key: cord-0908390-33dsacho authors: Yuksel, Bahar; Cakmak, Kubra title: Healthcare information on YouTube: Pregnancy and COVID‐19 date: 2020-06-17 journal: Int J Gynaecol Obstet DOI: 10.1002/ijgo.13246 sha: 6434e1facb354167cd8b34a87dfc2fd5b5daa492 doc_id: 908390 cord_uid: 33dsacho OBJECTIVE: We aimed to analyze Turkish language videos on YouTube about Coronavirus and pregnancy. METHODS: YouTube was searched for the following keywords: "Coronavirus, gebelik," "Coronavirus, Hamilelik," "COVID‐19, gebelik" and "COVID‐19, hamilelik". All ranking data for each video was recorded, video sources and target audiences were analyzed. Videos were designated as "informative, "misleading" "personal experience" and "news update." The usefulness of the videos were analyzed by DISCERN score and the quality of the content was calculated by MICI score. RESULTS: Seventy‐six videos had a total of 1.494.860 views, with 40.849 likes and 575 dislikes. The source of information in informative videos was physicians (73%), and news agencies (20%), and the majority of these targeted patients. The DISCERN score of videos was 2.9 ± 1, 1.6 ± 0.9, and 1.9 ± 0.9 respectively for respectively for the informative group, personal experience group, and news update group. The mean MICI score for informative videos was low and calculated as 5.3 ± 2.8. CONCLUSION: YouTube videos are easily accessible sources of COVID‐19 information for pregnant women. The present study demonstrated that videos about pregnancy and COVID‐19 have high view rates, but are generally low in quality and trustworthiness. The coronavirus infection, originating from Wuhan, China, became an unexpected health crisis and affected almost 4 billion people worldwide. WHO declared a Public Health Emergency of International Concern, caused by a novel coronavirus, COVID-19, and then, on March 11, declared a pandemic. 1 Although the statistics showed the ratio of affected men was higher than women and children, and that older people were especially susceptible, pregnant women became concerned for the safety the fetus, due to their altered immune system and the unknown placental transference of the virus. 2 While it is not thought that pregnancy affects the predisposition to be infected, a series of cases showed increased side effects and prolonged hospital stays in pregnant women. 3 Turkey announced its first case on March 11 and, from the first day, started to apply strict rules, including transportation restrictions, quarantine rules, and reassigned obstetric polyclinics as pandemic polyclinics. Meanwhile, most hospitals postponed outpatient appointments and recommended that pregnant women stay at home and visit doctors only in emergencies. Online platforms, social media, and informative videos are increasingly common as sources of information at the present time. Visually presented information is usually preferred to text and audio, so video platforms are a rising trend. 4 YouTube was the first company to introduce video sharing in 2005 and now receives billions of uploads and visits per day. 5 Many of these concern diseases, disasters, and personal experiences. In addition, women use videos to understand the effects of pregnancy on their bodies and how to deal with these daily changes. 6 Research has focused on different conditions and diseases. Kumar et al. 7 analyzed the type of videos shared about the management of hypertension on YouTube, and Bora et al. 8 Recently, Khatri et al. 9 analyzed the impact of online videos about COVID-19 on the Singaporean population. As YouTube has no policy of filtering videos according to their potency or effectiveness, there are many videos online, and while some may be useful, others may be misleading. 10 The aim of the present study was to analyze Turkish language videos on YouTube about COVID-19 and pregnancy. The present observational study was conducted on May 1, 2020. The YouTube website was searched for keywords "Coronavirus, gebelik," "Coronavirus, hamilelik," "COVID-19, gebelik," and "COVID-19, hamilelik." "Hamilelik" and "gebelik" are Turkish translations for the word pregnancy. The search resulted in 133 videos. Videos in the search results in other languages or that had irrelevant content were ignored. Videos shorter than 2 minutes and longer than 15 minutes were excluded. This is because, in video ranking systems, graphs show that videos show an increase in popularity after 2 minutes and reach peak value at 15-16 minutes. 11 The remaining videos were recorded exactly as they appeared in the playlist to ensure that they were investigated homogenously. The playlist was analyzed individually by two independent obstetricians and gynecologists (BY, KC). After applying this filter, 76 videos were reviewed. Two independent doctors examined the videos, and in case of inconsistency, the videos were re-evaluated. Approval from the Institutional Review Board was not required as YouTube is a public website and the present study did not include any patient data. As the first step, all ranking data for each video were recorded, including "likes," "dislikes," length of the video, number of comments, number of views, and number of days on YouTube. Sources of videos and target audiences were analyzed; sources were classified as "news agencies," "individual doctors," and "nonprofessional individuals," while targets were grouped as "healthcare providers" and "patients." Videos were categorized as "informative" if they provided scientifically accurate information on epidemiology, etiopathology, symptoms, prevention techniques, lifestyle modifications, and proven treatment modalities, and categorized as "misleading" if they contained information conflicting with current guidelines or included personal propaganda. Videos containing individual experiences of patients with COVID-19 were categorized as "personal experience." News items uploaded by news agencies detailing updated demographic features of the pandemic were named "news update." DISCERN scores were used to evaluate the usefulness, reliability, and quality of each video. 