. As new videos are added on YouTube, the outcomes of our work will definitely evolve over time. The results of a standard search will be arranged based on a non-public algorithm, limiting the scope of any extensive YouTube library investigation. Another limitation of this study is that only 24 videos were analyzed after exclusion criteria were employed. In this study, only English-language videos were analyzed. Future research may be beneficial in determining the quality of foreign-language videos.

It is a foregone conclusion that a doctor's analysis of visual content may vary from that of a layperson. There may be differences in what doctors and patients accrue from video material, but there is presently insufficient research to determine what information parents and patients prefer to watch while searching for information related to medical issues on a website or YouTube. Despite these constraints, this study observed that the presence of a popular video-sharing website has a major influence on the patient and their family. Perhaps it will contribute to the enhancement of the quality of videos created by health professionals in the future.

Although YouTube is a low-quality resource of information on pediatric tracheostomy care, its vast audience has the potential to affect patients. To improve awareness of pediatric tracheostomy care and empower patients to differentiate between relevant and false information, health professionals need to know about and be excited about this new technology. Helpful and uninformative videos have similar viewership and popularity. YouTube does not seem to be a good option for parents to get useful information about pediatric tracheostomy care at this time. Patients should be cautioned about getting information, and health professionals should consider limitations and provide websites with high-quality materials.

Statements of Ethics: All procedures performed in study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Study approval statement: This research did not require permission from an ethical committee because it utilized only publicly accessible data.

Conflict of Interest Statement: The authors have no conflicts of interest to declare.

Funding Sources: No sources of funding were received for this research.

Author Contributions: All Authors contributed to the conception and design of the study. Yaşar Kemal Duymaz and Serap Önder wrote the first draft of the manuscript. Şamil Şahin, Burak Erkmen and Tuğçe Uzar co-designed concept and helped with data collection. Şamil Şahin and Burak Erkmen contributed to the data analysis. All authors contributed to manuscript revision and read and approved the submitted version.'

No Title. %22Similarweb Top Websites Ranking%22. Similarweb. Retrieved 2022-07-01.
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Table 1: Analysis of descriptive data, Dıscern scores, JAMA scores and GQS of all videos
	Min-Mak			Median	Mean±sd/n-%
Discern	16,7	-	53,0	41,0	38,0	±	13,1
JAMA	0,33	-	3,0	0,67	1,07	±	0,77
GQS	1,33	-	5,0	3,00	2,96	±	0,78
Time (second)	82,00	-	1364,0	221,00	337,5	±	302,1
Views	56	-	213035	22490	55094	±	65337
Number Of Like	0,0	-	1000,0	105,5	278,2	±	316,9
Health Professionals					15		62,5%
Independent Users					9		37,5%
^m Mann-whitney u test;GQS, Global Quality score; JAMA, Journal of the American Medical Association

Table 2: Intra Class Correlation
	Min-Max			Median	Mean±sd			r (% 95 CI)				p
*DISCERN*
Observer I	16,0	-	52,0	40,0	37,3	±	13,1	0,996	0,992	-	0,998	*0,000*
Observer II	17,0	-	55,0	41,5	38,6	±	13,0
Observer III	16,0	-	52,0	41,0	38,1	±	13,5
*JAMA*
Observer I	0,00	-	3,0	1,00	1,00	±	0,83	0,830	0,665	-	0,921	*0,000*
Observer II	0,00	-	3,0	1,00	1,13	±	0,90
Observer III	0,00	-	3,0	1,00	1,08	±	0,93
*GQS*
Observer I	1,00	-	5,0	3,00	3,00	±	0,93	0,867	0,737	-	0,938	*0,000*
Observer II	2,00	-	5,0	3,00	3,00	±	0,66
Observer III	1,00	-	5,0	3,00	2,88	±	0,99
GQS, Global Quality score; JAMA, Journal of the American Medical Association

Table 3: Effect of descriptive data on Discern, JAMA and GQS
	DISCERN		JAMA		GQS
	r	p	r	p	r	p
Time (second)	0,175	0,413	-0,053	0,807	0,201	0,347
Views	0,224	0,292	-0,227	0,287	0,285	0,176
Number Of Like	0,234	0,270	-0,209	0,326	0,249	0,241
Spearman Correlation; GQS, Global Quality score; JAMA, Journal of the American Medical Association

Table 4: Evaluation of video resources
	Health Professionals				Independent Users				p
	Mean±sd			Median	Mean±sd			Median	p
Discern	38,9	±	13,0	40,7	36,6	±	14,0	41,3	0,857	^m
JAMA	1,04	±	0,68	1,00	1,11	±	0,94	0,67	0,902	^m
GQS	2,82	±	0,73	3,00	3,19	±	0,84	3,00	0,649	^m
Time (second)	274,80	±	218,94	213,00	442,11	±	398,44	251,00	0,136	^m
Views	65747	±	76837	22304	37338	±	37065	22675	0,835	^m
Number Of Like	332,9	±	368,6	98,0	187,0	±	189,9	113,0	0,654	^m
^m Mann-Whitney U test; GQS, Global Quality score; JAMA, Journal of the American Medical Association

No competing interests reported.

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Evaluating YouTube as a Source of Patient Information for Pediatric Tracheostomy Care

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Abstract

Introduction

Materials And Methods

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Discussion

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