Before the internet, health education for pediatric orthopedics was mainly conducted with paper-printed media, such as newspapers, magazines, and books [1]. Then, technological progress and economic development led to the development and popularity of electronic media, such as telephones, radio, and television, which then evolved to impart health education through multimedia. Multimedia health education offers patients and their families an engaging, visually appealing, and memorable learning method that allows them to gain specialized condition knowledge, making health education more comprehensive, systematic, and standardized [2]. The emergence of the internet gave birth to social media. This stage is an era of network communication that mainly uses network platforms and social application software as the main communication methods, and the main body of communication has shifted from the original specific institutions and groups to diversification and equality. Everyone can be both an audience and a disseminator of information using social media [3]. Medical personnel’s approach has changed from passive inquiry to active education. A cooperative relationship in which doctors and patients participate and cooperate has been formed, which enhances the affinity with patients, improves patient satisfaction, and helps the treatment and nursing work to proceed smoothly.

The application of social media in health care is a bottom-up and patient-driven phenomenon that is changing people’s demand for and access to health information [4]. Nowadays, pediatric parents belong to a mostly younger generation group, and more parents can use the internet to obtain health information. A survey of parents of children undergoing pediatric surgery showed that 38.3% of parents had checked their children’s surgical issues online and 26.5% of parents had done online research before their first visit [5]; another study found that from 72% to 96% of parents who are ordinary internet users take their children to pediatric urology outpatient clinics [6]. The emergence of social media has brought about new changes in health education, forming a new win-win situation for medical institutions, medical personnel, and the general public. The widespread dissemination of information also has certain flaws, and the information is widely considered potentially incorrect or unauthorized. Unconfirmed information is flooding the field of pediatric orthopedics. Although there are scientific and objective suggestions, some parents lack an understanding of professional knowledge and have difficulty distinguishing the quality of the information; the content that is spread mainly involves normal variations in growth, such as flat feet, splayed feet, W-shaped sitting posture, and toe walking. These variations are considered abnormal and require some form of treatment, but children can improve on their own without intervention [7]. Published through various media without citations, information that lacks a scientific basis for research results and treatment recommendations may reduce the public’s trust in online health information and may even cause some people to question the professionalism of experts. Therefore, multiple parties need to maintain the network information-sharing platform.

Previous scoping and systematic reviews have already been published about the different uses of social media for health research [8,9]. However, they did not systematically identify and summarize all available evidence on the use of social media in pediatric orthopedics. By identifying the key characteristics and factors related to the use of social media in pediatric orthopedics, we can also better understand its potential impact on medical practice and patient care. The results of this review will provide valuable information for health care policy makers, educators, and practitioners, helping them to use social media tools better to improve the accuracy and accessibility of medical information.

This study aimed to explore the current use of social media in pediatric orthopedics through a scoping review and to address the following research questions:

The internal protocol, which was developed to direct the process and is accessible from the relevant author upon request, served as the basis for this scoping review. This methodology was chosen to summarize what was known and identify gaps based on the guidelines of scoping reviews developed by Arksey and O’Malley [10] and advanced by Levac et al [11]. This review adheres to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) [12].

This review was guided by the population, concept, and context framework suggested by the Joanna Briggs Institute [13], which is described in Textbox 1 [14].

An experienced information specialist (YC) developed the comprehensive search strategies. A search of the literature was performed in September 2023 using 5 electronic citation databases: PubMed, Embase (Elsevier), CINAHL (EBSCO), Web of Science Core Collection (Clarivate Analytics), and Cochrane. The searches were conducted for the period from the establishment of each database to September 21, 2023, using index terms, where appropriate, and free-text terms to capture the following defined search terms: (1) social media, including both general terms and specific platform names and terms (eg, Twitter, tweet, Facebook, TikTok, and YouTube); (2) pediatric, including children of all ages; and (3) musculoskeletal conditions, including general terms for some common conditions. The full search strategy is summarized in Multimedia Appendix 1.

The screening process was conducted using the PRISMA-ScR checklist (Multimedia Appendix 2) [12,15]. At least 2 reviewers (HO and GL) screened the titles and abstracts for assessment against the inclusion criteria. Following a preliminary screening of 56 reports, the full texts of the chosen studies were obtained for review, and 2 independent reviewers (HO and GL) conducted a thorough evaluation against the inclusion criteria. If full texts were inaccessible, the authors were contacted at least twice. If there were any disagreements between the reviewers, a third reviewer (YC) was engaged to mediate and resolve the disagreements.

