|Ahead of print
Analysis of the most viewed Hindi YouTube videos on breast cancer
Nibha Sinha, Alka Sharma
Department of Humanities and Social Sciences, Jaypee Institute of Information and Technology, A-10, Sector-62, Noida, Uttar Pradesh, India
|Date of Submission||18-Jul-2020|
|Date of Decision||01-Dec-2020|
|Date of Acceptance||16-Feb-2021|
|Date of Web Publication||29-Jun-2022|
Department of Humanities and Social Sciences, Jaypee Institute of Information and Technology, A-10, Sector-62, Noida, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Background: Breast cancer is the most common cancer diagnosed in women worldwide. Social media channels are a significant source of health information including breast cancer. YouTube has a broad range of educational materials on various health issues in many languages. However, the accuracy of these videos is contentious. This study aimed to examine the accuracy of the most viewed Hindi videos on YouTube related to breast cancer.
Methods: On YouTube, the “Breast Cancer-Hindi” term was searched for the 50 most viewed Hindi videos. To evaluate the videos' quality and reliability, global quality scores (GQS) and DISCERN (quality criteria for the assessment of written health information), and for credibility and usefulness Journal of the American Medical Association (JAMA) tool were used. Popularity was measured using a video power index (VPI). Comparisons of scores were made between professionals' and consumers' videos. Two health researchers independently rated the videos and their correlation was calculated for agreement.
Results: Of all the 50 videos viewed, 23 (46%) each were uploaded by consumers and professionals. GQS median 3 (1–5), DISCERN median 13 (5–23), JAMA median 2 (0.50–4), and VPI median 90.7 (50–96.93) were reported. All scores of professionals were higher than consumers at a significant level (P < 0.05). A significant correlation was found between both observers (P < 0.01).
Conclusion: YouTube has some good quality and reliable videos on breast cancer in the Hindi language. These videos are mostly of professionals in comparison with consumers with wide viewership. However, they are limited in numbers; therefore, health professionals should upload more videos with accurate information to spread awareness about breast cancer.
Keywords: Awareness, breast cancer, health communication, internet, social media
This study found limited quality Hindi YouTube videos on breast cancer and popular among users for their information. Strict guidelines are needed to upload videos to curb misleading content and health professionals must take cognizance of it.
| » Introduction|| |
Breast cancer is the most common cancer diagnosed in women worldwide. In a developing country like India, the most advanced stage cancer is diagnosed that eventually leads to a high mortality rate. Among other factors, low awareness about the disease contributes considerably to the advanced stage of diagnosis and high mortality rate.[3–5] Nowadays, interactive social media is being widely used as a health awareness tool.,
Launched in 2005, YouTube is largely accessed, watched, and popular social media website., It has a wide range of educational materials on health-related topics,, including breast cancer posted by a large number of individuals, patients, government, professional organizations, and healthcare professionals.[13–16] This health information is being accessed and viewed by the consumers. Despite the availability of a vast amount of health-related data, its substantial reach, and extensive access by the users, research on its public health implication is in a nascent stage., A few attempts have been made to understand the communication conveyed through YouTube about some health issues including breast cancer, but those of English language videos only.,,,, To the authors' knowledge, till date no study has attempted to assess the content quality, reliability, and usefulness of breast cancer videos of any non-English language despite its accessibility in 80 different languages and its popularity. According to the 2011 language census of India, Hindi is the mother tongue of 44% of total Indian population. In India, viewers generate a large traffic on YouTube website. Hence, this study attempted to evaluate the quality, reliability, and usefulness of the most viewed breast cancer YouTube videos available in the Hindi language.
| » Materials and methods|| |
In YouTube (www.youtube.com) search bar, the “Breast Cancer-Hindi” term was entered and then a search filter was used to sort the most viewed videos by view count. The search was conducted on June 26th, 2020 on a personal laptop and included videos uploaded till the 25th of June, 2020. Advertisements were excluded from the study. The metadata extracted included attributes of the videos like real or animated content, gender of presenter, upload date, total views, total likes, total dislikes, comments, video length in minutes, and upload source. The sources of the posts were classified into three categories: 1) professional; a doctor, a nurse, information uploaded on behalf of a hospital or any healthcare-related organizations, 2) consumers; any person who is not connected to the health profession, and 3) news-based; television or internet-based program, any web-based program. Video power index (VPI) was calculated to estimate the videos' popularity using the following formula:
VPI = number of likes/number of likes + number of dislikes × 100.
Further to confirm the videos' popularity, the mean of daily views was calculated by the following formula:
Total views since upload to retrieval date/the total number of days since upload to retrieval date.