8 The scale consists of five yes or no questions. All "yes" answers indicate positive aspects and scored 1 point and all "no" answers scored zero points. The possible total scores are in the range of 0-5 (for the scoring table please see File S1). The Medical Information and Content Index (MICI) scale was used to evaluate the content of the videos. 9, 12 The chart shows that scores are awarded 1-5 points for each of five components: prevalence, transmission, clinical symptoms, screening/testing, and treatment outcomes of the disease. The reviewers used the above guidelines to decide the type, efficiency, and quality of videos. The Statistical Package for the Social Sciences version 22 (SPSS IBM Corp., Armonk, NY, USA) program was used in the analysis of the data. Independent samples t-test was used to compare independent groups, and χ 2 and Fisher exact tests were used to compare categorical data. A post hoc test was used to compute pairwise comparisons. Inter-rater agreement was determined using Cohen kappa score. Quantitative data were expressed as mean ± standard deviation values in the tables. Categorical data were written as frequency (n) and percentages (%). The data were analyzed at a 95% confidence level and it was considered statistically significant if the P value was less than 0.05. From a total of 133 videos, 76 were found to be eligible according to the exclusion criteria. Of these, none were classified as misleading. Forty-five videos were classified as "informative," 15 as "personal experience," and 16 as "news update" (Fig. 1) . The DISCERN scores of videos were 2.9 ± 1, 1.6 ± 0.9, and 1.9 ± 0.9 for the informative group, personal experience group, and news update group, respectively. These results showed statistically higher scores for the informative videos compared to the other two categories (P=0.001). F I G U R E 1 Flowchart of the study. based on the number of views per day. The increasing demand for these videos is (likely) due to the limited number of Turkish language videos, because of the later outbreak of the pandemic in Turkey compared to those in East Asia and Western Europe. In addition, Nagpal et al. 12 argued that when the videos are grouped by popularity, the more informative and higher-quality videos were clustered in the high-ranked group, and they suggested that higher quality resulted It is believed that the absence of misleading videos in the present study was because of the rapid expansion and extremely serious nature of the outbreak, which made people wary of extreme and exaggerated claims. In addition, it is hypothesized that this pandemic was responsible for encouraging greater trust in the authorities and science-based information. In today's world, more than 80% of all Americans use Internet searches to access health information. 17 In Turkey, the corresponding figure is 55% of all populations. 18 it is clear that the information provided on online platforms has to be comprehensible, informative, and scientifically proven. Even though the present study is the first to analyze the COVID-19 and pregnancy-related videos, it is not without limitations. First, the results cover the videos in Turkish and makes no comparison with corresponding videos in English. In addition, it is still less than 2 months since the first case was announced in Turkey, and it can be expected that subsequent uploads will carry more accurate information about the disease, and thus make the current results less representative. In conclusion, YouTube videos are easily accessible and important sources of COVID-19 information for pregnant women. The present study demonstrated that videos about pregnancy and COVID-19 have high view rates but are generally low in quality and trustworthiness. Videos on YouTube need improvement and greater standardization before they can be regarded as an effective source of information on COVID-19 and its effects on pregnancy. BY contributed to the conception and design, acquisition of data, drafting the manuscript, and revision of the manuscript. KC contributed to the interpretation of data, drafting the manuscript, critical revision of the manuscript, statistical analysis, and supervision. World Health Organization. Coronavirus disease (COVID-19) pandemic [WHO website Clinical features of patients infected with 2019 novel coronavirus in Wuhan Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: A retrospective review of medical records YouTube" telling or selling you something? Tobacco content on the YouTube video-sharing website. Tobacco control Top 15 Most Popular Websites Internet use in pregnancy informs women's decision making: A web-based survey Are video sharing web sites a useful source of information on hypertension? Are internet videos useful sources of information during global public health emergencies? A case study of YouTube videos during the 2015-16 Zika virus pandemic YouTube as source of information on 2019 novel coronavirus outbreak: A cross sectional study of English and Mandarin content YouTube videos as a source of medical information during the Ebola hemorrhagic fever epidemic YouTube by the Numbers: Stats, Demographics A qualitative analysis of methotrexate self-injection education videos on YouTube YouTube as a source of information on dialysis: A content analysis Is YouTube useful as a source of information for Sjögren's syndrome? Health information obtained from the internet and changes in medical decision making: Questionnaire development and cross-sectional survey Health anxiety and behavioural changes of pregnant women during the Covid-19 Pandemic The authors thank all YouTubers for inspiring them to carry out this study. They would also like to thank Assistant Professor Faruk Ozgor for his support and advice. The authors have no conflicts of interest. Additional supporting information may be found online in the Supporting Information section at the end of the article.File S1. MICI score table.