Engaging but inaccurate: A cross-sectional analysis of acne videos on social media from non–health care sources

Abstract

To the Editor: Acne affects an estimated 85% of adolescents and young adults aged 12 to 24 years in the United States.1Bhate K. Williams H.C. Epidemiology of acne vulgaris.Br J Dermatol. 2013; 168: 474-485Crossref PubMed Scopus (426) Google Scholar This population is highly adept at accessing online acne information through social media platforms, with YouTube being the most frequently used of these platforms.2Anderson M. Jiang J. Teens, social media & technology 2018.https://www.pewinternet.org/2018/05/31/teens-social-media-technology-2018/Date: 2018Date accessed: March 22, 2019Google Scholar Despite its popularity, the validity of health care information on YouTube has not been studied extensively in dermatology. We aimed to determine the accuracy, quality, viewer engagement, and viewer experience of acne videos on social media. We conducted a cross-sectional study by collecting videos using the search terms acne and acne treatment on YouTube. For each term, we examined results from the first 3 pages (60 videos per term). Videos were categorized by source into 5 groups and into 2 large categories: (1) health care source, and (2) non–health care source (Table I). Three independent raters used 4 instruments to evaluate each video. Accuracy was assessed using the validated Accuracy in Digital Health Instrument3Borba, AJ, Young, PM, Read, C, Armstrong, AW. Development and initial validation of the Media Health Content Accuracy Instrument (MHCAI) and Viewer Experience Measure (VEM) using a video-sharing platform. Paper presented at: Winter Clinical Dermatology Conference, January 18-23, 2019; Koloa, HI.Google Scholar and the Dy et al. Accuracy Scale4Dy C.J. Taylor S.A. Patel R.M. McCarthy M.M. Roberts T.R. Daluiski A. Does the quality, accuracy, and readability of information about lateral epicondylitis on the Internet vary with the search term used?.Hand (N Y). 2012; 7: 420-425Crossref PubMed Scopus (37) Google Scholar (Fig 1). Quality was assessed using the Global Quality Scale.5Bernard A. Langille M. Hughes S. Rose C. Leddin D. Veldhuyzen van Zanten S. A systematic review of patient inflammatory bowel disease information resources on the World Wide Web.Am J Gastroenterol. 2007; 102: 2070-2077Crossref PubMed Scopus (176) Google Scholar Viewer engagement was assessed by an engagement ratio, defined as (numbers of likes + dislikes + comments)/total views. Overall viewer experience was assessed with the validated Armstrong Viewer Assessment3Borba, AJ, Young, PM, Read, C, Armstrong, AW. Development and initial validation of the Media Health Content Accuracy Instrument (MHCAI) and Viewer Experience Measure (VEM) using a video-sharing platform. Paper presented at: Winter Clinical Dermatology Conference, January 18-23, 2019; Koloa, HI.Google Scholar (Fig 1). Two-tailed t tests were used to determine significant differences between videos from health care and non–health care sources.Table IAcne video characteristics based on healthcare versus non–health care sources and source groupVideo characteristicsHealth care sources vs non–health care sourcesSource groupHealth care sources∗University/professional organizations, industry, individuals (health care professionals). (n = 18)Non–health care sources†Individuals (not health care professionals), lay media. (n = 51)P valueUniversity/professional organizations (n = 1)Industry (n = 2)Lay media (n = 20)Individuals: Health care professionals (n = 15)Individuals: Non–health care professionals (n = 31)P valueMean number of views450 764.70609 493.30.3224 937.00106 099.00829 770.05525 108.67467 379.32.89Mean video length, min5.767.17.173.137.124.855.768.67.10Mean upload duration, d1056.83788.55.13985.0030.50747.801198.47814.84.24Mean number of likes591410 396.22.22126.00451.509311.307028.2011 096.16.97Mean number of dislikes241.33260.80.4629.009.50339.35286.40210.13.88Mean number of comments351.06617.43.1712.0051.50546.90413.60662.94.92∗ University/professional organizations, industry, individuals (health care professionals).† Individuals (not health care professionals), lay media. Open table in a new tab A total of 120 videos were screened for inclusion. After applying inclusion and exclusion criteria, 69 videos were available for assessment of outcomes: 6 were non-English, and 45 were irrelevant to the topic (procedures showing comedone extraction or expression of cyst contents). Compared with health care sources, non–health care sources had higher mean numbers of views (609 493 vs 450 765), were less accurate (Accuracy in Digital Health Instrument: 2.40 ± 0.14 vs 2.97 ± 0.28, P = .041), of lower quality (Global Quality Scale: 2.73 ± 0.11 vs 3.39 ± 0.27, P = .020), and provided an inferior viewer experience (Armstrong Viewer Assessment: 2.13 ± 0.14 vs 2.74 ± 0.19, P = .007) (Fig 1). Specifically, videos from the lay media and lay individuals were of the lowest accuracy, quality, and viewer experience, whereas videos from universities/professional organizations were most accurate and had the highest quality and viewer experience. Additionally, non–health care sources were more engaging than health care sources (viewer engagement ratio: 0.030 ± 0.004 vs 0.015 ± 0.003, P = .002). Our findings suggest that viewers seeking video-based educational content on acne are exposed to significantly inaccurate and low-quality information. For example, some recommended methods of acne treatment on YouTube included highly restrictive diets or the addition of high-dose supplements, which currently lack scientific basis. These findings are particularly important to adolescents because acne is highly prevalent in this population, and this group is most likely to view information on YouTube.2Anderson M. Jiang J. Teens, social media & technology 2018.https://www.pewinternet.org/2018/05/31/teens-social-media-technology-2018/Date: 2018Date accessed: March 22, 2019Google Scholar Unless we actively address the problem of widely available inaccurate information, clinicians will spend much time dispelling inaccuracies that patients learn from these platforms, and patients will waste time experimenting with ineffective therapies that may be associated with harm. Educational efforts are needed to create accurate, engaging, and accessible content for the public on acne and other dermatologic diseases.