Two public health researchers agreed to evaluate the data, which was used to calculate the overall quality, reliability, and usefulness of the videos. They were trained to score videos accurately. One was a senior assistant professor (mass communication) and public health researcher having 15 years of experience. The second observer was the faculty of mass communication; founder of one nongovernmental organization and working for public health awareness for the past two decades. Both the observers made the independent view of the videos and their scoring was blinded to each other to control any bias. Reliability of content was scored on a five-point scale based on five questions which were adapted versions [Table 1] of the original DISCERN (quality criteria for the assessment of written health information) tool. The overall quality of the videos was scored on the global quality score (GQS) [Table 2]. GQS score comprised the quality of the information and how useful the videos would be for the users from the reviewers' perspective. Journal of the American Medical Association (JAMA) quality scores [Table 3] (used for evaluation of website content) were calculated on four subscales; authorship, attribution, disclosure, and currency on zero and one point. All three criteria helped to understand whether the content was credible, reasonable, and useful to make a measured informed decision.
|Table 1: DISCERN scoring system used to assess reliability of Hindi videos on breast cancer found on YouTube|
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|Table 2: Global quality scale (GQS) criteria used to score videos with information on breast cancer on YouTube|
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|Table 3: JAMA quality scale used to score videos with information on breast cancer on YouTube|
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All acquired data were analyzed using statistical package for the social sciences (SPSS)-21 statistical software package. Kolmogorov-Smirnov test was conducted to check the normality of the variables. Videos' characteristics were described using score and percentage for the categorical variable. Median (minimum-maximum) and interquartile range (IQR) were calculated for all continuous variables. Comparisons of DISCERNS, GQS, JAMA, and VPI scores were conducted between professionals' and consumers' videos, real and animated videos, and gender-wise using nonparametric Mann-Whitney U test because data were not normally distributed. To know the correlation between both the observers' rating scores of DISCERN, GQS, and JAMA, Spearman's correlation test was conducted. News-based videos were excluded from comparative analysis. All the comparisons were considered statistically significant at P < 0.05.
Ethical consideration: This study did not require any ethical approval as it did not involve any human being or animal during the entire conduction of the study.
| » Results|| |
Of all the videos (n = 50), 66% (n = 33) included real and 34% (n = 17) included animated content. Of the videos, 46% (n = 23) were uploaded by consumers and same 46% (n = 23) by professionals while 8% was news-based. In all 50 videos, 50% (n = 25) presenters were men and 42% (n = 21) were women. Six percent (all 3 news-based videos) videos were presented by both men and women and in one animated news-based video gender was not disclosed. The number of likes, dislikes, comments, total views, views per day, and VPI of all the videos is shown in [Table 4].
|Table 4: Distribution of all videos', professionals and consumers' videos' likes, dislikes, views, comments, views per day, and VPI on breast cancer found on YouTube|
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The median GQS was calculated as 3 (1–5), DISCERN median score was 13 (5–23), JAMA median value was 2 (0.5–4), and VPI median score was 90.73 (50–96.93). All the scores of both the observers were calculated separately. [Table 5]
|Table 5: DISCERN, JAMA, and GQS scores of two observers and their correlation scores on breast cancer videos found on YouTube|
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When the videos' quality was assessed as per GQS, 44% videos (n = 22) were of good quality, 38% (n = 19) moderate quality, 14% (n = 7) generally poor quality, 2% (n = 1) poor quality, and 2% (n = 1) excellent quality.
When the videos uploaded by professionals and consumers were compared; likes, dislikes, total views, and comments were higher for professionals videos but no statistically significant differences were found except for comments of professionals (U = 163, P = 0.026). All the scores of DISCERN (U = 63, P = 0.000), JAMA (U = 165, P = 0.024), GQS (U = 105.5, P = 0.000), and VPI (U = 154, P = 0.015) of professionals were statistically significantly higher than the videos of consumers. Further, the score for real videos' was statistically significantly higher than animated videos for GQS (U = 166, P = 0.012) and VPI (U = 81.5, P = 0.000) but no difference was found for DISCERN and JAMA scores. In addition, all the scores were compared on a gender basis for DISCERN, JAMA, GQS, and VPI scores between men and women, but no statistically significant difference was found. Scores of GQS, DISCERN, and JAMA for both the observers were found to be significantly correlated (P < 0.01) [Table 5].
| » Discussion|| |
Previous studies were conducted on various health problems such as prostate breast, anal cancer, rheumatoid arthritis, neurosurgery, obesity, breast cancer, and breast self-examination on English YouTube videos.,,,,,,,,, However, browsing and search can be performed in 80 languages on YouTube including Hindi. To the best of the authors' knowledge, this is the first study that analyzed Hindi YouTube videos to know the scientific accuracy and quality of the content. Given the fact that Hindi is a widely spoken language of India, this study result is very useful for health professionals, governmental organizations,' and for those who are working in the public health domain.
Considering the rising cases of breast cancer worldwide including India, a high percentage of people are anticipated to search for information about the causes, symptoms, screening methods, treatment, and prevention of the disease. Nowadays, the World Wide Web is increasingly being used by people for health information. YouTube is one such popular platform where open access breast cancer videos are available at no cost. This popular social media has the potential to make a large population informed decision-makers. However, there are a few concerns related to the accuracy and quality of the videos, which can harm the users. Firstly, there are various videos on any problem with contradicting information. Secondly, users are not aware that the information they are accessing has been authenticated by any approved authority. Moreover, the most important concern is that these videos can impact users' understanding of the disease and their decisions.
