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Approximately 80% of internet users access health information online and patients with chronic illnesses especially rely on internet-based resources. YouTube ranks second among the most accessed websites worldwide and hosts an increasing number of videos with medical information. However, their quality is sometimes unscientific, misleading, or even harmful.
As little is known about YouTube as a source of information on psoriasis, we aimed to investigate the quality of psoriasis-related videos and, if necessary, point out strategies for their improvement.
The quality of the 100 most viewed psoriasis-related videos was assessed using the DISCERN instrument and the Global Quality Scale (GQS) by categorizing the videos into useful, misleading, and dangerous and by evaluating the reception of the videos by users.
Evaluation of the videos exhibited a total of 117,221,391 views and a total duration of 10:28 hour. The majority of clips contained anecdotal personal experiences with complementary and alternative psoriasis treatments, topical treatments, and nutrition and diets being the most frequently addressed topics. While advertisements accounted for 26.0% (26/100) of the videos, evidence-based health information amounted to only 20.0% (20/100); 32.0% (32/100) of the videos were classified as useful, 52.0% (52/100) as misleading, and 11.0% (11/100) as even dangerous. The quality of the videos evaluated by DISCERN and GQS was generally low (1.87 and 1.95, respectively, on a 1 to 5 scale with 5 being the maximum). Moreover, we found that viewers rated poor-quality videos better than higher quality videos.
Our in-depth study demonstrates that nearly two-thirds of the psoriasis-related videos we analyzed disseminate misleading or even dangerous content. Subjective anecdotal and unscientific content is disproportionately overrepresented and poor-quality videos are predominantly rated positively by users, while higher quality video clips receive less positive ratings. Strategies by professional dermatological organizations are urgently needed to improve the quality of information on psoriasis on YouTube and other social media.
Social media has become increasingly important in the context of health care [
Identify upload sources, common topics, and YouTube categories of the 100 most-viewed videos
Investigate the quality of YouTube videos as a source of information on psoriasis by applying two different score instruments
Correlate viewers’ ratings with our quality assessments
Point out strategies for interventions that increase the quality of psoriasis video clips and medical content in general uploaded to YouTube and other social media platforms
In this cross-sectional study, YouTube was searched on July 27, 2017, using the term psoriasis and the filter settings English UK (language) and United Kingdom (country). Subsequently, videos were sorted by their view count. Non-English videos or channels were excluded until the top 100 videos in English were displayed (
After collecting qualitative and quantitative data (duration, upload data, source, likes/dislikes, category, license type), overall quality of the videos was assessed by 5 experienced dermatologists using two assessment tools [
In a first step, topics of the video clips were collected. If a video covered more than one topic, each topic was listed separately. The content was subsequently categorized according to commonalities and by topics and/or categories discussed in two previous YouTube studies on psoriasis [
The GQS, which is based on a 5-point scale, was developed in 2012 by Singh et al [
The DISCERN instrument is used to measure the quality of health information about treatment choices provided in video clips [
In addition, videos were classified into useful, misleading, or dangerous and categorized by topic or content, presence and profession of a presenter (to be seen in the video, health or nonhealth professional), and upload sources. In case of differing assessments by the analyzing dermatologists, the corresponding video was reassessed by the principal investigator (SM).
Descriptive statistics and Spearman correlation coefficients to calculate the number of likes and dislikes with the values of DISCERN and GQS, respectively, were performed using SPSS Statistics version 22.0 (IBM Corp). To assess the interrater reliability, the Cohen kappa coefficients and intraclass correlation coefficients were calculated.
The 100 videos had a total of 117,221,391 views and a total duration of 10:28 hours (mean duration per video 6:17 [SD 6:39] minutes). The two most viewed videos accounted for 93,736,280 views (79.96% of the total) and were pharmaceutical advertising with a Creative Commons license and likes, dislikes, and comment functions disabled. This kind of license authorizes users not only to download the video but also to use the entire clip or parts thereof for their own video clip productions. The other 98 videos had a Standard YouTube License, which allows the use of the clips only after prior permission of the author.
The majority (65/100, 65.0%) of the videos were uploaded from the United States. The most frequent category was People & Blogs (36/100, 36.0%), a diverse mix of content and the most famous category on YouTube [
Most videos contained anecdotal, personal, unscientific, or commercial information on psoriasis (
Distribution of topics, information providers and upload sources (multiple categories may apply to one video); *including websites from psoriasis associations.
Topics presented in the videos (Note: a video clip can cover more than one topic; *alternative treatment includes complementary treatment; UVR: ultraviolet radiation).
Distribution of the uploaded videos over the period 2007-2016 (n=100).
Comparison of quality assessments of the videos (n=100) performed with the DISCERN instrument (blue bars) and the Global Quality Scale (orange bars).
Of the videos, 32.0% (32/100) were classified as useful and 63.0% (63/100) as misleading—of these, 17.5% (11/63) were even considered dangerous because of potential mechanical or chemical injury or harmful recommendations regarding sun exposure or diets; 5% (5/100) of the videos were neither useful nor misleading.
With a value of .74, the kappa statistic revealed a good level of agreement among the raters.
In terms of the view count, we excluded the 2 most viewed videos from further analyses as they were pharmaceutical advertisements, accounting for 79.96% (93,736,280/ 117,221,391) of all views. The misleading videos (63/100) garnered 18,387,077 views including 4,611,126 views of videos with potentially dangerous content (11/63). Useful videos (32/100) had 5,098,034 views resulting in a ratio of 3.61 (18,387,077:5,098,034) misleading to useful videos.
