Study on the Quality, Relevance, and Comparability of YouTube Videos Expressing Stroke and Its Consequences From Various Sources

Background and objective Stroke-related deaths have been one of the major causes of death worldwide due to its rising risk factors. As a result, several people rely on YouTube as a great source of information on stroke without knowing the genuineness of the content. This study aims to assess the quality and reliability of the information on stroke uploaded on the YouTube platform using the Global Quality score (GQS) and DISCERN score (DS), respectively. Methodology A cross-sectional observational study was conducted in April 2023. Stroke-related keywords were used to search for videos on YouTube. Videos that met inclusion criteria were evaluated for baseline characteristics (likes, comments, views, duration of video, time since posted, and uploader type) and type of information in the video about stroke (symptoms, etiology, treatment, and other parameters). These videos were then evaluated for quality and reliability of information using GQS and DS, respectively. Results After applying inclusion and exclusion criteria and removing the duplicates, 73 YouTube videos were selected. The videos had a total number of 23,927,445 views, 385,324 likes, and 31,927 comments. Maximum videos were uploaded by hospitals (25, 34.2%). Several videos described the symptoms (54, 73.97%), treatment (50, 68.49%), and etiology (49, 67.12%) of stroke. The reach of videos measured by the Video Power Index (VPI) was highest for videos uploaded by healthcare organizations (mean VPI = 120.11). There was no statistically significant difference (P > 0.05) in the quality (GQS score) and reliability (DS) of videos uploaded by doctors, hospitals, healthcare organizations, and news channels. Conclusions YouTube can become an important source to disseminate information about health-related conditions like stroke if the videos uploaded are of high quality (GQS score) and reliable (DS).


Introduction
The World Health Organization has defined a stroke as a rapidly developing clinical sign of focal or global disturbance of cerebral function, lasting more than 24 hours or leading to death, with no apparent cause other than vascular origin [1].As per the World Stroke Organization -Global Stroke Fact Sheet 2022, stroke is the second-leading cause of death and the third-leading cause of death and disability combined in the world [2].Nonmodifiable risk factors like age, ethnicity, genetics, and family history contribute to stroke risk [3], but there are disparities in stroke risk, rates, and treatment worldwide.
YouTube, the second-most-popular video-sharing platform in the world, with over two billion subscribers, has become a popular platform to disseminate health information [4][5][6].Social media platforms like YouTube have been evaluated for validity and dependability for several diseases like glioblastoma, abdominal aortic aneurysms, and chronic obstructive pulmonary disease [7][8][9][10][11][12].Stroke, the fifth-leading cause of mortality in the United States, is still not being given enough consideration in this regard [13].The lack of reliable information on stroke on platforms like YouTube highlights the need for video analysis and implementation of an audience engagement criterion for video creators to guarantee that viewers get accurate education, particularly since stroke is a medical emergency requiring immediate care to minimize the damage [14].Therefore, this study aims to assess the reliability and quality of stroke information presented on YouTube.
This study aims to assess the reliability and quality of the information on stroke on YouTube using the DISCERN score (DS) and the Global Quality score (GQS), respectively.

Materials And Methods
This research was a cross-sectional observational study carried out in April 2023.Our study did not require institutional permission because there were no human participants.
A Google Forms survey was designed with preset parameters, concentrating on three main traits.As a starting point, we looked into the fundamental details of the videos, such as the origin of the uploaded videos and the posting period.Second, we looked for descriptions of symptoms, causes, investigations, prevention, therapy, mortality, rehabilitation, and personal stories from patients and their families as we examined the informational content of the videos.We also took into account whether the article included material that was sponsored by medical professionals or pharmaceutical firms.Following this, the quality and reliability of each video were evaluated using GQS [15] and DS [16].Using keywords such as stroke, paralysis, stroke treatment, stroke prevention, stroke cause, stroke cure, and stroke support, each of the seven authors searched for and analyzed 15 YouTube videos (Appendix).
The YouTube videos that specifically addressed symptoms, causes, and treatment options of stroke; had a duration of at least two minutes (too short to convey information) but did not exceed 20 minutes (does not hold the viewer's attention); and were in English language (to maintain a homogeneous set of videos) were included in this study.YouTube videos that were unrelated to stroke, shorter than two minutes or longer than 20 minutes, and in language other than English were excluded from the study.Any duplicate entries were excluded from the study.
The information gathered from the selected videos was entered into Google Sheets and later transferred to Microsoft Excel for further analysis (Appendix).Statistical analysis was conducted using IBM SPSS Statistics for Windows (Version 21.0,IBM Corp., Armonk, NY, USA).

Results
For this study, a total of 105 videos (15 videos by each of the seven authors) were evaluated.However, after applying the inclusion and exclusion criteria and removing duplicate videos, only 73 videos were included in this study.The popularity of the videos was assessed based on several characteristics, such as the number of views, likes, dislikes, and comments.The median GQS score was 4 for all the groups, which signifies that there was no significant difference in the quality of videos uploaded by the groups (Table 4).
The median DS was higher for doctors, hospitals, and healthcare organization (median DS = 4), suggesting a higher reliability of such videos compared to other groups.But the difference was not statistically significant (P > 0.05; Table 4).