Health professionals must be aware of the possibility of inaccurate and unreliable videos uploaded on YouTube and its further consequences for the users. In previous studies, various scales were used to evaluate the accuracy and quality of the videos.,, In our study, we used DISCERN, JAMA, GQS scores to evaluate the quality and reliability of the Hindi YouTube videos related to breast cancer that were commonly used in previous studies.
In the present study, almost half of the YouTube Hindi videos (44%) on breast cancer were found to be of good quality, reliable, and useful. The overall quality of the videos is moderate. This result may be attributed to the fact that almost half of the videos are of professionals (46%) so the overall quality of the videos was found to be of moderate quality. This finding is also in line with previous studies where fewer videos were uploaded by professionals and that was found to be one major reason for the overall poor quality of the videos. Our result also demonstrates that Hindi videos uploaded by professionals are more (46%) than that of English videos (14%) reported in the previous study.
In our study, almost half of the viewed videos have followed the criteria of GQS, JAMA, and DISCERN scales. In addition, professionals' scores of DISCERN, JAMA, and GQS are significantly higher than that of consumers' scores. However, professionals' videos have not followed all the criteria of applied scales. Only three of their videos have given information about authorship, attribution, currency, and disclosure that are the criteria of JAMA. Only a few videos have followed the criteria of DISCERN scale and no video was rated five for all five questions of DISCERN by any of the two observers. In this study, 17 videos of professionals are of good quality on GQS scale. Single video of professional was found to be of excellent quality on GQS scale by both the observers. This result demonstrates that even professionals are not aware about the various criteria that must be followed while uploading any health video on social media platform like YouTube. Previous study on breast cancer on English YouTube also exhibited the same result that videos uploaded by physicians were not of sufficient quality. Our finding also suggests that health professionals need to actively participate in developing accurate and reliable educational content on breast cancer, especially for this popular platform for the users.
In our study, median of total views is 127,804 (29,419–2,288,266), median likes is 1,000 (1–26,000), median dislikes is 96.5 (1–1,700) median comments is 89.50 (1–1,800), and VPI median is 90.5 (1–1,700). These scores of views, likes, dislikes, comments, and VPI is for a median of 814.5 (133–3,678) days. This result indicates that breast cancer-related videos available in the Hindi language on YouTube are popular among users. This popularity is for a median of 7.17-minutes (1.05–18.22) long videos. Professional videos have more views, likes, and dislikes than consumers' videos, but these differences are not significant. These findings demonstrate that viewers could not differentiate between professional and consumer videos while viewing, liking, and disliking the videos. Previous studies also reported that users' likes and dislikes were the same for useful and misleading videos., This may be analyzed with the rationale that mostly users are not interested in the source of information. However, in our study, professionals' videos are significantly more popular among users and they have significantly commented more on professionals' videos than consumers' videos. This finding may be explained with the reason that even if users could not differentiate between professionals and consumers' videos or search for the source, they might find professionals' information more reliable and of good quality than that of consumers' videos, so it became popular among them and also they were motivated to raise their queries and commented for the same.
In our study, 66% of videos are real and 34% are animated videos. Real videos are of good quality than animated videos on the GQS scale. Further, real videos were significantly more popular among users than animated videos. This result demonstrates that some good quality real Hindi YouTube videos on breast cancer were found more useful than animated videos. It might be possible that users were finding it convenient to connect with real videos than animated ones. This result also suggests the need for more real video production. However, in the English language animated videos were found to be more useful than real videos. There is no significant difference between videos' quality and reliability on a gender basis. In addition, the popularity of the videos is also not affected by the gender of the presenter. Therefore, it can be said that videos that are spreading quality breast cancer information are mainly of professionals whether it is presented by men or women.
Overall in our study, some of the Hindi videos have maintained the quality and accuracy of the content. However, users are not able to differentiate between the accuracy and inaccuracy of the available content with much clarity. Given the high prevalence of breast cancer cases and health-related video popularity on YouTube, our study result has backed the concerns of accuracy and reliability of these videos on breast cancer. Hence, there is an urgent need for regulations and policies to restrict misleading videos being uploaded on a platform like YouTube and some guidelines for users as well for their search practices.
In our study, some limitations were observed. Firstly, we evaluated only the most viewed videos that may not represent the information appropriately. Secondly, we extracted the videos only on the 26th of June, 2020, restricted to only one day but the order of the videos change on a day-to-day basis. Thirdly, we analyzed only a limited number of videos. Finally, only the Hindi language videos were analyzed. Further studies should consider a big sample size with a longer period including the analysis of the comments on the videos that will disclose the video's impact on the consumers and their needs too.
| » Conclusions|| |
This study has filled the gap of non-English YouTube videos' accuracy analysis on breast cancer. Our study findings indicate that some good quality, reliable, and useful videos were available on YouTube related to breast cancer in the Hindi language. These videos are mostly of professionals in comparison with consumers. However, these videos are very limited in numbers. Health professionals must be aware of the content available on this popular platform for their users. To serve this purpose, they should upload more accurate information about the disease to improve health awareness among Hindi-speaking users who have limited resources for the purpose.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]