The ratings using the DISCERN and GQS scores were consistent, yielding the categorizations shown in
The intraclass correlation coefficients calculated for the DISCERN and GQS were .81 and .78, respectively, indicating a high level of agreement between the assessors.
The videos received 113,147 likes and 9260 dislikes yielding a like to dislike ratio of 12.4 (113,147:9260). In 7 videos, the like/dislike function was disabled. When correlating the viewer ratings with our quality assessments, we found a negative correlation between the number of likes and the DISCERN mean values (Spearman correlation coefficient ρ=–0.23,
Psoriasis patients are avid users of social media, including YouTube, as a source of information on their disease [
This study found that the majority of video clips contained anecdotal personal experiences mainly addressing topics such as alternative treatment options for psoriasis and putative benefits of diets. Alarmingly, more than half of the videos spread misleading and about 1 in 10 even dangerous information and recommendations. Furthermore, the quality of the video clips was rather low, and the fact that viewers rated poor quality better than higher quality videos indicates that the majority of health seekers are not capable to recognize low quality medical information in videos as such.
We found that nearly two-thirds of the top 100 psoriasis-related YouTube videos disseminate misleading information. While this proportion of misleading content is in line with previous nondermatological studies [
It is unclear why the two pharmaceutical company videos account for almost 80% (93,736,280) of the more than 117 million visitors to the top 100. As the statistical information provided by YouTube did not allow us to determine whether the videos accessed were actually or completely viewed and when they were left, the significance of this figure is limited. It is, however, conceivable that at least some of the visits were due to the Creative Commons License, which, as mentioned above, allows the use of YouTube videos for personal video clip productions.
A total of 11% of the videos we analyzed contained potentially dangerous content. For example, psoriasis patients were encouraged to remove their plaques using a knife blade, glue, Brazilian waxing, and apple cider vinegar. In addition, sunbathing without reference to sun protection, unnecessary diets (eg, avoidance of dairy or gluten), and the use of the one and only miracle cure were praised in such videos. This advice was frequently posted by patients reporting a personal negative long-term experience with conventional medicine who eventually found salvation in alternative treatments. It has been reported that patients with moderate to severe psoriasis are more apt to rely on psoriasis user–generated content in social media than their counterparts suffering from milder forms [
Interestingly, the main topics published in psoriasis-related videos revolve around complementary and alternative psoriasis treatments, (homemade) current therapies, and nutrition and diet topics that allow patients to take measures to improve their skin condition without consulting a physician or health care professional. According to the results of the GQS and DISCERN tools, only 11% and 12% of the videos, respectively, were of good or excellent quality with unbiased, evidence-based or at least science-based information. This and our analyses of the uploaded sources indicate, in accordance with Lenczowski et al [
These findings raise question about why certain viewers are so drawn to low-quality videos and how best to deal with this phenomenon to bring about change. To answer this, it is first of all helpful to gain knowledge of the characteristics of the typical psoriasis health seeker [
First, it is urgently necessary that dermatology associations, psoriasis self-help organizations, etc, provide medically accurate, high-quality, and easy-to-understand information—including videos—for laymen dealing not only with pathophysiology, clinical manifestations, and evidence-based therapeutic options for psoriasis but also with non–evidence-based treatments and their inefficacy and potential hazards.
Second, it is important to keep in mind that YouTube videos reach a large audience, a fact that the World Health Organization has recognized; it explicitly recommends the use of this platform in its strategic communications framework [
To our knowledge, this is the first study to include the DISCERN tool in the context of dermatology-related YouTube videos. The mean score gained from the overall rating of the DISCERN tool (question number 16) was very similar to the GQS score (both approximately 1.9). However, as the DISCERN scoring system provides important additional information, we believe that this tool is better suited for quality assessment of videos and should therefore also be used to evaluate films from professional health organizations before they are posted.
Third, as the majority of health seekers rely on the first 10 results from the search engine, it is important to ensure that websites, videos, etc, of professional health care providers appear on the first 2 result pages [
Furthermore, cooperation between social media and search engine providers and dermatology associations and psoriasis self-help organizations would enable the positioning of medically accurate information in a prominent location on the results page and easier access to corresponding websites and videos. Such an approach had already proved successful in 2003 during the SARS epidemic, when the internet company Google ensured that the World Health Organization and Centers of Disease Control and Prevention websites were displayed at the top of the first results page in its search engine [
Finally, one could also think about subjecting websites and video clips with medical content to standardized quality control or setting minimum standards through government regulations. However, due to the amount of media posted daily and the philosophy of the YouTube platform, this seems hardly feasible.
Despite their unmistakable strengths, such as the comprehensive analyses of a high number of videos and the application of two different scoring tools (GQS and DISCERN), there are some limitations to our study. Although we performed comprehensive analyses, we neither evaluated the comments posted by viewers nor did we investigate potential associations between the duration of YouTube videos and their quality, the number of likes and dislikes they received, etc, which might have allowed us, among other things, to make statements about preferences of viewers and optimal durations of video clips.
Our study demonstrates and confirms the results of others that the vast majority of psoriasis videos presented on YouTube contain misleading and sometimes potentially harmful information about this disease. Moreover, our findings suggest that a large number of users looking for clips on psoriasis on YouTube are not only unable to distinguish between medically accurate and inaccurate information but even tend to rate videos of inferior quality better than videos of higher quality.
According to our findings and in agreement with the five previous dermatological YouTube studies [
Links to YouTube videos.
Scores used for quality evaluation of video clips.
Rating of the 15 items of the DISCERN tool on a scale from 1 to 5 (with 5 being the maximum).
Global Quality Score
ultraviolet radiatio
None declared.