One reviewer (HO) extracted all data from the included articles using abstract data, when available, with Zotero (version 6.0). The extracted data included article characteristics (title, abstract, year of publication, journal, country of the first author, and article type), study design, study object, study objective, study conclusion, social media platform, and preidentified categories related to the content for social media use. Extracted data were exported from Zotero into Microsoft Excel for analysis using descriptive statistics (eg, totals and percentages).

Guided by the approach of Zhao et al [14], the use of the social media for implementing evidence (SMILE) conceptual framework aimed to understand how social media was used as a knowledge-transformation strategy to help policy makers, health care professionals, and patients make health care decisions. Meanwhile, we applied the SMILE framework to analyze the resulting types of social media applications, which include data collection, dissemination of information, education and training, health interventions, increased attention, privacy ethics, professional development, recruitment of study participants, health care decision-making, recruitment of study participants, and social support. The SMILE framework is analyzed as shown in Table 1. Step 6, stakeholder consultation, as recommended by Arksey and O’Malley [10], was not completed because of limited resources.

On the basis of the initial search, 3400 articles were identified. After the removal of duplicates, 2586 (76.06%) articles remained for screening. During the title and abstract screening stage, 2530 (97.83%) articles were excluded. The remaining 56 (2.17%) articles were retrieved for full-text review. Of these, 21 (38%) articles were excluded for reasons detailed in Figure 1, resulting in a final inclusion of 35 (62%) studies. Data extraction was performed by 1 reviewer (HO, with a second reviewer (GL) assisting in the screening process.

The study identified 35 articles across 25 different journals. The number of articles published on pediatric orthopedics’ use of social media has increased significantly over time, ranging from 2013 to 2023. The number of publications continuously increased during the past 5 years, showing that social media use in pediatric orthopedics received growing attention from researchers. Influenced by the COVID-19 pandemic, the year 2021 was found to have the highest number of social media application studies on pediatric orthopedics; this number, however, started to decrease thereafter. Articles were most commonly published in the Journal of Pediatric Orthopaedics (7/35, 20%), Spine Deformity (3/35, 9%), BMC Musculoskeletal Disorders (2/35, 6%), and the Journal of Pediatric Orthopaedics B (2/35, 6%). The remaining journals published 1 paper each. An analysis of the articles’ research subjects found that researchers began to focus on a diverse group of research subjects, with almost half of the articles having social media–related subjects (18/35, 51%), which covered videos, websites, and tweets, followed by patients and their families (11/35, 31%), health care professionals (8/35, 14%), and finally, the general public (1/35, 3%). First authors of the included articles represented 9 different countries, most commonly the United States (13/35, 37%), China (5/35,14%), Canada (5/35, 14%), Ireland (3/35, 9%), Turkey (3/35, 9%), and Saudi Arabia (2/35, 6%). The remaining countries of origin are shown in Table 2.

A total of 5 general quality of information (QOI) tools, 7 specific QOI tools, and 6 readability tools were used in the 12 studies under review. Table 5 provides an overview of these QOI tools and readability tests used in the studies.

Regarding the tools for assessing the quality of social media content about pediatric orthopedic conditions, researchers often use DISCERN, modified DISCERN, JAMA, GQS, and HONcode, which have generally been shown to be effective in assessing the QOI. However, DISCERN, JAMA, and HONcode apply to websites and were not developed specifically for video content. Therefore, the applicability of these tools needs to be explored, and it should be noted that the DISCERN tool was originally designed for written content. Because of the rigor of the questions, when applied to video-based content, the category scores may be lower [72], and therefore, researchers may not be able to assess QOI using a single tool accurately.

Specific QOI tools are diverse and can effectively evaluate quality based on condition, but there are differences in variables and evaluation criteria, and the evaluation results of different studies lack comparability to some extent. Some specific QOI tools only have entry scores and lack rating criteria, so they cannot qualitatively judge the QOI. The review found that the specific QOI tools were not effectively disseminated, and different specific QOI tools were used for the same category of AIS diseases, probably because the researchers did not realize that they could retrieve the tools that had already been developed at the time of the study, or that the specific QOI tools for a particular condition could not be widely used in other situations.

Only 4 studies [44-47] in pediatric orthopedic conditions focused on the readability of health information on social media, suggesting that researchers are not paying enough attention to this aspect. However, the formula calculation may be difficult for some researchers. Readability is important for patients, and more difficult information may not be understood by patients, or may even be misinterpreted, which is not conducive to doctor-patient communication and leads to an increased burden on medical staff. In addition, better readability makes it easier for the public to choose to watch and enhances the duration of viewing.

