Evaluating Video Quality, Understandability, and Actionability of YouTube Content for Gender Affirming Surgery: Metoidioplasty
Reade Otto-Moudry, BA2, Alexandra E. Hunter, BA1, Cynthia Yusuf, BS3, Rena D. Malik, MD4, Rachel A. Moses, MD, MPH1.
1Dartmouth Hitchcock Medical Center, Lebanon, NH, USA, 2Geisel School of Medicine at Dartmouth, Hanover, NH, USA, 3University of Maryland School of Medicine, Baltimore, DC, USA, 4University of Maryland Medical Health System, Baltimore, DC, USA.
Introduction and Objective: With the rise of social media platforms, consumer-style web-based health information has become more accessible to patients. The objective of this study was to analyze the quality, understandability, and actionability of metoidioplasty content on social-media platform YouTube.
Methods: A YouTube search for “Metoidioplasty” was conducted, and the first 50 relevant video results were analyzed. Videos greater than 30 minutes in length, non-English speaking, or exclusively showing a surgical procedure were excluded. Each video was characterized by speaker and presenter demographics, channel/video statistics, and clickbait. Completeness was calculated based on what percentage of the categories of anatomy, treatment options, outcomes, benefits, and risks were discussed. A complete video discussed all five topics. Calculated scores for validated DISCERN and PEMAT metrics were the primary outcome variables and were used to quantify the quality, actionability, and understandability. Cutoffs of DISCERN ≥ 3 and PEMAT 75% were used to differentiate between “poor” versus “good/sufficient.” Multivariate and univariate logistic regressions were performed to assess associations and impact of variables on primary outcome variables (alpha < 0.05).
Results: Of the videos analyzed, 29% (n=13) were good quality, 49% (n=22) had good understandability, 13% (6) had good actionability. Patients/consumers were the most common content publishers (n=35, 78%) and speaker/narrator (n=35, 78%). Twenty percent (n=8) were complete. Of all the video characteristics analyzed, there was a statistically significant association between completeness and good actionability (OR, 0.64; 95%CI, .012, 6.94; p=0.05). Conclusion: Informational videos available to transgender patients interested in metoidioplasty on YouTube have overall poor quality, actionability, and understandability. In the videos that were complete, content creators were less likely to suggest actionable steps viewers can take to learn more about metoidioplasty. The information that is available to patients on social media influences the patients' ability to make informed decisions on options for gender affirmation. As such, it is essential for physicians to be aware of the quality of content and source of their patient's information. At this time, it is unclear whether the overall lack of high quality videos and a lack of videos published by accredited physicians and hospitals are attributed to a lack of created content or to preferential display of patient-centered content curated by YouTube's internal algorithm.
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