Discussion
YouTube has emerged as a highly popular platform for accessing medical information in recent times.Before seeking professional help, numerous patients rely on the Internet as a valuable and reliable source of healthrelated information [17].As the second most widely utilized search engine on the internet, YouTube plays a significant role in facilitating the acquisition of such information.This content has the potential to assist individuals in enhancing their health management and stroke recovery [1].In our study, the median quality score and reliability score of videos posted by doctors, hospitals, and healthcare organizations were higher compared to the other groups.However, it is important to recognize that YouTube still has certain limitations despite being a valuable resource for patients seeking information about stroke [13].
In this study, a total of 105 videos were evaluated; only 73 met the inclusion criteria, while in other studies, it was found that 101 out of 150 videos [13] and 21 out of 200 videos met the inclusion criteria [2].
In a study by Yasin and Altunisik in October 2019, it was found that the mean overall quality of YouTube videos according to the DS was of fair quality [17].Whereas in this study, the median reliability score of videos uploaded by doctors, hospitals, and healthcare organizations was of good quality (DS = 4).In another study where 150 videos were analyzed, the reliability and quality analysis of YouTube was done using the DS and the Journal of American Medical Association (JAMA) score, respectively [17].In this study, 105 videos were analyzed using GQS, DS, and VPI to compare and analyze the quality, reliability, and reach, respectively, of YouTube videos uploaded by different uploaders.It was found that a P-value > 0.05 indicates that there is no significant difference in the VPI, GQS, or reliability score among all the uploaders.The GQS of all types of uploaders was similar.Thus, in this study, it was reflected that overall, the quality of the content uploaded by different uploaders is of moderate to good quality.
In this study, the total number of views, likes, and comments were 23,927,445, 385,324, and 31,927, respectively, while in a study conducted by Yasin and Altunisik, the total number of views, likes, and comments were 115,875, 482, and 28, respectively [17].
However, every effort was made to include new videos, but only 11 (15.1%) were recently uploaded within a year.In this study, it was found that the majority of the videos (25, 34.2%) were uploaded by hospitals and 15 (20.5%) by doctors, compared to another study by Szmuda et al.where 66 (65.3%) videos were uploaded by hospitals and 31 (30.69%) were uploaded by educational channels [13].This indicates that the videos uploaded by uploaders, such as news agencies and healthcare organizations, were overlooked by doctors and healthcare professionals, so these videos too are reliable and provide authentic information to the viewers.This also reflects the fact that many hospitals and educational YouTube channels were eager to educate their followers.
This study also showed that the most popular videos were those from healthcare organisations (high VPI).This was primarily because these channels or uploaders used animation and three-dimensional (3D) illustrations of the causes and mechanisms of stroke that were understandable to a common person.Furthermore, these channels placed a greater focus on developing intriguing content and applying highquality animation to provide viewers with a pleasing audiovisual experience.However, videos from physicians or news channels were less popular because the information was conveyed verbally without any animation.Thus, scientists and news channels can reflect on this and apply visual techniques to attract more viewers.The ability of the internet and social media to connect and educate individuals about stroke provides possibilities to improve their quality of life and learn about novel treatments.The internet's easier access to information has also contributed to the globalization of medical knowledge and led to the development of new social support groups.Patients, particularly those who have impairments such as stroke, may discover information on novel treatments for neurological diseases online.Patients may even frequently turn to social media to manage their illnesses.
In  [13].It was also found that 32 (43.84%) videos discussed investigations and 34 (46.58%)videos discussed prevention.Hence, from this study, it can be observed that most of the videos were trying to educate viewers about etiology, symptoms, and treatment, while very few videos were educating them about investigations and tests, mortality, rehabilitation, and support groups.Most of the videos educating about treatment did not discuss the advantages, disadvantages, or risks associated with them.They were providing an overview of different treatment modalities and did not go much in depth.However, the good thing is that only a few videos included promotional content.Thus, it can be said that the uploaders were more concerned about trying to educate the viewers instead of promoting pharmaceutical companies or devices, making the videos more educational than a means of promotion.
Our study had several limitations.First, only 105 videos were evaluated, out of which 73 videos were taken into this study, after following inclusion and exclusion criteria.Although there are several videos available on YouTube about stroke, a viewer will watch only the top-performing videos, and thus, we included only the top videos.Second, the total number of likes, comments, and views changes over time.Third, there may be interobserver differences in the GQS and DS for the same video.Same video was not evaluated by more than one author, and duplicates were removed.

Conclusions
YouTube can become an important source to disseminate information about health-related conditions like stroke if the videos uploaded are of high quality (GQS score) and reliable (DS).The videos uploaded by 2023 Nanda et al.Cureus 15(8): e43277.DOI 10.7759/cureus.432773 of 10uploaders other than doctors, hospitals, and healthcare organizations need strict evaluation for quality and reliability before or after they are uploaded, to ensure that correct information is shared with viewers.

Table 1
highlights the popularity of the videos evaluated.The total number of views, likes, and comments were 23,927,445, 385,324, and 31,927, respectively.

Table 2
highlights the duration since the video was uploaded and the source of information.

Table 3
highlights how most of the videos discussed the etiology and treatment of the disease.A single video can discuss multiple types of information as well.A total of 54 (73.97%) videos discussed symptoms, 50 (68.49%)about treatment, and 49 (67.12%) about cause or etiology.Only 20 (27.4%) videos discussed mortality, while 19 (26.03%) videos had information about rehabilitation, 16 (21.92%)videos had patient sharing their own experience, 9 (12.33%)videos had parents sharing their experience with their