Overall, there is a small amount of literature assessing the quality of short social media videos related to pediatric orthopedic conditions and health sciences. We found a limited number of publications (n=12), and our results suggested that most pediatric orthopedic condition–related information is of moderate quality. Some studies have suggested that physicians recommend sites with the HONcode logo as an indicator of reliable information or sites they have personally reviewed. In addition, social media platform searches should be upgraded with the appropriate algorithms to recommend and encourage high-quality pediatric orthopedic health education information. This requires a concerted effort by health care providers and medical staff to maximize the benefits of social media.

According to most studies analyzed [40-42], information provided by a large proportion of medical staff and professional organizations usually has higher quality scores. The explanations of illnesses by nonprofessionals are of poor quality and may even be misleading, ultimately affecting the doctor-patient relationship. The proportion of non–health care professionals was maintained at 3%, which would be more favorable for video viewers to be exposed to high-quality content, considering that the proportion of non–health care professionals was maintained at 3% [39].

Most of the evaluated websites had a FRES result indicating a university-graduate reading level, which is higher than the recommended standard [44]. Some accurate and reliable health information content is difficult for patients to understand and contains many medical terms that are difficult to read; therefore, there is a need to improve readability and provide translation services, which will improve the usability of social media. This suggests that health care organizations and health care professionals need to consider the literacy level of the target audience when publishing professional health information content, which can be done using diagrams or animated videos in educational materials to convey meaning, using simple vocabulary in a conversational style and avoiding jargon.

Currently, the development of medical social media is still in its preliminary stage. There are problems, such as uncertainties related to internet-obtained information, individual differences in use, lack of conditions for interdisciplinary teamwork, and insufficient development of the institutional system [73]. The support of the national government, society, medical institutions, medical personnel, and the public is essential. This is necessary to promote the equalization of basic public services in the health field; maintain the public welfare nature of basic medical and health services; gradually narrow the differences in basic health services and health levels between urban and rural areas, regions, and groups; achieve universal health coverage; and promote social equity.

Within the current economic, medical, and educational environment, the effect of social media–based science education is becoming increasingly significant. At present, social media is mostly oriented toward diagnosed diseases and focuses on reducing the occurrence of complications and promoting tertiary prevention in disease management. It is helpful for disease treatment, prognosis, and recovery, and reduces the disability and mortality rates of children. Development of this field indicates that the future aim is to promote disease screening to achieve the secondary prevention goals of early detection and early treatment, improving the public’s ability to identify diseases, and preventing patients from missing the best treatment opportunities. The effect of primary prevention is to develop healthy living habits and exercise methods. We should focus on mastering disease prevention knowledge, integrating internet-based medical care with health examinations and health consultations, promoting the development of health services, and realizing the construction of a health innovation network.

Telemedicine is also gradually gaining public attention. Using social media platforms, online consultations can be achieved without leaving home. Although current social media is still limited to text, pictures, or videos, new diagnoses and treatment models can be created based on scientific and technological progress. With the help of various social media platforms, data regarding children’s current health conditions are collected through questionnaires and other forms and assessed and analyzed by medical professionals in the telemedicine system. Then, based on the classification of children’s health status, the system determines whether further observation or health intervention is needed and integrates this information to form an overview of the child’s health status and provide parents with professional advice, for example, the risk of pediatric orthopedics in the future and what they need to pay attention to. Science popularization has targeted health knowledge and improved parents’ ability to identify conditions. By retaining data after testing, the system can make personalized recommendations based on various aspects of children’s physical conditions, deliver precise health education, and protect children’s health in many aspects, such as diet, exercise, and psychology, and ensure healthy physical and mental growth of children. Hospitals and communities establish relevant databases to form an all-in-one care model of medical treatment, nursing, nutrition, and rehabilitation.

This study has certain limitations. Because of the limited databases searched, some relevant articles may have been omitted. Conference papers, dissertations, and gray literature were also excluded. In addition, we searched only for keywords found in the title and abstract, rather than the full text, which may have resulted in the exclusion of articles that mentioned social media in pediatric orthopedics in the review. Furthermore, most of the included articles evaluated content created by health care providers, offering limited information on the quality, accuracy, and readability of content created by the public.

This scoping review found that literature on the use of social media in pediatric orthopedic conditions is steadily increasing, and that social media plays an increasingly important role in knowledge dissemination and educational engagement. A variety of tools have been used to assess the QOI, but partly differences in tool types limit comparability across studies. In addition, only a small number of studies have evaluated the readability of online content, leaving this area underexplored. Overall, the quality of pediatric orthopedic information available on social media is generally fair, with readability levels often exceeding recommended standards. Health care professionals are encouraged to actively participate in social media by providing accurate, easy-to-understand content evaluated using reliable metrics to support patient education and informed decision-making. Future research should continue to investigate the role of social media in pediatric orthopedics, with particular attention to improving both the quality and accessibility of information.